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NURS480 Nursing Diagnosis Study Guide Practice Exam With Answers (250 Solved Questions)

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    NURS 480 EXAM 1 - 3 STUDY GUIDES WITH COMPLETE SOLUTIONS what issues have you faced after the school was made aware of your son's HIV? Single - Living alone, unmarried Nuclear dyed (two)/childless - Married couple without children Nuclear - Offspring involved, parents and children 2 generations of family, parents, and their own/adopted children in the same house Binuclear - two separate families with children, family is a member of both Two postdivorce families with children as members of both Blended - 1+ parents are married and they're bringing the children together Extended/multigenerational - 2+ adult generations and one that includes grandparents and grandchildren living in the same household Single parent - One parent and child(ren) residing in one household Commune - Group setting, group of men/women/children Cohabitation - Sharing a home between 2 people who aren't married, might be emotionally involved Living together apart - couples share living space and may share financial, household, or parenting responsibilities with no romantic attachment to each other Living apart together - 2 people with/without children forgoing cohabitation entirely, preferring to keep their separate homes

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    Accordion families - the ways members move in and out of the house Interpret family genograms: - square - circle - X - link - link w/ cross - dotted line - solid line from parents - solid and dotted line from parents - solid line with X - solid line with X and no shape - solid line w/ triangle - two solid lines with a line connecting the two shapes - Square = male Circle = female X = death Link = marriage Link with cross in between = divorce Dotted line = cohabitation Solid line from parents = biological child Solid and dotted line from parents = adopted child Solid line with X = stillbirth Solid line with X and no shape = abortion Solid line with triangle = pregnancy Two solid lines with a line connecting the two shapes = identical twins Three foundational components of family nursing - (1) determining how family is defined (2) understanding the concepts of family health (3) knowing the current evidence about the elements of a healthy family. How does the US census bureau define family? - 2+ people living together who are related by birth, marriage, or adoption

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    Legal family - Relationships through blood ties, adoption, guardianship, marriage Biological family - Genetic biological networks among and between people Sociological family - groups of people living together with or without legal or biological ties Psychological family - Groups with strong emotional ties Nuclear family - a couple and their dependent children, regarded as a basic social unit. Blended families - remarried couples who have at least one stepchild living with them Cohabitation - People living together who aren't married Family health - People centered care that expands the care to individuals, families, communities, and society Approaches to family nursing - as the context for individual development - the family serves as context for the individual as either a resource or stressor to the individual's health and illness Approaches to family nursing - as a client - family nurse is interested in how all the family members are individually affected by the health event of one family member Approaches to family nursing - as a system - Family is viewed as an interactional system in which the whole is more than the sum of its parts the interactions between members are the target for nursing interventions Approaches to family nursing - component of society - the family is a basic/primary unit of society and is part of the larger system of society Traits of a healthy (well functioning) family - Communicates and listens Fosters table time (eats meals together)

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    Affirms and supports each other Develops trust Laughs and plays Balance of interaction Teaches right and wrong Has rituals and traditions Shares religious core Respects privacy Values service Admits to services and seeks help Affective family functioning - How members relate to one another and those outside immediate family boundaries Discuss how family members teach a sense of belonging, emotional and psychological health, and the potential for optimal developmental patterns Economic family dynamic - The economy affects when people get jobs, get married, have children, retire Consumerism, money management Responsibilities of family members to gain and maintain economic stability Health care family dynamic - Families influence when to seek treatment, whether to follow or ignore treatment options Family processes - Interactions among members of a family including relationships, communication patterns, time spent together, satisfaction with family life Family structure - the ordered set of relationships within the family, without respect to roles and function Theories - abstract, general ideas subject to rules and organizations

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    - all theories contain concepts, relations, and propositions - all theories show logical relationships between concepts to illustrate patterns (like family cohesion and mental health) - theories attempt to make sense of complex phenomenon in the world (like domestic violence) - level of evidence for nursing practice Concepts - the building blocks of theory, words that create mental images or abstract representations of phenomena of study Major ideas expressed by a theory, may exist on a continuum from empirical to abstract Propositions - statements about the proposed relationship between 2+ concepts suggest a relationship between the subject and object Conceptual model - Set of general propositions that integrate concepts into meaningful configurations or patterns Inductive reasoning - A type of logic in which generalizations are based on a large number of specific observations. Deductive reasoning - reasoning in which a conclusion is reached by stating a general principle and then applying that principle to a specific case (The sun rises every morning; therefore, the sun will rise on Tuesday morning.) Change theory - Systems of relationships appear to possess a tendency toward progressive change Transition theory - Understanding and predicting the transitions families experience over time by combining Role Theory, Family Development Theory, and Life Course Theory

