Chapter 14: Multiproblem Families


Chapter 14: Multiproblem Families
Test Bank


1. A community/public health nurse has been having difficulty interacting with a family with multiple problems and has asked the agency supervisor for advice. Which of the following actions will most likely be suggested?
a. Exchange caseloads with another nurse at periodic intervals to obtain fresh insight.
b. Reassure the family that things will eventually be alright.
c. Help the family recognize how they are responsible for their own problems.
d. Recognize that the family has potential for improvement.
All families can be recognized as families of promise who have potential for growth. Viewing the family as a family of promise helps decrease the nurse’s tendency to blame the family and helps convey an attitude of hopefulness.

DIF: Cognitive Level: Application REF: pp. 372-373

2. A home health nurse felt overwhelmed and asked to be assigned to a better neighborhood. Why would the agency supervisor decline to change the nurse’s assignment?
a. Although the nurse is just beginning to assess the families, the nurse’s continued efforts to visit and support the families will be therapeutic.
b. Lots of nurses are willing to work in nice neighborhoods; most agencies need nurses who are willing to work in poor, needy neighborhoods.
c. The nurse had signed a contract and must work where assigned, regardless of personal feelings.
d. The nurse is capable of learning about how to improve interactions with these families and will do better with experience.
All families have potential for improvement, so the nurse should continue efforts to work with the assigned families. However, the agency supervisor should provide the nurse with support within the agency and help the nurse be more realistic in expectations and goal setting. The nurse must have the situation be reframed as visiting families of promise rather than hopeless situations.

DIF: Cognitive Level: Application REF: pp. 372-373

3. Which of the following is the most crucial factor in how a family responds to a natural disaster that almost destroyed their house?
a. How many of the family’s relatives will allow them to move in temporarily
b. How much of house is repairable
c. How much governmental aid will be given to them to rebuild their house
d. How the family perceives the disaster and their ability to cope
Whether the family is in a state of crisis or can adapt depends on the stressor and the family’s resources but most importantly on how the family perceives the event.

DIF: Cognitive Level: Application REF: p. 373

4. Which of the following is the most probable reason that some families have multiple problems?
a. Presence of multiple, ongoing, intense stressors beyond their resources
b. Lack of cultural integration into mainstream society
c. Being supported by government resources for several generations
d. Being unwilling to change or consider new approaches to problems
Families vulnerable to or at risk for having multiple problems include those who suffer from severe poverty and clusters of stressors, such as assault or abandonment, or those who have more stressors than resources with which to cope.

DIF: Cognitive Level: Comprehension REF: pp. 373-374

5. Having completed an initial assessment, a nurse was overwhelmed with the current problems the family was facing. Which of the following actions should the nurse take first?
a. Arranging for tangible sources of external support
b. Helping the family explore current and alternative coping mechanisms
c. Providing information on crisis management and the health issues that the family is facing
d. Recognizing sources of family resiliency and strength
Although all the options provided will be helpful, the nurse must begin by recognizing sources of strength because those are the resources the nurse must use in addressing problems. Strengths must be recognized before problems can be addressed.

DIF: Cognitive Level: Application REF: p. 374

6. Which of the following would make a family with a newborn who is severely handicapped be considered a vulnerable family?
a. When all of the choices related to the situation have negative consequences
b. When there are no backup caregivers to care for the severely handicapped infant
c. When the family welcomes someone else taking responsibility for them
d. When the family has to choose a lifestyle that is dependent on others
Sometimes all of the available choices are negative, and any choice or its consequences will create more problems. The other potential options may also cause the family problems; however, this would not cause them to be considered a vulnerable family.

DIF: Cognitive Level: Application REF: p. 374

7. Statistically, what are poverty-stricken families more likely to have demographically?
a. A female head of the family, with few social and financial resources
b. Employment outside the immediate neighborhood
c. More children than the male head of household can support
d. Ongoing predictable life events
Characteristics of the poverty life cycle are female heads of family, extended family, numerous unpredictable life events, few resources available, and less time for development.

DIF: Cognitive Level: Knowledge REF: p. 375

8. In addition to having low income and few resources, how are poverty-stricken families often notably different from mainstream families?
a. Children have been removed from the household by Children’s Protective Services.
b. Many predictable life events occur for which they do not prepare.
c. The time for each developmental period is shorter, with ambiguous transitions.
d. They have relationships with controlling family members.
Although any of the situations might occur, research has determined that low-income families typically have a truncated life cycle; that is, there is less time available to allow unfolding of developmental stages, and life transitions are not clearly delineated.

DIF: Cognitive Level: Comprehension REF: p. 375

9. Which of the following statements is a reality regarding disturbances in family dynamics and high-risk problems in families?
a. “Chronic ongoing problems have no relationship to disturbed family dynamics.”
b. “Chronic family problems lead to difficulties in family dynamics.”
c. “Disturbances in these areas lead to the majority of problems in families.”
d. “It is impossible to state which issue leads to the other.”
Although disturbances in family dynamics, as well as high-risk problems in families, may lead to many of the problems experienced by families, researchers have been unable to clarify whether disturbances in dynamics lead to more family problems or whether response to problems leads to unhealthy family dynamics.

