Psychiatric Mental Health Nursing 9th Edition By Townsend – Test Bank

Psychiatric Mental Health Nursing 9th Edition By Townsend – Test Bank

Chapter 11. Intervention With Families
Multiple Choice
1. A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family
constellation, and why?
A. Abnormal; the grandmother should be concerned with issues other than childrearing.
B. Abnormal; a two-parent household is the most advantageous arrangement for parenting.
C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures. ANS: C
The nurse should be aware that cultural differences and specific events may lead to variety in family
constellations. This is normal. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
2. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According
to Bowens family systems theory, how should the community health nurse interpret the teenagers action?
A. The teenager is attempting to differentiate self.
B. The teenager is triangulating self.
C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits. ANS: A
The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need:
Psychosocial Integrity
3. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal
grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home?
A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present.
B. The grandparental subsystem is not successfully managing separation from the parental subsystem.
C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing. ANS: C
The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in
this culture. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need:
Psychosocial Integrity
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4. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After
the client received a college acceptance, the mother repeatedly states, Thats wonderful. Ill be fine all alone. How would the nurse interpret the mothers statements?
A. The mother is withholding supportive messages.
B. The mother is expressing denigrating remarks.
C. The mother is communicating indirectly. D. The mother is using double-bind communication. ANS: D
The clients mother says she is fine with him going away to college but then tries to make him feel guilty about
her being left alone. The client is in a no-win situation because his mother has given a mixed messagea double- bind communication. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis | Client Need:
Psychosocial Integrity
5. In a family that is in the life cycle stage called The Family with Adolescents, which changes must occur for
the family to proceed developmentally?
A. Making adjustments within the marital system to meet the responsibilities of parenthood
B. Establishing a new identity as a couple by realigning relationships with extended family
C. Redefining the level of dependence so that adolescents are provided with greater autonomy
D. Reestablishing the bond of the dyadic marital relationship
ANS: C
Stage IV of the family life cycle is described as The Family with Adolescents. The task of this stage is to
redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain
responsive to teenagers dependency needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
6. A clinic nurse is caring for a 40-year-old client who lives with his parents. The clients mother continues to
do the clients laundry and provides spending money. Based on this situation, which family dynamic does the
nurse recognize?
A. Taking over
B. Communicating indirectly
C. Belittling feelings
D. Making assumptions
ANS: A
Taking over occurs when a family member fails to allow another member to develop a sense of responsibility
and self-worth. By doing the clients laundry and managing finances, the mother is fostering the clients
dependence. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
Test Bank – Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 94
7. A 30-year-old client seeking therapy states, My mom cries when she is not included in all my social
activities and thinks of my friends as her own. How would the nurse describe the boundaries between this
familys parent and child subsystems?
A. The boundaries are rigid.
B. The boundaries are restructured.
C. The boundaries are enmeshed. D. The boundaries are disengaged. ANS: C
With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The clients mother is trying to prevent independence by generating feelings of guilt. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |Client Need:
Psychosocial Integrity
8. A nurse enters an inpatient room and finds the family disagreeing about the clients living arrangements after
discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts?
A. All family members should use past incidents to make their point.
B. One family member should act as a gatekeeper in order to avoid family confrontation.
C. One family member should act as a compromiser to preserve harmony in the family system. D. All family members should respect differing opinions and use compromise and negotiation. ANS: D
Functional families allow and respect differences among members. They learn to handle differences and
conflict through negotiation and compromise. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Health Promotion and Maintenance
9. After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the
childs behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize
that this is an example of which family system concept?
A. Differentiation of self
B. Triangulation
C. Fusion
D. Emotional cutoff
ANS: B
Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into
the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couples
marital problems. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
10. An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to
Test Bank – Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 95
give an example of a well-differentiated parent and adult child relationship. Which student example meets the
instructor requirement?
A. An adult child considers, but is not governed by, the advice of his or her parents.
B. An adult child appears to listen, but ignores, the advice of his or her parents.
C. An adult child respects and is governed by the wishes of his or her parents. D. An adult child never requests advice or feedback from his or her parents. ANS: A
The correct student example of a well-differentiated parent and adult child relationship is when an adult child
considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated
enough not to be threatened by parental advice and should be able to consider the parental advice without
feeling the advice must be followed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
11. During family counseling a husband states, Every time my wife and I discuss child discipline, we get into
shouting matches. The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays
for 30 minutes. What intervention is the nurse using?
A. Reframing
B. Restructuring the family
C. Expressive psychotherapy
D. Paradoxical intervention
ANS: D
In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This
removes control over the behavior from the family to the therapist. Clients are made more aware of the
defeating behavior and this can lead to behavioral change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
12. During family counseling a child states, I just want to surf like other kids. Mom says its okay, but Dad says
Im too young. The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize?
A. Multigenerational transmission
B. Disengagement
C. Motherchild subsystem
D. Emotional cutoff
ANS: C
In this situation the mother and child have formed a subsystem in which they have aligned themselves against
the father. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity