Family Focused Nursing Care Ist Edition By Sharon A. Denham -Test Bank

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Sample Test

Chapter 3- Moving to Family-Focused Care

MULTIPLE CHOICE

1. Which of the following does not contribute to the high costs of medical care in the last year of life?

1.	Caring for severe illness
2.	Functional impairment
3.	Nursing home expenditures
4.	Over-prescribing practices

ANS: 4

Rationale:

According to Hogan (2001), caring for severe illness, functional impairment, and nursing home expenditures contribute to the high cost of medical care in the last year of life.

PTS: 1

KEY: Content Area: Differentiate among terms like healthy, unhealthy, and societal health | Integrated Process: Caring | Client Need: Physiological Integrity | Cognitive Level: Knowledge | Question Type: Multiple Choice

2. What percent of U.S. adults are overweight or obese?

1.	Less than 25%
2.	34%
3.	40%
4.	More than 50%

ANS: 2

Rationale:

The obesity crisis is of great concern. According to the Centers for Disease Control and Prevention (2011), about 33.8% of U.S. adults are overweight or obese.

PTS: 1

KEY: Content Area: Differentiate among terms like healthy, unhealthy, and societal health | Integrated Process: Nursing Process | Client Need: Physiological Integrity | Cognitive Level: Knowledge | Question Type: Multiple Choice

3. Consider the following statements:

Statement A. When physicians discuss end-of-life with cancer patients, their health-care costs are much higher in the last week of life.

Statement B. Many dying persons never get referred to hospice care.

1.	Both statements A and B are true.
2.	Both statements A and B are false.
3.	Statement A is true and statement B is false.
4.	Statement A is false and statement B is true.

ANS: 4

Rationale:

According to Zhang et al. (2009), costs are much lower when physicians discuss end-of-life care with their patients. Yet many dying persons are never referred to hospice. More than a third of those referred only spend seven days enrolled, although many would benefit greatly from aspects of care management lasting longer (Jennings, Ryndes, D’Onofrio, & Baily, 2010).

PTS: 1

KEY: Content Area: Differentiate among terms like healthy, unhealthy, and societal health | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Knowledge | Question Type: Multiple Choice

4. An ____ point of view encourages one to see connections between society and individual or societal health.

1.	Educated
2.	Ecumenical
3.	Ecological
4.	Environmental

ANS: 3

Rationale:

An ecological point of view encourages one to see connections between society and individual or societal health.

PTS: 1

KEY: Content Area: Discuss ways thinking family improves individual, family, and societal health | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Knowledge | Question Type: Multiple Choice

5. How much greater is U.S. health-care spending compared to other nations?

1.	About 2.5 times as high
2.	About 4 times as high
3.	About 7.5 times as high
4.	About 10 times as high

ANS: 1

Rationale:

The United States is one of the wealthiest nations in the world and spends more money on health care than anywhere else; health-care spending is about 2.5 times as high as other nations.

PTS: 1

KEY: Content Area: Discuss ways thinking family improves individual, family, and societal health | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Knowledge | Question Type: Multiple Choice

6. Which of the following is not a priority of the Affordable Care Act’s quality improvement strategy?

1.	New health-care delivery models.
2.	Families engaged as partners in care.
3.	Less emphasis on preventive care.
4.	Use of best practices.

ANS: 3

	Feedback
1	New health-care delivery models, families engaged as partners in care, and use of best practices are all priorities of the Affordable Health Care Act’s quality improvement strategy.
2	New health-care delivery models, families engaged as partners in care, and use of best practices are all priorities of the Affordable Health Care Act’s quality improvement strategy.
3	Rather than less emphasis on preventive care, a priority is to promote the most effective prevention and treatment practices for leading causes of mortality.
4	New health-care delivery models, families engaged as partners in care, and use of best practices are all priorities of the Affordable Health Care Act’s quality improvement strategy.

PTS: 1

MULTIPLE RESPONSE

1. Which of the following may prevent illness?

1.	Adequate sleep
2.	Early diagnosis
3.	Stress management
4.	Adequate nutrition

ANS: 1, 3, 4

Rationale:

Adequate sleep, nutrition, and stress management help to prevent illness. Early diagnosis of illness is important too, but it does not prevent illness.

PTS: 1

KEY: Content Area: Identify various perspectives linked with health and illness | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Knowledge | Question Type: Multiple Response

2. Which of the following increase risk for illness?

1.	Physical activity
2.	Tobacco use
3.	Sedentary lifestyle
4.	Poverty

ANS: 2, 3, 4

Rationale:

Tobacco use and a sedentary lifestyle are high-risk behaviors; socioeconomic status also correlates with increased risk for illness.

PTS: 1

3. What do families desire from hospice care?

1.	Continuity of care.
2.	Comfort for the dying family member.
3.	Autonomy for family members.
4.	Case management.

ANS: 1, 2, 3, 4

Rationale:

Continuity of care, comfort for the dying family member, autonomy for family members, and case management are all aspects of hospice care.

PTS: 1

KEY: Content Area: Differentiate among terms like healthy, unhealthy, and societal health | Integrated Process: Caring | Client Need: Safe and Effective Care Environment | Cognitive Level: Knowledge | Question Type: Multiple Response

4. Which of the following factors influence societal health?

1.	Access to care providers
2.	Educational institutions
3.	Wealth distribution
4.	Respect of human rights

ANS: 1, 3, 4

Rationale:

Access to care providers, distribution of wealth, and respect of human rights all influence the health of society. Educational institutions are not essential for health and wellness.

PTS: 1

5. Which of the following are reasons the United States has a growing health disadvantage when compared with peer countries?

1.	Uninsured segments of the population
2.	High poverty rates
3.	An efficient health-care delivery system
4.	Lack of care coordination

ANS: 1, 2, 4

Rationale:

Uninsured people, high poverty rates, and lack of care coordination contribute to the growing health disadvantage of the United States, despite it being one of the wealthiest countries and spending more on health care compared to other nations. The U.S. health-care system is not efficient. There is much duplication, yet there are many gaps in care.

PTS: 1

6. Which of the following assumptions about the family perspective will guide nursing actions?

1.	Family members need full disclosure and clear explanations.
2.	Family members are usually afraid of being involved in care.
3.	Family confidence influences care giving.
4.	Family members have rights and can make choices.

ANS: 1, 3, 4

Rationale:

Assumptions that may help to guide nursing actions include that family members need full disclosure and clear explanations, that their confidence influences care giving, and that they have rights and can make choices. Families are usually comfortable with other family members and want to be involved, but will need information that will enable their involvement.

PTS: 1

KEY: Content Area: Describe ways nurses think family to deliver family focused care | Integrated Process: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Application | Question Type: Multiple Response

7. Which of the following actions by the nurse demonstrate the nurse is thinking family? Susan, a nurse who thinks family:

1.	Introduces herself to each of her patients in the acute-care setting.
2.	Ensures that family members are not in the room when procedures are done.
3.	Practices active listening with all her patients’ visitors.
4.	Commends family members for their positive interactions with her patients.

ANS: 3, 4

Rationale:

Thinking family is demonstrated by actively listening to patients’ visitors and commending family members for their positive interactions with patients. Introducing oneself to each patient and ensuring that family members are not in the room when procedures are done only shows concern for the individual, not for the family.

PTS: 1

KEY: Content Area: Describe ways nurses think family to deliver family focused care | Integrated Process: Communication and Documentation | Client Need: Psychosocial Integrity | Cognitive Level: Application | Question Type: Multiple Response

COMPLETION

1. As early as 1995, the American Nurses Association’s Social Policy Statement described ____________________ as a target for nursing care.

ANS: family

PTS: 1

KEY: Content Area: Discuss ways thinking family improves individual, family, and societal health | Integrated Process: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Knowledge | Question Type: Completion

SHORT ANSWER

1. List several influencers of norms or standards regarding health.

ANS:

Age, genetics, geographical region, culture/ethnicity, etc.

PTS: 1

2. Compare and contrast obesity and malnutrition as public health issues, and describe how families can influence them.

ANS:

Nurses and the general public are often unaware of public health measures that might be used to reverse the obesity epidemic. Some solutions rest outside the health-care industry, but clinicians might make important differences. For example, lifestyle choices, the built environment, leadership capacities, prevention, public policy, and government interventions offer alternative approaches to the obesity problem. Coordinated actions are needed to solve a problem of this magnitude. Nurses that think family can help by looking beyond primary care settings and find ways to address this concern—one of which is to educate families. Malnutrition and starvation are also growing problems, not only for the homeless or the unemployed, but one that is faced daily by families with inadequate incomes. Families often choose between food and other basic needs (e.g., rent, utilities, and medical care). Nurses that think family consider the health and illness of the family units and the larger society, not merely individuals.

PTS: 1

3. Explain what is meant by this statement of the Royal College of Physicians and Surgeons:

“Societal needs for medical health care have both quantitative and qualitative perspectives.”

ANS:

Quantitative means that the appropriate number, type, and mix of physicians, nurses, or other health-care professionals are available. Qualitative needs have to do with the adequacy of the professionals’ knowledge, skills, attitudes, and willingness to assume the roles needed by diverse societies. Professional competencies needed by population groups are often culturally specific responses to societal needs, social determinants of health, and the burden of illness.

PTS: 1

Chapter 4- Communication With and About Families

MULTIPLE CHOICE

1. Which of the following is the best rationale for a nurse to spend time communicating with a family member of a hospitalized patient?

1.	The nurse often has information that needs to be shared with a family member who is a primary social structure caring for an individual.
2.	A nurse’s communication can supports the nurse’s position of power in the health-care system caring for an individual.
3.	Communication with family members is critical to increase a nurse’s satisfaction with the role.
4.	Nurses use communication to develop an efficient interprofessional team that exchanges information.

ANS: 1

	Feedback
1	The family is the primary social structure that cares for family members and will be involved in caregiving when the individual returns home.
2	Nurses maintaining power over a family does not support a partnership.
3	Satisfaction with nurse’s role does not offer the best rationale for communicating with families. Family satisfaction and family care are optimal goals.
4	The interprofessional team communication does not fully address the family role in caring for an individual. The efficiency of the team is not the best rationale for family communication.

PTS: 1

KEY: Content Area: Providing effective communication | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice

2. Effective communication can assist a nurse to achieve which of the following desired health outcomes?

1.	Readmissions with chronic disease exacerbations.
2.	A nurse-individual-family relationship that supports quality nursing care.
3.	Improved written documentation of errors in nursing.
4.	Decrease in time spent communicating with difficult families.

ANS: 2

	Feedback
1	Readmissions are not a desired health outcome.
2	Nurses who practice family-focused care recognize the importance of a relationship in providing quality nursing care for the individual and family.
3	Improved documentation of errors is not the highest priority for health outcomes.
4	Decreasing time communicating with families is not a goal of family-focused care.

PTS: 1

KEY: Content Area: Communication and nursing practice | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice

3. The nurse is beginning a shift caring for a 26-year-old adult female who has just been admitted to the critical care area of a hospital with a pneumonia and respiratory failure. The nurse is told that the patient’s parents are anxiously sitting in the waiting room. Which of the following statements best reflect a nurse’s understanding of the communication needs of the parents?

1.	“I will hurry with my assessment of your daughter so you can spend time with her after I leave.”
2.	“Why don’t you go have a cup of coffee while I assess your daughter?”
3.	“Since your daughter is an adult, I really can’t share any information with you about her condition.”
4.	“All of this is probably frightening for you. Would you like to come with me into the room so I can explain equipment and information to you while I care for your daughter?”

ANS: 4

	Feedback
1	Leaving the family alone in the room with a newly admitted patient fails to take advantage of the opportunity to build a family partnership and nurse-family relationship.
2	Suggesting a family leave during a time when they are anxious does not minimize their uncertainty or address their concerns.
3	Confidentiality can be maintained while informing family members and exchanging information.
4	A nurse can anticipate distress in family members when there is an acute illness. The nurse can plan to include the family, invite the family, and explain the environment to minimize the anxiety.

PTS: 1

KEY: Content Area: Communication and nursing practice | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | Question Type: Multiple Choice

4. Which of the following factors of a health-care system foster effective family-focused communication?

1.	An environment that uses complex technology.
2.	A nurse’s stance that health-care providers maintain power in a relationship.
3.	Educational materials that consider the health literacy of families.
4.	A family’s fears and anxiety about an individual member’s illness.

ANS: 3

Rationale:

A technological environment, a nurse’s stance of power, and family’s concerns in a health-care system introduce possible barriers to communication. Written documents and education materials that consider health literacy have the opportunity to provide information and reduce anxiety.

PTS: 1

KEY: Content Area: Communication: A basic tool | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice

5. Which of the following reflect inaccurate assumptions of family-focused care?

1.	Communication in a family and health-care setting can influence health.
2.	Effective therapeutic communication is at the core of family-focused care.
3.	Nurses can facilitate communication among family members to support family health.
4.	Family members can be expected to reach out to nurses when they need information.

ANS: 4

	Feedback
1	Communication among family members and in a health-care system can influence health and outcomes.
2	Therapeutic communication is a basis for family-focused care.
3	Family focused nursing care facilitates family communication that supports health
4	A nurse must expect to initiate an interaction with a family that is experiencing distress and concerns during times of family health concerns. Families need nurses to initiate a partnership and relationship.

PTS: 1

6. Julie is a 42-year-old wife and mother who has recently experienced a mastectomy for breast cancer. The nurse enters the room to check vital signs and sees tears in the eyes of Julie and her husband. Which of the following statements by the nurse reflect accurate understanding of approaches to communication in a therapeutic relationship?

1.	“I know this is a difficult time for you and your family. It is probably best if we wait and talk about your concerns when you a little stronger.”
2.	“I think it will be helpful if you both remain hopeful and stay focused on the positive.”
3.	“I know this is a stressful time for you; would you like to visit with the chaplain?”
4.	“You seem to be troubled, which is understandable. In what ways can I be the most helpful to you at this time?”

ANS: 4

	Feedback
1	Waiting to talk about concerns may not be the family’s choice. It may be difficult to have patient and husband focused on this topic in the future.
2	Encouraging a family to stay hopeful and positive does not acknowledge their current experience.
3	Referring the family to the pastor may not match their spiritual needs, and the chaplain may not have the information they need at this time.
4	Calling attention to their distress acknowledges their experience. Allowing the family to indicate their priority concerns at this time and offering assistance in the area the family chooses allows them to direct the conversation. This statement allows the family to gain trust in the nurse.

PTS: 1

KEY: Content Area: Relationship-focused communication | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Application | Question Type: Multiple Choice

7. A nurse is caring for a male who has been informed of a prognosis of only several months before death. He wants to return to his home with hospice care. He has a wife and two daughters who do not support this decision. Which of the following communication principles should guide the nurse during this family situation?

1.	A nurse guides families by staying focused solely on the patient’s needs and wishes.
2.	Families need to be informed that they are unable to provide the quality care needed in the home.
3.	Exploring the family’s beliefs about hospice, death, and their role can help families make decisions.
4.	Helping family members understand the benefits of a patient dying at home produces the best outcomes.

ANS: 3

	Feedback
1	At times the nurse guides a family by helping a family understand the unique needs and wishes of the entire family. This often helps resolve family conflicts and increase awareness of multiple perceptions in a family.
2	Taking the approach of telling a family the action to take limits their choices and support for a decision.
3	Examining families’ beliefs is important to family decision-making. The unique beliefs of the family members must be explored for a family to reach consensus.
4	At times a family member’s choices related to end-of-life care are best met at home, and at other times they are best met by the health-care system.

PTS: 1

8. Motivational interviewing techniques reflects which of the following premises?

1.	Asking and listening are core communication skills needed when using motivational interviewing techniques.
2.	This type of communication relies on the nurse’s identification of the behavior needing to be changed.
3.	This type of communication requires a nurse who can be directive and clear.
4.	This type of communication is best used with an individual approach, rather than a family.

ANS: 1

	Feedback
1	Being able to actively listen and asking the client to identify the changes are guiding principles to motivational interviewing.
2	For an effective outcome, the patient or family, rather than the nurse, must identify the necessary change.
3	A nurse’s communication technique is more guiding when motivational interviewing communication is used. Directing will create more resistance.
4	A family can participate in a motivational interview.

PTS: 1

KEY: Content Area: Developing relationship-based care | Integrated Process: Communication and Documentation | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice

9. A nurse is visiting a patient who has been discharged to home for a follow-up evaluation. The patient was diagnosed with diabetes many years ago. She has been hospitalized multiple times with infections and renal insufficiency. She now needs dialysis on a regular basis. Which of the following actions would support a therapeutic relationship between the nurse and family?

1.	The nurse needs to limit the time given to the family to tell their story to stay focused on the patient.
2.	The wound care and weight assessments are the priorities during this visit.
3.	Using linear questioning techniques will help the family share their understandings of the situation.
4.	Spending time assessing the patient’s symptoms and the family’s experiences will produce best outcomes.

ANS: 4

	Feedback
1	Technical skills and relationship skills can be blended during nursing care. Limiting the time with the family may disrupt the future relationship. Telling the illness story may give the nurse essential information needed for future care.
2	The wound and weight gain are a priority, but family information may also be necessary at this time to determine future directions.
3	Circular questioning techniques are more likely to help a family share their understandings.
4	Family-focused care identifies the patient and the family as the recipients of care. Assessing the patient’s symptoms and the family’s experience creates a therapeutic conversation and relationship.

PTS: 1

KEY: Content Area: Creating therapeutic conversations | Integrated Process: Caring | Client Need: Safe and Effective Care Environment | Cognitive Level: Analysis | Question Type: Multiple Choice

10. A nurse is caring for a family with apparent language barrier. The nurse is preparing to discharge the patient who has been recently started on insulin and just learning to administer the medication and follow the dietary regime. Which of the following statements by the nurse reflects an understanding of communication in this context?

1.	“I know this is a great deal of information to learn as you prepare for Mr. H to return home. If it’s okay with you, I will come back later and we can review the information again.”
2.	“You probably have many questions. But they will get answered as you read these materials.”
3.	“Families have different ways of approaching the chronic disease of diabetes, but it is important for your family to understand the right way to approach this disease.”
4.	“I know it is difficult for Mr. H to accept this diagnosis, but it needs to be his disease to manage, rather than depend on you as his family.”

ANS: 1

	Feedback
1	This response demonstrates understanding that a new diagnosis and treatment regime may require repetition of information and time for acquisition of knowledge.
2	Assuming that a family can read and understand written materials does not consider health literacy.
3	Being directive with the way to manage an illness does not reflect an understanding of a family’s need to partner with a nurse in identifying the directions.
4	Illness is a family experience and affair. The family is a system where an illness impacts the entire family and needs to be addressed by family system.

PTS: 1

11. Which of the following statements describe accurate information about family-focused communication? A nurse’s communication with a family:

1.	Usually focuses on the individual family member with an illness.
2.	Usually begins with a nurse sharing personal information.
3.	Aims to develop a caring relationship that sees the individual and family as the unit of care.
4.	Most often requires a nurse to determine the direction for family-focused communication.

