Chapter 24: Family Context in Nursing
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
1. The student nurse is talking to her friends about holiday plans with their families. One
friend described her family as her mother, brother, and sister-in-law. Another stated her
family consisted of her mother, father, grandmother, and her aunt. The student nurse’s
family is her mother, stepfather, sister, and stepsister. The uniqueness of these families is
known as which of the following?
a. Family resilience
b. Nuclear family
c. Family diversity
d. Family durability
ANS: C
Family diversity is the uniqueness of each family. Family resiliency is the ability of the
family to cope with expected and unexpected stressors. Family durability is the intrafamilial
system of support and structure that extends beyond the walls of the household. A nuclear
family consists of a husband and wife (and perhaps one or more children).
PTS: 1
DIF: Cognitive Level: Remembering (Knowledge)
REF: 617 | 619
OBJ: Discuss common family forms and their health implications.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
2. A woman is making plans for her holiday dinner and shares with her butcher that she will be
inviting her family. When the butcher asks who will be coming, she replies, “My two
children and their spouses, my ex-son-in-law is bringing my grandson, and my
ex-mother-in-law is coming.” This is an example of which of the following?
a. Family durability
b. Family resiliency
c. Family diversity
d. Nuclear family
ANS: A
Family durability is the intrafamilial system of support and structure that sometimes extends
beyond the walls of the household. Through divorce, remarriages, or cohabitation new
members are added to a family. In addition, an extended family also includes contact with
former spouses or partners. Family diversity is the uniqueness of each family. Family
resiliency is the ability of the family to cope with expected and unexpected stressors. A
nuclear family consists of husband and wife (and perhaps one or more children).
PTS:
REF:
OBJ:
TOP:
1
DIF: Cognitive Level: Remembering (Knowledge)
617 | 619
Discuss how the term family is defined to reflect family diversity.
Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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3. A nurse is caring for a patient. Visitors at the bedside include the patient’s life partner,
widowed mother, sister, and nephew. The nurse acknowledges that current trends in
American families include which of the following?
a. Couples deciding to have many children
b. A declining divorce rate
c. Changing family patterns
d. Fewer people choosing to live alone
ANS: C
Families are constantly changing. People may marry later, delay childbirth, and couples
choose to have fewer children or none at all. The number of people living alone is
expanding and accounts for approximately 26% of households. Divorce rates have tripled
since the 1950s, and although the rate appears to have stabilized, it is estimated that 54% of
all marriages will end in divorce.
PTS: 1
DIF: Cognitive Level: Applying (Application)
REF: 619
OBJ: Examine current trends in the American family.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
4. In regard to American families, the nurse understands that which of the following is true?
a. The number of single-parent families is increasing.
b. Single fathers head most single-parent families.
c. Most single parent families are the result of the death of one parent.
d. Father-only families are on the rise.
ANS: D
Although mothers head 83% of single-parent families, father-only families are on the rise.
The number of single-parent families appears to be stabilizing at about 26% of all families
with children. Forty-one percent of children are living with mothers who have never
married; many of these children result from an adolescent pregnancy.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 619
OBJ: Examine current trends in the American family.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
2
5. A nurse is admitting a teen-aged woman to the Labor and Delivery unit to have her baby.
She is not married but is holding hands with her boyfriend who is the baby’s father. The
nurse realizes that:
a. adolescent pregnancy is a decreasing concern in modern society.
b. teenage pregnancies are little more than a temporary bump in the road of life.
c. increased numbers of children mean greater income and a way out of poverty.
d. teenage pregnancies affect teenage fathers as well as mothers.
ANS: D
Teenage fathers also have stressors placed on them when their partner becomes pregnant.