DIF: Cognitive Level: Comprehension REF: p. 375

10. What typically happens to the adults who grew up in maladaptive families?
a. They create very different lifestyles, as they promised themselves when very young.
b. They look back and laugh at how naive they were.
c. They repeat the multigenerational life patterns of their parent or parents.
d. They attempt to change, but some behaviors consistent with their parents’ behaviors remain.
Multigenerational patterns are those that are passed down from one generation to another. The tendency to repeat these patterns is great, especially in view of the fact that the family members have known no other family experience. Doing what the individual knows how to do is easier than changing to something unfamiliar and unknown.

DIF: Cognitive Level: Comprehension REF: p. 376

11. A community/public health nurse is visiting a new teenaged mother in her home. As the teenage mother walked into the room, the baby’s grandmother stated, “This whole thing is your fault. Why are you still in this house?” The teenager walked out the front door with her baby. Which of the following reasons explains why the grandmother would say such a thing to her teenage daughter?
a. The teenager created the problem; therefore, she should be the one to cope with it.
b. The grandmother is jealous that the teenager is young and lacks responsibility.
c. The use of scapegoating is an attempt to decrease overwhelming anxiety.
d. The fight had begun earlier, and the nurse just witnessed a part of the conversation.
Scapegoating, or identifying one family member as the problem, is one behavioral pattern for decreasing anxiety. Distancing, or cutting off a family member, can occur when anxiety is so high that family members can no longer tolerate contact with each other.

DIF: Cognitive Level: Application REF: p. 376

12. Which of the following internal coping strategies is often used by resilient and adaptive families?
a. Expressing their hopelessness with other family members
b. Supporting other family members while communicating information
c. Refusing to change lifestyles or functions until the crisis is over
d. Seeking financial assistance and information from community resources
Supporting other family members is a healthy internal coping strategy, whereas expressing hopelessness, refusing to change, or seeking others to rescue them are not adaptive or resilient behaviors. A resilient family proceeds through several stages after the presentation of a stressor: struggling to survive, adapting, accepting, growing stronger, and, sometimes, helping others. This allows the family to keep a sense of hopefulness.

DIF: Cognitive Level: Comprehension REF: pp. 376-377

13. Although there were many problems, a family was struggling to survive and reached out to others with similar problems. What was this family doing that made the difference between them and families who were not able to cope?
a. Expressing their hopelessness and frustration through acting out
b. Rearranging roles and tasks of family members while communicating information
c. Refusing to change lifestyles or functions until the crisis is over
d. Retaining a sense of hope and mutual support
The resilient family will proceed through several stages, including struggling to survive and sometimes even helping others. This family has an emotional atmosphere that fosters trust, cooperation, acceptance, and, of most importance, a sense of hope.

DIF: Cognitive Level: Application REF: p. 377

14. A community/public health nurse is caring for a family in poverty, who has stated that the nurse’s visits cause them increased stress. Which of the following assumptions has the family made about health care providers?
a. That health care providers blame the family for their problems
b. That health care providers expect the family to know about available resources
c. That health care providers plan for the short term and do not recognize long-term needs
d. That health care providers wait for the family to decide what should be done
Health care professionals base their appraisal of family behavior on their own comfort zone of normality. Professionals also assume that families will act upon professionals’ expertise and accept their advice. Because multiproblem families may engage in illegal behaviors, such as abusing drugs, abusing children, or being absent from the family because of incarceration, some professionals may believe the family caused their own problems—and they let their feelings show. It must be remembered that health professionals are also people who are not perfect.

DIF: Cognitive Level: Synthesis REF: p. 377

15. A nurse is planning care for multiproblem families. Which of the following is the most important action for the nurse to take?
a. Bring another nurse along to assist.
b. Keep goals concrete, realistic, and mutually desired.
c. List all needs to be addressed in a systematic, organized manner.
d. Plan for longer-than-normal visits.
Although the nurse might choose any of these options, it is most important that the goals be accepted by both nurse and family and focus on the concrete and feasible.

DIF: Cognitive Level: Comprehension REF: p. 377

16. After obtaining several resources for a family with multiple problems, a nurse was unprepared when, during the next visit, although two children peeked out the window, no one answered the door. Which of the following best explains why the family did not answer the door?
a. They did not want those particular resources.
b. They had really expected more from the nurse than they had received.
c. They had not had time to clean their house.
d. They were testing the nurse to see whether she was really reliable and consistent.
Although any of the listed reasons may apply, the most probable reason for such behavior is to test the nurse and to retain control.

DIF: Cognitive Level: Application REF: p. 378

17. A home health nurse did not know what to do when a family was home but did not invite the nurse in. Which of the following actions should the nurse take?
a. Leave a note saying the nurse would come back, and return as stated in the note.
b. Give care to someone who wants nursing care services.
c. Report the incident to the agency supervisor and ask to be reassigned elsewhere.
d. Stay for awhile; the family might change their mind and let the nurse in.
To build trust, the nurse should try again in a consistent manner. The best demonstration of this is leaving a note saying when the nurse will return and then returning when stated. This will help to build trust with the family. Multiproblem families often test professionals, and one responsibility of the nurse is to build trust through being reliable and consistent.

