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While caring for a family, the nurse determines that first-order changes have occurred with which of the following?
- A. The children are all in school, and the parent returns to work.
- B. The daughter leaves home to attend college.
- C. The son marries his long-time sweetheart and moves into his own home.
- D. The grandmother who has been living in the household dies.
Correct Answer: A
Rationale: First-order changes are superficial adjustments within a family system that do not alter its structure, such as a parent returning to work when children start school. Options B, C, and D involve structural changes (leaving home, marriage, or death), which are second-order changes.
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A nurse is assessing the communication patterns in the family. When observing the interaction, which of the following would be important to keep in mind? Select all that apply.
- A. Who sits next to who?
- B. Which topics are not addressed?
- C. Which situations are identified as stressful?
- D. Who makes the decisions for child care?
- E. How does the family handle conflict?
Correct Answer: A,B,C,D,E
Rationale: Assessing family communication involves observing seating arrangements (A), avoided topics (B), stressful situations (C), decision-making roles (D), and conflict management (E), as all provide insight into family dynamics and interaction patterns.
A group of nursing students is reviewing information about the changing family structure and its effect on mental health and illness. The students demonstrate understanding of the information when they identify which of the following?
- A. Middle-aged childless adults are more vulnerable to loneliness and depression.
- B. In stepfamilies, caring for the children often is a primary stressor to the marital partners.
- C. Separation because of relocation provides additional support from extended family.
- D. Same-sex families typically demonstrate lower rates for depression and stress.
Correct Answer: B
Rationale: In stepfamilies, caring for children often introduces stress to marital relationships due to complex dynamics, a well-documented effect. Childless adults may face loneliness but not universally, relocation often reduces extended family support, and same-sex families do not consistently show lower depression rates.
The nurse is assessing a family system applying the family system framework model. Which assessment would be important for the nurse?
- A. Acceptance of the family rules
- B. Adjustment to the family boundaries
- C. Degree of enmeshment in the system
- D. Interpersonal differentiation
Correct Answer: C
Rationale: The family systems framework, such as Bowen?s theory, emphasizes assessing the degree of enmeshment (overly close emotional boundaries) to understand family dynamics. Acceptance of rules, boundary adjustment, and differentiation are relevant but secondary to enmeshment, which directly impacts family functioning.
Assessment of a family reveals that the youngest child has moved out of the family home to live by herself. One of the other two children is married, and the other child has just gotten engaged. The nurse interprets this family to be in which stage of the family life cycle?
- A. Families with adolescents
- B. Launching children and moving on
- C. Families in later life
- D. Leaving home: single young adults
Correct Answer: B
Rationale: The family is in the 'launching children and moving on' stage, as the youngest child has moved out, another is married, and one is engaged, indicating children transitioning to independent lives. Adolescents, later life, and single young adults are different stages.
A nurse is constructing a genogram of a family. Which of the following would the nurse do?
- A. Use circles to represent the male members.
- B. Use horizontal lines to connect the parents with children.
- C. Use horizontal lines to show marriages.
- D. Use asterisks to denote ages listed at the bottom.
Correct Answer: C
Rationale: In a genogram, horizontal lines represent marriages, connecting spouses. Males are represented by squares (not circles), vertical lines connect parents to children, and ages are typically noted near the individual, not with asterisks.