These young men have poorer support systems and fewer resources to teach them how to
parent. As a result, both of these adolescent parents often struggle with the normal tasks of
development and identity, but are also forced to accept a responsibility that they are not
ready for physically, emotionally, socially, and/or financially. Adolescent pregnancy is an
ever-increasing concern. The majority of these adolescents continue to live with their
families. A teenage pregnancy tends to have long-term consequences for the mother and
often severely stresses family relationships and resources. In addition, there is an increased
risk for continued poverty for the family.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 619
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
6. A student nurse is working on a community health project with her peers. One of the
concerns in her community is the rise in homelessness resulting from the economy. The
student nurse understands that which of the following is true?
a. Almost all homeless families are made up of single-parent families.
b. Children in homeless families are usually in good health.
c. Families with children are the fastest growing segment of the homeless
population.
d. Children in homeless families have no way to attend school so are illiterate.
ANS: C
The fastest growing segment of the homeless population is families with children. This
includes complete nuclear families and single-parent families. More than 794,000 homeless
are enrolled in the public school systems. Children of homeless families are often in fair or
poor health and have higher rates of asthma, ear infections, stomach problems, mental
illness, and have poor immunization documentation. As a result, usually the only access to
health care for these children is through the emergency department.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 619 | 620
OBJ: Examine current trends in the American family.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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7. The nurse is caring for a 78-year-old patient with liver cancer. The patient and his wife live
at home. In addition to caring for the patient, the nurse also assesses caregiver stress in the
patient’s wife. Which of the following indicates caregiver stress?
a. Increased visits from church members
b. Asking her daughter for help with shopping
c. Remaining cheerful and without depression
d. Contracting pneumonia
ANS: D
Assess for caregiver stress, such as tension in relationships with family and care recipient,
changes in level of health, changes in mood, and anxiety and depression. Contracting
pneumonia could be a sign of caregiver stress because it is a change in the level of health.
Visits from church members and shopping with her daughter demonstrate good relationships
with family and friends.
PTS: 1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 631
OBJ: Discuss the role of families and family members as caregivers.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
8. The family is the primary social context in which health promotion and disease prevention
take place. Placed in this context, it is reasonable for the nurse to assume which of the
following is true?
a. The family’s beliefs, values, and culture strongly influence health behaviors.
b. Families function haphazardly without creating goals.
c. Good health is always highly valued in family settings.
d. The long-term habits of one family member has no effect on the others.
ANS: A
The family’s beliefs, values, culture, and practices strongly influence the health-promoting
behaviors of its members. When the family satisfactorily meets its goals through adequate
functioning, its members tend to feel positive about themselves and their family.
Conversely, when they do not meet goals, families view themselves as ineffective. Good
health is not always highly valued; in fact, harmful practices are acceptable in some
families. Some of these practices might include poor dietary habits, such as high-calorie,
high-fat diets. A long-term illness in one of the family members affects the well-being and
health of the entire family. In addition, long-term habits such as smoking also influence the
health of members in the family unit.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 621
OBJ: Compare family as context to family as patient and family as system and explain the
way that these perspectives influence nursing practice.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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9. The parents of an 18-year-old who joined the military and is being deployed overseas,
discuss with him how they plan to stay in touch and purchase a laptop computer for him to
take with him so they can e-mail and use the webcam to see each other. What approach to
stress does this family exhibit?
a. Resiliency
b. Hardiness
c. Heredity
d. Genetics
ANS: B
Family hardiness is the internal strengths and durability of the family unit. A sense of
control over the outcome of life, a view of change as beneficial and growth producing, and
an active rather than passive orientation in adapting to stressful events characterize family
hardiness. Resiliency helps to evaluate healthy responses when individuals and families are
experiencing stressful events. Resources and techniques a family or individuals within the
family use to maintain a balance or level of health assist in understanding a family’s level of
resiliency. Genetic factors reflect a family’s heredity or genetic susceptibility to a disease
that may or may not result in actual development of the disease.
PTS: 1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 621
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
10. What should the nurse do when planning goals for a family?
a. View the family as a group of individuals rather than a system.
b. Make the goals as vague as possible so that they are attainable.
c. Be flexible since families are continually changing.
d. Recognize that, although individuals go through developmental stages, families
do not.