ANS: 3

	Feedback
1	Family-focused communication addresses a family member with an illness as well as the family.
2	A nurse sharing personal information sets a tone of the nurse being focused on self, rather than the family.
3	Family-focused communication addresses the need for nurses to care for individuals and the family.
4	The family often identifies the direction and priority for communication.

PTS: 1

12. The Juarez family includes Maria, age 76, Juan, age 72, and three adult children. Maria has been managing a diagnosis of heart failure for approximately 10 years. Documentation suggests the family has had a great deal of stress with recent hospitalizations and caregiving in their home. The adult children voice their concerns about Maria’s decision to complete an advanced directive. Which of the following demonstrate an insufficient understanding of family-focused nursing care and communication?

1.	A nurse should make a statement such as, “Your family has had a great deal of distress lately; why don’t you just let Maria make her own decisions.”
2.	A nurse’s questioning techniques may help identify the family’s beliefs and understandings about advanced directives.
3.	A nurse should make a statement such as, “Your family has done a good job of caring for each other during this lengthy illness.”
4.	A nurse should attempt to clarify misunderstandings and share accurate information about the health status of the patient.

ANS: 1

	Feedback
1	This statement fails to recognize the role of a family in decision-making. Even though maintaining patient autonomy is important, a family-focused nurse should also address the family’s concerns.
2	This statement is correct because understanding the family’s beliefs will require questioning techniques to provide family-focused nursing care.
3	This statement is correct because family-focused care commends a family for their strengths.
4	This statement is correct because family-focused care provides information about the status of an ill family member to a family.

PTS: 1

COMPLETION

1. Relate three elements of communication to a family-focused communication technique discussed in this chapter.

Element of communication Family Communication Technique

________________________________________________________________

ANS:

Element of communication Examples of Family Communication

Communicators The nurse strives to develop a partnership with the individual and family.

Context Nurse provides information to family in a complex and foreign health-care setting.

Critical Thought Nurse uses questioning techniques to identify unique family experiences and meanings.

Message Identify family’s usual communication patterns and how illness is impacting their relationship and communication.

Method Nurse communicates with a family in a meeting, or refers family to an online social support system.

Assign Meaning Explore the individual differences in a family.

Effects Dialogue with family about how individual’s illness impacts the family unit.

Feedback Provide family members with praises for their strengths.

Rationale:

Multiple examples of family communication could be used to demonstrate family-focused communication.

PTS: 1

SHORT ANSWER

1. Identify three underlying assumptions of communication in family-focused nursing care.

ANS:

Examples of assumptions:

1. The nurse forms a partnership with the family and individuals in a family.

2. Communication among family members influences health of individual family members and the family.

3. Illness has the potential to disrupt prior family communication patterns.

4. A family develops communication techniques that influence health.

5. A nurse’s communication techniques have potential to influence the health of a family.

6. Family focused care integrates psychomotor and communication skills.

7. A nurse strives to empower a family with communication techniques.

8. Whether a family is present or not, they may continue to influence health and communication.

9. A therapeutic relationship rests on a family developing trust in the nurse.

10. Health literacy is considered when teaching and informing family members.

11. Barriers to family-focused communication can be recognized and managed.

12. Privacy and confidentiality can be ensured while providing family-focused communication.

13. Communication among members of an interprofessional team can support quality care.

14. Quality individual and family-focused care requires effective individual-nurse-family communication.

15. Both nonverbal and verbal communication of the individual, family, and nurse are important in family-focused communication.

PTS: 1

2. Describe the underlying foundation of family communication in family-focused care.

ANS:

Examples of answers:

1. The nurse forms a partnership with the family and individuals in a family.

2. Family-focused care requires effective individual-nurse-family communication.

3. Communication techniques influence health of the individual and family.

4. Elements of communication including the message, context, thoughts, meanings, and feedback influence communication with an individual or a family.

5. Nurses must consider communication with the family critical to care of the individual.

PTS: 1

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