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    Family systems theory - a theory that views the family as a system of interacting parts whose interactions exhibit consistent patterns and unstated rules - focus on circular interactions among family members - all parts are interconnected - whole > sum of parts - all systems have boundaries between the system and the environment ASSESSMENT - family members as individuals, family as a whole - communication: linear vs circular - three generations of influence - family changes across time, and family's strategies to maintain balance Developmental and life cycle theory - Understanding family changes and experiences across time. Based on the idea that stress happens with expected and unexpected transitions. Disequilibrium=stress Interventions aim at adjusting family roles, power structure, and relationships to return to a state of equilibrium for the next transition. - Impact of chronic illness on family development (progressive like cancer, constant like blindness, relapsing/episodic like multiple sclerosis) ASSESSMENT - How the family has adjusted to recent transitions - adjustments to individual developmental changes - power structure, roles of members across time and transitions - how illness has changed the family Phases of the family cycle of health and illness - 1. family member health - health promotion and risk reduction 2. Family vulnerability and symptom experience - identification of illness and beginning treatment of symptoms

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    3. Sick role and family appraisal - family coping to accept, adjust, and accept the illness 4. Diagnosis - working relationship w health team to get info and accept the diagnosis 5. Illness career: accept treatment plan, recognize family roles, maintain health care team 6. Recovery and rehabilitation: reestablish normal and relinquish the "sick role" 7. Adjust to social stigma, maintain health care team, grieve 8. Death and family reorganization: grieve and integrate loss into new family transition Biological systems theory - Bronfenbrenner - influences of an individual, the family, etc - Microsystems: unique member traits - Mesosystems: family characteristics - Exosystems: geographic location, extended family - Macrosystems: societal, cultural, political influences - Chronosystems: time - all systems interact in a bidirectional manner, children influence their parents and vice versa Illness beliefs model - - enhance the therapeutic ways nurses help families suffering in their experience of serious illness - used to discover family core beliefs that may constrain or facilitate health or healing - used to create therapeutic conversations INTERVENTIONS - create a calm, trusting environment that invites open expression of family member's feelings about the illness experience - commend family members for positive actions taken - invite questions and answer them carefully

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    Rolland's chronic illness framework - - explains how families w/ similar illness stories adapt differently - Onset of the illness (acute or gradual) Level of disability resulting from the conditions (capacitating or incapacitating) Outcome of the illness (fatal, unpredictable, nonfatal) Stability of the disease (progressive, constant vs relapsing symptoms) Time phase of the chronic illness (diagnosis, mid illness, or terminal phase) the reaction/adaptation of the individual and family to a chronic condition differs according to whether the disability is considered on time and expected vs off time and unexpected Family nursing assessment and intervention model - Addresses 3 areas - health promotion activities and lines of defense within the family - family reaction and instability at lines of defense of resistance - restoration of family stability and family functioning at levels of prevention and intervention IDEAS - responses to stressors develop over time and become patterns within families - lines of resistance function to stabilize family functioning or to move the family to a higher level of functioning after experiencing a stressor - all families are constantly changing between reacting to stressors and stabilizing or returning to a state of equilibrium ASSESSMENT - General family system stressors: How has chronic illness impacted the family? - Specific family system stressors: How has the patient's illness impacted family roles? - Family system strengths: what are the strengths of each family member and the family as a whole? INTERVENTIONS - support the family through general stressors and specific stresors

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    Implicit family policies - Zoning ordinances Traffic, criminal, environmental, corporate, and voting laws Explicit family policies - Designed to achieve specific goals for families example- adoption, childcare, marriage policies/programs/laws around marriage, divorce, adoption, child care, family leave, reproductive rights, and so on Social determinants of health - The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels Physical, social, educational, and economic determinants of health - Income, housing, education, employment, accessterm-50 to health care, public safety, transportation, and availability of community based resources (can be classified as changeable or unchangeable depending on policies and cultural constructs) Health literacy - The degree to which individual have the ability to find, understand, and use health related info that they can then use to make informed decisions about their health Low health literacy has been linked to... - Lower adherence to healthy lifestyles Lower participation in health screening programs Poorer management of chronic disease Poorer adherence to medical regimens and protocols Less participation in community groups Less use of primary care services Increased use of emergency and urgent care services Family nursing process - 1. Analysis of family story 2. Designing plan of action 3. Family intervention 4. Family evaluation

