TOWNSEND MENTAL HEALTH NURSING

TOWNSEND MENTAL HEALTH NURSING

CH 11 QUESTIONS AND ANSWERS 2022

• 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?

• Abnormal; the grandmother should be concerned with issues other than

childrearing.

• Abnormal; a two-parent household is the most advantageous arrangement for

parenting.

• Normal; cultural variations exist in the family life cycle.
• 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.

PTS: 1 REF: 204

KEY: Cognitive Level: Application | Integrated Process: Assessment

• In defiance of parental wishes, a Japanese teenager succumbs to peer pressure

and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action?

• The teenager is attempting to differentiate self.
• The teenager is triangulating self.
• 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.

PTS: 1 REF: 210

KEY: Cognitive Level: Application | Integrated Process: Evaluation

• 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?

• The parents have diffuse boundaries and have allowed the grandparental

subsystem to be present.

• The grandparental subsystem is not successfully managing separation from the

parental subsystem.

• Extended family living arrangements are common in some cultures.
• 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.

PTS: 1 REF: 205

KEY: Cognitive Level: Application | Integrated Process: Evaluation

• 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, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements?

• The mother is withholding supportive messages.
• The mother is expressing denigrating remarks.
• The mother is communicating indirectly.

D. The mother is using double-bind communication. - ANS: D

The client's 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 message—a double-bind communication.

PTS: 1 REF: 206

KEY: Cognitive Level: Application | Integrated Process: Evaluation

• Which task should the nurse recognize as appropriate to stage IV of the family life

cycle?

• Making adjustments within the marital system to meet the responsibilities of

parenthood

• Establishing a new identity as a couple by realigning relationships with extended

family

• 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 "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.

PTS: 1 REF: 203

KEY: Cognitive Level: Application | Integrated Process: Assessment

• A clinic nurse is caring for a 40-year-old client who lives with his parents. The

client's mother continues to do the client's laundry and provides spending money.Based on this situation, which family dynamic does the nurse recognize?

• Taking over
• Communicating indirectly
• 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 client's laundry and managing finances, the mother is fostering the client's dependence.

PTS: 1 REF: 207

KEY: Cognitive Level: Application | Integrated Process: Assessment

• 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 family's parent and child subsystems?

• The boundaries are rigid.
• The boundaries are restructured.
• The boundaries are enmeshed.

D. The boundaries are disengaged. - ANS: C

With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The client's mother is trying to prevent independence by generating feelings of guilt.

PTS: 1 REF: 213

KEY: Cognitive Level: Application | Integrated Process: Assessment

• A nurse enters an inpatient room and finds the family disagreeing about the

client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts?

• All family members should use past incidents to make their point.
• One family member should act as a gatekeeper in order to avoid family

confrontation.

• One family member should act as a compromiser to preserve harmony in the

family system.

• 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.

PTS: 1 REF: 208

KEY: Cognitive Level: Application | Integrated Process: Implementation

• After hearing parents discuss divorce, a 5-year-old develops behavioral problems.

Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept?

• Differentiation of self
• Triangulation
• 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 couple's marital problems.

PTS: 1 REF: 210-211

KEY: Cognitive Level: Application | Integrated Process: Evaluation

• An instructor is teaching about differentiated parent and adult child relationships.

Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement?

• An adult child considers, but is not governed by, the advice of his or her parents.
• An adult child appears to listen, but ignores, the advice of his or her parents.
• An adult child respects and is governed by the wishes of his or her parents.

• 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.

PTS: 1 REF: 210

KEY: Cognitive Level: Application | Integrated Process: Assessment

• 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?

• Reframing
• Restructuring the family
• 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.

PTS: 1 REF: 215

KEY: Cognitive Level: Application | Integrated Process: Implementation

• During family counseling a child states, "I just want to surf like other kids. Mom

says it's okay, but Dad says I'm 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?

• Multigenerational transmission
• Disengagement
• Mother-child 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.

PTS: 1 REF: 210 | 213

KEY: Cognitive Level: Application | Integrated Process: Assessment

• During family counseling, a husband tells his wife to spend more time with the

family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement?

• The husband is expressing an emotional cutoff.
• The husband is expressing double-bind communication.
• The husband is expressing indirect messages.

D. The husband is expressing avoidance behaviors. - ANS: B