ANS: C
Families are continually changing. As a result, the need for family support changes over
time, and it is important for you to understand that the family is more complex than simply a
combination of individual members. Family nursing practice has three levels of approaches:
(1) family as context, (2) family as patient, and (3) family as system. The goals need to be
concrete, realistic, compatible with the family’s developmental stage and expectations, and
acceptable to the family. Although families are far from identical to one another, they have a
basic pattern and similarity in experiences, resulting in predictable stages. Each of these
developmental stages has its own challenges, needs, and resources and includes tasks that
need to be completed before the family is able to successfully move on to the next stage.
PTS: 1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 621 | 622 | 623 | 626
OBJ: Compare family as context to family as patient and family as system and explain the
way that these perspectives influence nursing practice.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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11. A student nurse is caring for a 4-year-old patient who has been admitted to the pediatric unit
with acute asthma. As the student nurse admits the patient, he learns that both parents smoke
in the home. The nurse plans to discuss with the parents the implications of smoking around
the patient and to provide them with information on smoking cessation. This is an example
of what approach to family nursing?
a. Family as context
b. Family as patient
c. Family as system
d. Family as a stagnated group
ANS: A
When you view the family as context, your primary focus is on the health and development
of an individual member existing within a specific environment (i.e., the patient). Although
you focus the nursing process on the individual’s health status, you will also assess the
extent to which the family provides the individual’s basic needs. When you view the family
as patient, the family processes and relationships (e.g., parenting or family caregiving) are
your primary focus of care. When you care for the family as a system, you are caring for
each family member (family as context) and the family unit (family as patient), using all
community, social, and psychosocial resources. Families are continually changing. As a
result, the need for family support changes over time, and it is important for you to
understand that the family is more complex than simply a combination of individual
members.
PTS: 1
DIF: Cognitive Level: Analyzing (Analysis)
REF: 622 | 623
OBJ: Compare family as context to family as patient and family as system and explain the
way that these perspectives influence nursing practice.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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12. A patient comes from a close-knit extended family. If the patient’s family functions as
context, what does the nurse need to evaluate?
a. Attainment of health of an individual member in a specific environment
b. Family processes
c. Family relationships
d. The family member and unit
ANS: A
When you view the family as context, your primary focus is on the health and development
of an individual member existing within a specific environment (i.e., the patient’s family).
When you view the family as patient, the family processes and relationships (e.g., parenting
or family caregiving) are your primary focus of care. Focus your nursing assessment on the
family patterns versus individual member characteristics. When you care for the family as a
system, you are caring for each family member (family as context) and the family unit
(family as patient), using all community, social, and psychosocial resources.
PTS: 1
DIF: Cognitive Level: Applying (Application)
REF: 623
OBJ: Compare family as context to family as patient and family as system and explain the
way that these perspectives influence nursing practice.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
13. When a family is in a transitional phase of the life cycle perspective (e.g., birth of a first
child), it is important for the nurse to do which of the following?
a. Accept that this is usually a time of decreased stress and anxiety.
b. Use the knowledge of stress and coping to assist in family care.
c. Explain that the health of one family member does not depend on the family
system.
d. Draw on psychological theory as the major basis for family care.
ANS: B
Your knowledge of stress and coping will assist in family care. When a family is in a
transitional phase of the life cycle perspective (e.g., birth of a first child) or there is an
additional stressor to the family unit (e.g., chronic illness), it creates considerable anxiety
and stress within the family system. The health and functioning of each member in the
family to some degree depends on the health of the family system as a whole. Family care
draws on knowledge from growth and development, psychology, communication, family
theories, sociology, and the family life cycle.
PTS: 1
DIF: Cognitive Level: Applying (Application)
REF: 623
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
7
14. A nurse is attempting to complete the nursing admission data on a patient. To complete the
admission and formulate a plan of care, the nurse needs to do which of the following?
a. Know that the individual is the same as the family as a whole.
b. Realize that family health is the summation of the health of all members.
c. Evaluate the form, structure, and function of the family.
d. Discount negative views by the patient toward the family.
ANS: C
Areas included in family assessment are the form, structure, and function of the family; its
developmental stage; and its progress toward or accomplishment of developmental tasks. It
is essential to assess the patient and family thoroughly. The family as a whole differs from
individual members. The measure of family health is more than a summation of the health
of all members. Begin assessment by considering the views of the patient toward the family.
PTS:
REF:
OBJ:
TOP:
1
DIF: Cognitive Level: Applying (Application)
624
Use the nursing process to provide for the health care needs of the family.
Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
15. The nurse is admitting a Hispanic patient to the oncology unit of the hospital. To provide
culturally competent care, the nurse needs to determine the influence of culture on the
patient’s family. Which of the following questions would best accomplish this?
a. “What types of foods do you eat?”
b. “Since you’re Hispanic, would you like to order beans for supper?”
c. “I am assuming that you’re Catholic. Do you want to see the priest?”
d. “Hispanics have large families. Do you have questions about visitation policies?”
ANS: A
To determine the influence of culture on a family, you might want to ask the patient about
his or her cultural background. Then ask questions concerning cultural practices. For
example, “What type of foods do you eat?” “Who cares for sick family members?”
Overgeneralizations in terms of racial and ethnic group characteristics do not lead to greater
understanding of the culturally diverse family.
PTS: 1
DIF: Cognitive Level: Applying (Application)
REF: 625
OBJ: Discuss the role of families and family members as caregivers.
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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16. The nurse is admitting a 45-year-old patient and asks about her family. The patient states
that she lives with her daughter and son-in-law. The nurse knows that this is an example of
which of the following family forms?
a. Nuclear
b. Extended
c. Blended
d. Alternate pattern relationship
ANS: B
The extended family includes relatives (aunts, uncles, grandparents, and cousins) in addition
to the nuclear family. The nuclear family consists of husband and wife (and perhaps one or
more children). The blended family is formed when parents bring unrelated children from
prior or foster parenting relationships into a new, joint living situation. Alternate pattern
relationships include multi-adult households, “skip-generation” families (grandparents
caring for grandchildren), and communal groups with children, “nonfamilies” (adults living
alone), and cohabitating.
PTS: 1
DIF: Cognitive Level: Remembering (Knowledge)
REF: 619
OBJ: Discuss common family forms and their health implications.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
17. A nursing instructor is raising her two granddaughters after her daughter and son-in-law
were killed in a motor vehicle accident. How is this family form best described?
a. Extended family
b. Single-parent family
c. Blended family
d. Alternative pattern of relationship
ANS: D
Alternate patterns of relationships include multi-adult households, “skip-generation”
families (grandparents caring for grandchildren), communal groups with children,
“nonfamilies” (adults living alone), and cohabitating partners. The extended family includes
relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. The
single-parent family is formed when one parent leaves the nuclear family because of death,
divorce, or desertion or when a single person decides to have or adopt a child. The blended
family is formed when parents bring unrelated children from prior or foster parenting
relationships into a new, joint living situation.
PTS: 1
DIF: Cognitive Level: Remembering (Knowledge)
REF: 619
OBJ: Discuss common family forms and their health implications.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
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18. A married couple takes four children to an immunization clinic. The nurse notes that the
children’s permission slips include three children with one last name and one child with a
different last name. On questioning the parents the nurse discovers that this family group is
an example of a(n) _____ family.
a. nuclear
b. blended
c. extended
d. single-parent
ANS: B
The blended family is formed when parents bring unrelated children from prior or foster
parenting relationships into a new, joint living situation. A nuclear family consists of
husband and wife (and perhaps one or more children). The extended family includes
relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. The
single-parent family is formed when one parent leaves the nuclear family because of death,
divorce, or desertion or when a single person decides to have or adopt a child.
PTS: 1
DIF: Cognitive Level: Remembering (Knowledge)
REF: 619
OBJ: Discuss common family forms and their health implications.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
19. The nurse is caring for a family within an impoverished community. What is it important for
the nurse to understand about families?
a. They are made up of a set of interacting individuals related by blood, marriage or
adoption.
b. They are comprised of a group of individuals living together who may not be
related.
c. They all have one unique form independent of cultural or ethnic orientations.
d. They all have the same strengths, weaknesses, resources and challenges.
