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== SAMPLE =-=

Chapter 2 Family-Centered Care: Theory and Applications
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
1)

The mother of a newly hospitalized pediatric patient asks the nurse about the advantages of “rooming in.” The nurse could say that which items are confirmed by research as benefits when a parent “rooms in”? (Select all that apply.)
A)

Patients sleep more soundly.
B)

Children require shorter recovery periods.
C)

Children have less anxiety during procedures.
D)

Patients require fewer analgesics after surgery.
Answer:

B, C, D
Explanation:

A)

These research studies did not investigate the childs sleep depth or patterns.
B)

When parents stayed in the hospital with their child, research found that the child experienced shortened recovery periods, exhibited decreased anxiety during procedures, required less analgesics for pain relief after surgery, was quieter, had improved coping, and was happier. These research studies did not investigate the childs sleep depth or patterns.
C)

When parents stayed in the hospital with their child, research found that the child experienced shortened recovery periods, exhibited decreased anxiety during procedures, required less analgesics for pain relief after surgery, was quieter, had improved coping, and was happier. These research studies did not investigate the childs sleep depth or patterns.
D)

When parents stayed in the hospital with their child, research found that the child experienced shortened recovery periods, exhibited decreased anxiety during procedures, required less analgesics for pain relief after surgery, was quieter, had improved coping, and was happier. These research studies did not investigate the childs sleep depth or patterns.
Cognitive Level: Application
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 2-1

2)

A 7-year-old client tells you, “Grandpa, Mommy, Daddy, and my brother live at my house.” The nurse identifies this family type as a:
A)

Binuclear family.
B)

Extended family.
C)

Gay and lesbian family.
D)

Traditional nuclear family.
Answer:

B
Explanation:

A)

A binuclear family includes divorced parents who have joint custody of their biological children; the children alternate spending varying amounts of time in the home of each parent.
B)

An extended family contains a parent or a couple who share the house with their children and another adult relative.
C)

A gay or lesbian family is comprised of two same-sex domestic partners; they might or might not have children.
D)

The traditional nuclear family consists of an employed provider parent, a homemaking parent, and the biological children of this union.
Cognitive Level: Application
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2-2

3)

During assessment of a childs biological family history, it is especially important that the nurse asking the mother for information use the term “childs father” instead of “your husband” in the situation of a:
A)

Traditional nuclear family.
B)

Traditional extended family.
C)

Two-income nuclear family.
D)

Heterosexual cohabitating informal stepfamily.
Answer:

D
Explanation:

A)

In the traditional nuclear family, the traditional extended family, and the two-income nuclear family, the childs father is the same person as the mothers husband.
B)

In the traditional nuclear family, the traditional extended family, and the two-income nuclear family, the childs father is the same person as the mothers husband.
C)

In the traditional nuclear family, the traditional extended family, and the two-income nuclear family, the childs father is the same person as the mothers husband.
D)

The mother from the heterosexual cohabitating informal stepfamily does not have a husband; the nurse should be asking about the childs father. In the traditional nuclear family, the traditional extended family, and the two-income nuclear family, the childs father is the same person as the mothers husband.
Cognitive Level: Analysis
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2-2

4)

The community health nurse is assessing several families for various strengths and needs in regard to afterschool and backup child care arrangements. The family type that typically will benefit most from this assessment and subsequent interventions is the:
A)

inuclear family.
B)

Extended family.
C)

Single-parent family.
D)

Traditional nuclear family.
Answer:

C
Explanation:

A)

The binuclear family, the extended family, and the traditional nuclear family generally have at least two adults who can share in the care for and the nurturing of its children.
B)

The binuclear family, the extended family, and the traditional nuclear family generally have at least two adults who can share in the care for and the nurturing of its children.
C)

The single-parent family most typically lacks social, emotional, and financial resources. Nursing considerations for such families should include referrals to options that will enable the parent to fulfill work commitments while providing the child with access to resources that can support the childs growth and development.
D)

The binuclear family, the extended family, and the traditional nuclear family generally have at least two adults who can share in the care for and the nurturing of its children.
Cognitive Level: Application
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2-2

5)

The community health nurse is making an initial visit to a family. The most effective and efficient way for the nurse to assess the parenting style in use is to:
A)

Observe the parent interacting with the child for five minutes.
B)

Ask, “What rule is hardest for your child to obey?”
C)

Ask, “How do you handle situations that require limit setting?”
D)

Ask the children how the parents set rules.
Answer:

D
Explanation:

A)

A less complete picture of parenting style is obtained during a brief artificial observation.
B)

Learning about rules is less helpful than is an explanation of enforcement efforts and success.
C)

Learning about rules is less helpful than is an explanation of enforcement efforts and success.
D)

Parental styles are assessed while the family explains how it handles situations that require limit setting. Learning about rules is less helpful than is an explanation of enforcement efforts and success.
Cognitive Level: Analysis
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2-3

6)

The nurse is working on parenting skills with a group of mothers. The mother who would need the fewest discipline-related suggestions is the:
A)

Authoritarian one.
B)

Authoritative one.
C)

Indifferent one.
D)

Permissive one.
Answer:

B
Explanation:

A)

Children in the authoritarian parenting family are denied the opportunity to develop some skills in the areas of self-direction, communication, and negotiation.
B)

The authoritative parenting style is one that results in positive outcomes for the behavior and learning of children. Nurses have observed that children from homes using this parental style more frequently have personalities manifesting self-reliance, self-control, and social competence. These parents should be praised for using the preferred approach.
C)

The indifferent parenting style results in children who often exhibit destructive behaviors and delinquency.
D)

Under the permissive parenting style, children do not learn the socially acceptable limits of behaviors.
Cognitive Level: Analysis
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 2-3

7)

The nurse in the pediatric clinic observes a parental lack of warmth and interest toward the child. The nurse knows that observation most frequently is seen in families that employ the parenting style known as:
A)

Authoritarian.
B)

Authoritative.
C)

Indifferent.
D)

Permissive.
Answer:

C
Explanation:

A)

Parents who favor the authoritarian style might exhibit a punitive attitude toward the child who is misbehaving, but are not disinterested.
B)

Parents employing the authoritative style and the permissive style have children who report that “My parent loves me and shows affection regularly.”
C)

Parents displaying the indifferent parenting style fail to demonstrate consistent warmth and interest in their children.
D)

Parents using the permissive parenting style usually have children who do not learn the socially acceptable limits of behaviors.
Cognitive Level: Analysis
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2-3

8)

The nurse is working with a mother of three children on parenting skills. The nurse demonstrates a strategy that uses reward to increase positive behavior. This strategy is called:
A)

Time-out.
B)

Reasoning.
C)

Behavior modification.
D)

Experiencing consequences of misbehavior.
Answer:

C
Explanation:

A)

Time-out and experiencing consequences of misbehavior show the child that unacceptable behavior brings undesirable outcomes.
B)

Reasoning attempts to use explanation to end misbehavior.
C)

Behavior modification identifies and gives rewards for desired behaviors.
D)

Time-out and experiencing consequences of misbehavior show the child that unacceptable behavior brings undesirable outcomes.
Cognitive Level: Application
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 2-3

9)

The nurse is assigned to a child in a spica cast for a fractured femur suffered in an automobile accident. The childs teenage brother was driving the car, which was totaled. The nurse learns that the father lost his job three weeks ago, and that the mother has just accepted a temporary waitress job. An appropriate diagnosis for this family is:
A)

Compromised Family Coping related to the effects of multiple simultaneous stressors.
B)

Impaired Social Interaction (parent and child) related to the lack of family or respite support.
C)

Interrupted Family Processes related to child with significant disability requiring alteration in family functioning.
D)

Risk for Caregiver Role Strain related to child with a newly acquired disability and the associated financial burden.
Answer:

A
Explanation:

A)

Compromised Family Coping related to the effects of multiple simultaneous stressors best fits the multiple crises to which this family is responding.
B)

Lack of family members and lack of respite support were not mentioned in the scenario.
C)

The spica cast might require alteration in family functioning; however, fractures generally are not considered a significant long-term disability.
D)

The need for a spica cast is not considered a newly acquired disability.
Cognitive Level: Application
Client Need: Psychosocial Integrity
Nursing Process: Diagnosis
Learning Outcome: 2-4

10)

Several children arrived at the Emergency Department accompanied by only their fathers. The nurse knows that the father who legally may sign emergency medical consent for treatment is:
A)

The divorced one from the binuclear family.
B)

The stepfather from the blended or reconstituted family.
C)

The divorced one when the single-parent mother has custody.
D)

The non-biologic one from the heterosexual cohabitating family.
Answer:

A
Explanation:

A)

The divorced father from the binuclear family may sign informed consent, because he has equal legal rights with the mother under joint custody arrangements.
B)

The non-biologic stepfather from the blended or reconstituted family, the divorced biologic father when the single-parent mother has custody, and the non-biologic father from the

heterosexual cohabitating family are without legal authority to seek emergency medical care for the child.
C)

The non-biologic stepfather from the blended or reconstituted family, the divorced biologic father when the single-parent mother has custody, and the non-biologic father from the heterosexual cohabitating family are without legal authority to seek emergency medical care for the child.
D)

The non-biologic stepfather from the blended or reconstituted family, the divorced biologic father when the single-parent mother has custody, and the non-biologic father from the heterosexual cohabitating family are without legal authority to seek emergency medical care for the child.
Cognitive Level: Application
Client Need: Safe, Effective Care Environment
Nursing Process: Planning
Learning Outcome: 2-5

11)

