Hockenberry & Wilson: Wong’s Essentials of Pediatric Nursing,
8th Edition

Pub Review

Chapter 3: Family Influences on Child Health Promotion

MULTIPLE CHOICE

1. Which of the following family theories is described as a series of tasks for the family throughout its life span?
a.|Interactional theory|
b.|Developmental systems theory|
c.|Structural-functional theory|
d.|Duvall’s developmental theory|

ANS: D
d. Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span. a and c. These are not family theories.
b. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.

DIF: Cognitive Level: Knowledge REF: Page 32
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

2. Which of the following family theories explains how families react to stressful events and suggests factors that promote adaptation to these events?
a.|Interactional theory|
b.|Developmental systems theory|
c.|Family stress theory|
d.|Duvall’s developmental theory|

ANS: C
c. Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction.
a. This is not a family theory. Interactions are the basis of general systems theory.
b. Developmental systems theory is an outgrowth of Duvall’s theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others.
d. Duvall’s developmental theory describes eight developmental tasks of the family throughout its life span.

DIF: Cognitive Level: Knowledge REF: Page 32 | Page 33
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

3. What is the term for a family in which the paternal grandmother, the parents, and two minor children live together?
a.|Blended|
b.|Nuclear|
c.|Binuclear|
d.|Extended|

ANS: D
d. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.
a. A blended family contains at least one step-parent, step-sibling, or half-sibling.
b. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household.
c. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

DIF: Cognitive Level: Knowledge REF: Page 33
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

4. What is the term for a family in which a mother, her children, and a stepfather live together?
a.|Blended|
b.|Nuclear|
c.|Binuclear|
d.|Extended|

ANS: A
a. A blended family contains at least one step-parent, step-sibling, or half-sibling.
b. The nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household.
c. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.
d. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling.

DIF: Cognitive Level: Knowledge REF: Page 33
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

5. Birth position of children affects their personalities. Which of the following is considered characteristic of children who are the youngest in their family?
a.|More dependent than firstborn children|
b.|More outgoing than firstborn children|
c.|Identify more with parents than with peers|
d.|Are subject to greater parental expectations|

ANS: B
b. Later-born children are obliged to interact with older siblings from birth and seem to be more outgoing and make friends more easily than firstborns. a, c, and d. These are characteristics of firstborn children and only children.

DIF: Cognitive Level: Knowledge REF: Page 37
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

6. Studies about the ordinal position of children suggest that firstborn children tend to:
a.|be praised less often.|
b.|be more achievement oriented.|
c.|be more popular with the peer group.|
d.|identify with peer group more than parents.|

ANS: B
b. Firstborn children, like only children, tend to be more achievement oriented. a, c, and d. These are characteristics of later-born children.

DIF: Cognitive Level: Knowledge REF: Page 37
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

7. Which of the following applies to the rate of frequency of monozygotic (identical) twins being born?
a.|Is affected by heredity|
b.|Is affected by maternal age|
c.|Varies among races|
d.|Occurs uniformly in all populations|

ANS: D
d. Monozygotic twins occur with the same frequency uniformly in all populations.
a. The tendency toward monozygotic twins is unaffected by heredity.
b. Monozygotic twins are not affected by maternal age, but higher-order births are.
c. The frequency is uniform among races.

DIF: Cognitive Level: Knowledge REF: Page 37
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

8. Nicole and Kelly, age 5 years, are identical twins. Their parents tell the nurse that the girls always want to be together. The nurse’s suggestions should be based on which of the following?
a.|Some twins thrive best when they are constantly together.|
b.|Individuation cannot occur if twins are together too much.|
c.|Separating twins at an early age helps them develop mentally.|
d.|When twins are constantly together, pathologic bonding occurs.|

ANS: A
a. Twins work out a relationship that is reasonably satisfactory to both. They develop a remarkable capacity for cooperative play and considerable loyalty and generosity toward each other. Parents should foster individual differences and allow the children to follow their natural inclinations.
b. Individuation does occur. In twinship, one member of the pair is more dominant, outgoing, and assertive than the other.
c. Early separation may produce unnecessary stresses for the children.
d. There is no evidence that this occurs.

DIF: Cognitive Level: Knowledge REF: Page 38
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

9. The nurse is teaching a group of new parents about the experience of role transition. Which of the following statements by a parent would indicate a correct understanding of the teaching?
a.|“My marital relationship can have a positive or negative effect on the role transition.”|
b.|“If an infant has special care needs, the parents’ sense of confidence in their new role is strengthened.”|
c.|“Young parents can adjust to the new role easier than older parents.”|
d.|“A parent’s previous experience with children makes the role transition more difficult.”|

ANS: A
a. If parents are supportive of each other, they can serve as positive influences on establishing satisfying parental roles. When marital tensions alter caregiving routines and interfere with the enjoyment of the infant, then the marital relationship has a negative effect.
b. Infants with special care needs can be a significant source of added stress.
c. Older parents are usually more able to cope with the greater financial responsibilities, changes in sleeping habits, and reduced time for each other and other children.
d. Parents who have previous experience with parenting appear more relaxed, have less conflict in disciplinary relationships, and are more aware of normal growth and development.