ANS: A
A family is a set of interacting individuals related by blood, marriage, or adoption who
usually live together and fulfill functions of socialization, division of labor, economic
provisions, and cooperatively meet affective and emotional needs of the individuals within
the family unit. In addition, individuals living together, regardless of their relationship or
whether they fulfill common social functions, constitute a household. When you provide
individualized family care, understand that families take many forms and have diverse
cultural and ethnic orientations. In addition, no two families are alike. Each has its own
strengths, weaknesses, resources, and challenges.
PTS:
REF:
OBJ:
TOP:
1
DIF: Cognitive Level: Remembering (Knowledge)
619
Discuss how the term family is defined to reflect family diversity.
Nursing Process: Assessment
MSC: NCLEX: Management of Care
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
10
MULTIPLE RESPONSE
1. When providing care for families, of what should the nurse be aware? (Select all that apply.)
a. Family hardiness is the internal strength and durability of the family.
b. Resiliency helps to evaluate healthy responses in stressful times.
c. Good health is always highly valued within the family unit.
d. Along-term illness in one family member affects the entire family
e. Family members may be a primary force for coping.
ANS: A, B, D, E
Family hardiness is the internal strengths and durability of the family unit. A sense of
control over the outcome of life, a view of change as beneficial and growth producing, and
an active rather than passive orientation in adapting to stressful events characterize family
hardiness. Resiliency helps to evaluate healthy responses when individuals and families are
experiencing stressful events. Resources and techniques a family or individuals within the
family use to maintain a balance or level of health assist in understanding a family’s level of
resiliency. Good health is not always highly valued; in fact, harmful practices are acceptable
in some families. Some of these practices might include poor dietary habits, such as high
caloric, high fat diets. A long-term illness in one of the family members affects the
well-being and health of the entire family. In addition, long term habits, such as smoking
also influence the health of members in the family unit. Although illness strains
relationships, research indicates that family members have the potential to be a primary
force for coping.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 621
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
2. Domestic violence includes which of the following? (Select all that apply.)
a. Only live-in partners
b. Dating relationships
c. Spouses
d. The elderly almost exclusively
e. Child abuse
ANS: B, C, E
Domestic violence includes not only intimate partner relationships of spousal, live-in
partners, and dating relationships, but also familial, elder, and child abuse.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 620
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
11
3. The nurse is caring for a patient who gives indications of being a victim of abuse. The nurse
understands that abuse is which of the following? (Select all that apply.)
a. Can be physical battering
b. Is sometimes manifested as sexual assault
c. Generally declines over a period of time
d. Is sometimes classified as emotional abuse
e. Can be psychological in nature
ANS: A, B, D, E
Abuse generally falls into one or more of the following categories: physical battering,
sexual assault, and emotional or psychological abuse; and it generally escalates over a
period of time.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 620
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
4. The cause of family violence is complex and multidimensional. Factors associated with
family violence include which of the following? (Select all that apply.)
a. Stress
b. Peer pressure
c. Psychopathology
d. Learned family behavior
e. Wealth
ANS: A, C, D
The cause of family violence is complex and multidimensional. Stress, poverty, social
isolation, psychopathology, and learned family behavior are all factors associated with
violence.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 620
OBJ: Explain how the relationship between family structure and patterns of functioning
affects the health of individuals within the family as well as the family as a whole.
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
12
5. Homeless children are more likely to do which of the following? (Select all that apply.)
a. Drop out of school.
b. Develop risky behaviors.
c. Become more employable because of life experience.
d. Develop long-term health problems.
e. Be better supervised after school.
ANS: A, B, D
Homeless children face barriers, such as meeting residency requirements for public schools
and inability to obtain previous enrollment records, when enrolling and attending school.
These children frequently lack adult supervision to assist them with homework and other
school-related projects and issues. As a result, these children are more likely to drop out of
school, develop risky behaviors, and become unemployable. Homeless families and their
children are at serious risk for developing long-term health, psychological, and
socioeconomic problems, thus posing a major challenge for our entire society.
PTS: 1
DIF: Cognitive Level: Understanding (Comprehension)
REF: 619 | 620
OBJ: Examine current trends in the American family.
TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity
All items and derived items © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
13