The camp nurse is assessing a group of children attending summer camp. The nurse will expect which children to be most likely to have problems perceiving a sense of belonging?
A)

Children whose parents divorced recently
B)

Children who gained a step-parent recently
C)

Children recently placed into foster care
D)

Children adopted as infants
Answer:

C
Explanation:

A)

Children whose parents divorce often fear abandonment.
B)

Children who gain a step-parent might have problems trusting the new parent.
C)

Children in foster care are more likely to have problems perceiving a sense of belonging.
D)

Infants who are adopted at birth can have minimal problems with acceptance when parents follow pre-adoption counseling about disclosure.
Cognitive Level: Application
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2-5

12)

A new pediatric hospital will open soon. While planning nursing care, the hospital administration is considering two models of providing health care: family-focused care and family-centered care. The best example of a nursing action in the family-centered care approach would be when the nurse:
A)

Tells the family what must be done for the familys health.
B)

Assumes the role of an expert professional to direct the health care.
C)

As healthcare authority, intervenes for the child and family as a unit.
D)

Confers with the family in deciding which health care option will be chosen.
Answer:

D
Explanation:

A)

Telling the family what should be done is family-focused care. In family-focused care, the health care worker assumes the role of professional expert. Though a good way of providing pediatric health care, those participating in this type of care will miss contributions that the family brings to the health care meeting, as in family-centered care.
B)

Directing the care as a professional is an example of family-focused care. In family-focused care, the health care worker assumes the role of professional expert while missing the multiple contributions the family brings to the health care meeting.
C)

Intervening for the family as a health care authority is an example of family-focused care. In family-focused care, the health care worker assumes the role of professional expert while missing the multiple contributions the family brings to the health care meeting.
D)

Conferring with the family exemplifies family-centered care. The benefit of employing the

family-centered care philosophy is that the priorities and needs as seen by the family are addressed as a partnership between a family and a nurse develops.
Cognitive Level: Application
Client Need: Safe, Effective Care Environment
Nursing Process: Planning
Learning Outcome: 2-6

13)

The nurse is assessing a familys effective coping strategies and ineffective defensive strategies. The nurse will use the family social system theory known as:
A)

Family stress theory.
B)

Family development theory.
C)

Family systems theory, as evolved from general systems theory.
D)

The Resiliency Model of Family Stress, Adjustment, and Adaptation.
Answer:

A
Explanation:

A)

Family stress theory determines an array of coping strategies that effectively help reduce stress, in contrast with the defensive strategies of dysfunctional families.
B)

Family development theory suggests developmental tasks for families in each stage.
C)

Family systems theory looks at the relationships among and between family members and the environment.
D)

The Resiliency Model of Family Stress, Adjustment, and Adaptation discusses two levels of severity for crises; one requires adjustment, while the other requires adaptation.
Cognitive Level: Application
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2-6

14)

The nurse is assessing a family with a variety of tools. The family-assessment tool that identifies the degree of satisfaction with ones family is the:
A)

Calgary Family Assessment Model.
B)

Family APGAR.
C)

Family Adaptability and Cohesion Evaluation Scales III (FACES III).
D)

Home Observation for Measurement of the Environment (HOME).
Answer:

C
Explanation:

A)

The Calgary Family Assessment Model uses three categories to reveal information about a familys strengths and problems.
B)

The Family APGAR gives initial measurements about the adaptability, partnership, growth, affection, and resolve of a family.
C)

The Family Adaptability and Cohesion Evaluation Scales III (FACES III) evaluates differences between scores for an ideal family and the family in question to distinguish ones level of satisfaction with ones own family.
D)

The Home Observation for Measurement of the Environment (HOME) focuses upon strategies for interacting with a child in the home to promote learning.
Cognitive Level: Application
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2-7

15)

A nurse is working with the family of a pediatric client. The nurse is planning to obtain an accurate family assessment. The initial step would be to:
A)

Establish a trusting relationship with the family.
B)

Select the most relevant family-assessment tool.
C)

Focus primarily on the mother, while learning her greatest concern.
D)

Observe the family in the home setting, since this step always proves indispensable.
Answer:

A
Explanation:

A)

Establishment of a trusting relationship between the family and the nurse is the essential preliminary step in obtaining an accurate family assessment.
B)

There is benefit when the tool used matches the familys strengths and resources; however, selecting the most relevant family assessment tool is not indispensable to accuracy in the assessment.
C)

Focusing primarily on the mother while learning her greatest concern is counterproductive, and prevents the nurse from acknowledging multiple perceptions held by the familys members.
D)

Observing the family in the home setting is recommended only in some cases.
Cognitive Level: Application
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2-8

1)

B, C, D

2)

B

3)

D

4)

C

5)

D

6)

B

7)

C

8)

C

9)

A

10)

A

11)

C

12)

D

13)

A

14)

C

15)

A