DIF: Cognitive Level: Application REF: Page 39
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Developmental Stages and Transitions

10. When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called:
a.|permissive.|
b.|dictatorial.|
c.|democratic.|
d.|authoritarian.|

ANS: A
a. Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. b and d. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly.
c. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect the child’s individual nature.

DIF: Cognitive Level: Knowledge REF: Page 40
TOP: Integrated Process: Nursing Process: Diagnosis
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

11. When discussing discipline with the mother of a 4-year-old child, the nurse should include which of the following?
a.|Children as young as 4 years rarely need to be punished.|
b.|Parental control should be consistent.|
c.|Withdrawal of love and approval is effective at this age.|
d.|One should expect rules to be followed rigidly and unquestioningly.|

ANS: B
b. For effective discipline, parents must be consistent and must follow through with agreed-on actions.
a. Realistic goals should be set for this age-group. Parents should structure the environment to prevent unnecessary difficulties. Requests for behavior change should be phrased in a positive manner to provide direction for the child.
c. Withdrawal of love and approval is never appropriate or effective.
d. Discipline strategies should be appropriate to the child’s age, temperament, and severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old.

DIF: Cognitive Level: Analysis REF: Page 41
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

12. Which of the following is most characteristic of the physical punishment of children, such as spanking?
a.|Psychologic impact is usually minimal.|
b.|Children rarely become accustomed to spanking.|
c.|Children’s development of reasoning increases.|
d.|Misbehavior is likely to occur when parents are not present.|

ANS: D
d. Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake, but rather out of fear of punishment.
a. Spanking can cause severe physical and psychologic injury and interfere with effective parent-child interaction.
b. Children do become accustomed to spanking, requiring more severe corporal punishment each time.
c. The use of corporal punishment may interfere with the child’s development of moral reasoning.

DIF: Cognitive Level: Analysis REF: Page 43
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

13. A 3-year-old girl was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which of the following guidelines concerning adoption should the nurse use in planning her response?
a.|Telling the child is an important aspect of their parental responsibilities.|
b.|Best time to tell the child is between ages 7 and 10 years.|
c.|It is not necessary to tell the child who was adopted so young.|
d.|It is best to wait until the child asks about it.|

ANS: A
a. It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child’s identity. b, c, and d. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to keep third parties from telling the children before the parents have had the opportunity.

DIF: Cognitive Level: Analysis REF: Page 44
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems

14. A parent of a school-age child tells the school nurse that the parent is going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which of the following?
a.|Indicative of maladjustment|
b.|Common reaction to divorce|
c.|Suggestive of lack of adequate parenting|
d.|Unusual response that indicates need for referral|

ANS: B
b. Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. a, c, and d. These are common responses of school-age children to parental divorce.

DIF: Cognitive Level: Application REF: Page 46
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Psychosocial Integrity: Coping Mechanisms

15. A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, “I want to go back to work, but I don’t want Eric to suffer because I’ll have less time with him.” The nurse’s most appropriate answer would be which of the following?
a.|“I’m sure he’ll be fine if you get a good babysitter.”|
b.|“You will need to stay home until Eric starts school.”|
c.|“You should go back to work so Eric will get used to being with others.”|
d.|“Let’s talk about the child-care options that will be best for Eric.”|

ANS: D
d. This open-ended statement will assist the mother in exploring her concerns about what is best for both her and Eric. a, b, and c. These answers are directive. They do not address the effect of her working on Eric.

DIF: Cognitive Level: Application REF: Page 48
TOP: Integrated Process: Communication and Documentation
MSC: Area of Client Needs: Psychosocial Integrity: Therapeutic Communication

MULTIPLE RESPONSE

1. Dunst, Trivette, and Deal identified the qualities of strong families that help them function effectively. Which of the following qualities are included? (Select all that apply.)
a.|Ability to stay connected without spending time together|
b.|Clear set of family values, rules, and beliefs|
c.|Adoption of one coping strategy that always promotes positive functioning in dealing with life events|
d.|Sense of commitment toward growth of individual family members as opposed to that of the family unit|
e.|Ability to engage in problem-solving activities|
f.|Sense of balance between the use of internal and external family resources|

ANS: B, E, F b, e and f. A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families also are able to engage in problem-solving activities and to find a balance between internal and external forces.
a. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs.
c. Strong families use varied coping strategies.
d. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

DIF: Cognitive Level: Application REF: Page 34
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Family Systems