DIF: Cognitive Level: Application REF: p. 378

18. When working with a multiproblem family, which of the following goals should the nurse approach first?
a. The goal that best matches the agency’s policies and procedures
b. The goal that can be achieved “behind the scenes” without any effort from the family
c. The goal easiest for the nurse to complete because of her or his expertise
d. The goal that the family believes is the most important
Although goals may be chosen for any of the reasons listed, the goal that must be approached first is the goal of most importance to the clients. Families are more likely to work toward goals they choose and support. Mutual goal setting is the most important process to bring to multiproblem families.

DIF: Cognitive Level: Application REF: p. 378

19. A home health nurse was visiting an assigned multiproblem family. The grandmother welcomed her in. Two toddlers were playing on the floor, but none of the other adults was present. Which of the following actions should the nurse take?
a. Complete a developmental assessment on the two toddlers playing on the floor.
b. Focus on interacting with the grandmother, who is caring for the toddlers.
c. Refuse to stay because none of the other adults were present.
d. Spend the majority of time discussing the need for interaction with the toddlers.
The nurse should take every opportunity to work with any part of the family, knowing that she may be unable to interact with other members. Therefore, she should interact with the grandmother while the grandmother continues her care of the two toddlers.

DIF: Cognitive Level: Application REF: pp. 378-379

20. A nurse believed that it would be unprofessional to continue in a role that had become intolerable and left the community/public health area to work in acute care. Which of the following actions should the nurse continue to perform?
a. Advocate for health legislation and funding supportive of families and professional nursing.
b. Encourage new graduates to enter the community/public health nursing area of practice.
c. Send cards and small gifts to the staff at the nurse’s former agency.
d. Write letters to the newspaper editorial page describing the heroism of the agency’s nurses in their ongoing endeavors against great odds.
Nurses who assume the role of advocate for families within a larger social context may ultimately achieve the most effect on family health.

DIF: Cognitive Level: Application REF: p. 379

21. What is the most important requirement in order for a community/public health nurse to continue to be effective when serving multiproblem families?
a. Ongoing graduate study
b. Supervision when requested
c. Support from other agency staff
d. Time for continuing education travel opportunities
Caring for multiproblem families is extremely draining emotionally, challenging, time consuming, and less rewarding than the care of clients with relatively concrete, short-term problems. Consequently, agency staff must support each other.

DIF: Cognitive Level: Comprehension REF: p. 380


1. A community/public health nurse is assessing a family who is experiencing multiple problems. Which of the following observations is the nurse most likely to make if the family is experiencing a disturbance in internal dynamics? (Select all that apply.)
a. The family adapts to changing situations and problems.
b. Communication is indirect and sometimes inconsistent.
c. Family myths and secrets are shared among family members.
d. Achievement of tasks for the developmental stage is difficult.
e. Parental roles and functions are shared among the various family members.
f. Values are established and modifiable.
Tasks for the next developmental stage are delayed or not accomplished and communication is unclear, not honest, and indirect in families who have a disturbance in internal dynamics. Families who are not experiencing such a disturbance do a better job adapting to change and sharing myths and secrets, as well as parental roles, and values are established but flexible so that they may be modified.

DIF: Cognitive Level: Application REF: p. 380

2. Which of the following nursing interventions would be appropriate when a nurse is working with a multiproblem family? (Select all that apply.)
a. Assuring the family that the nurse will be there to help them with their problems
b. Describing how one person’s thoughts and behaviors affect another family member
c. Expressing the nurse’s own feelings about the family and its situation
d. Giving feedback on emotions and behavior and distinguishing between them
e. Role-modeling circular communication with adequate ambiguity and vagueness
f. Working toward small but achievable success in small areas
ANS: B, D, F
Helpful interventions for families that do not respond may include (1) helping family members gain awareness of the distinctions between feelings and behaviors to help curb impulsivity; (2) giving feedback that illustrates the mutual influence each person has on another’s feelings, thoughts, and actions; and (3) working with the family toward small but achievable successes, which will empower the family for the future. The nurse should keep personal feelings private and not make promises that cannot be kept, such as “always being there” for the family.

DIF: Cognitive Level: Analysis REF: p. 380

3. Which of the following strategies should a nurse use when working with multiproblem families? (Select all that apply.)
a. Encouraging rapid progress toward change in behaviors
b. Focusing on empowering the family and developing its self-esteem
c. Helping the family identify its strengths
d. Organizing possible sources of tangible support
e. Pointing out opportunities for doing things differently
f. Trying to resolve one major problem before beginning work on another
ANS: B, C, D, E
With multiproblem families, work on small pieces of problems at a time because the major problems are not amenable to easy solution; be patient and do not expect instant solutions. Successful strategies include empowering the families, helping families identify strengths, organizing possible sources of tangible support, and pointing out opportunities for doing things differently.

DIF: Cognitive Level: Analysis REF: pp. 380-381