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    5. Nurse reflection Friedman Family Assessment Model - takes a broad approach to family assessment, which views families as a subsystem of society. Identification Data, developmental stage and history of family, environmental, family structure, family functions, family stress and coping Calgary family assessment model - A family system is part of a larger suprasystem and is also composed of many subsystems family as a whole > sum of parts change in one family member affects all family members Genomics - the study of all genes in the human genome and their interactions with each other, the environment, and other factors Genetics - the study of individual genes and their impact on clinical disorders Huntington chorea - inherited disease of the CNS characterized by quick, involuntary movements, speech disturbances, and mental deterioration autosomal dominant Definitive diagnosis through genetic testing Prenatal testing (as early as 8-10 weeks) is possible Prenatal testing - testing for a genetic disorder that occurs prior to birth Carrier testing - a genetic test that determines whether an individual is heterozygous for a given gene that results in a genetic disorder Predictive testing - used to clarify the genetic status of asymptomatic family members

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    Presymptomatic genetic testing - Tests people to determine whether they have inherited a disease-causing gene before the symptoms of the disease have appeared. Pharmacologic testing - Analyzes a person's genes to understand how drugs may move through the body and be broken down Direct to consumer genetic testing - genetic test marketed directly to consumers that provides access to ones' genetic information without medical professional involvement Health teacher - The family nurse teaches about family wellness, illness, relations, and parenting, to name a few. The teacher-educator function is ongoing in all settings in both formal and informal ways. Examples include teaching new parents how to care for their infant and giving instruction about diabetes to a newly diagnosed adolescent boy and his family members Coordinator, collaborator, and liaison - The family nurse coordinates the care that families receive, collaborating with the family to plan care. For example, if a family member has been in a traumatic accident, the nurse would be a key person in helping families to access resources — from inpatient care, outpatient care, home health care, and social services to rehabilitation. The nurse may serve as the liaison among these services. "Deliverer" and supervisor of care and technical expert - The family nurse either delivers or supervises the care that families receive in various settings. To do this, the nurse must be a technical expert both in terms of knowledge and skill. For example, the nurse may be the person going into the family home on a daily basis to consult with the family and help take care of a child on a respirator.

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    Family advocate - The family nurse advocates for families with whom they work; the nurse empowers family members to speak with their own voice, or the nurse speaks out for the family. An example is the nurse who is advocating for family safety by supporting legislation that requires wearing seat belts in motor vehicles. Consultant - The family nurse serves as a consultant to families whenever asked or whenever necessary. In some instances, he or she consults with agencies to facilitate family-centered care. For example, a clinical nurse specialist in a hospital may be asked to assist the family in finding the appropriate long-term care setting for their sick grandmother. The nurse comes into the family system by request for a short period and for a specific purpose. Counselor - The family nurse plays a therapeutic role in helping individuals and families solve problems or change behavior. An example from the mental health arena is a family who requires help with coping with a long-term chronic condition, such as when a family member has been diagnosed with schizophrenia. "Case finder" and epidemiologist - The family nurse gets involved in case-finding and becomes a tracker of disease. For example, consider the situation in which a family member has been recently diagnosed with a sexually transmitted disease. The nurse would engage in sleuthing out the sources of the transmission and in helping to get other sexual contacts in for treatment. Screening of families and subsequent referral of the family members may be a part of this role. Environmental specialist - The family nurse consults with families and other health care professionals to modify the environment.

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    For example, if a man with paraplegia is about to be discharged from the hospital to home, the nurse assists the family in modifying the home environment so that the patient can move around in a wheelchair and engage in self-care. Clarify and interpret - The nurse clarifies and interprets data to families in all settings. For example, if a child in the family has a complex disease, such as leukemia, the nurse clarifies and interprets information pertaining to diagnosis, treatment, and prognosis of the condition to parents and extended family members. Surrogate - The family nurse serves as a surrogate by substituting for another person. For example, the nurse may stand in temporarily as a loving parent to an adolescent who is giving birth to a child by herself in the labor and delivery room Researcher - The family nurse should identify practice problems and find the best solution for dealing with these problems through the process of scientific investigation. An example might be collaborating with a colleague to find a better intervention for helping families cope with incontinent elders living in the home. Role model - The family nurse is continually serving as a role model to other people through his or her activities. A school nurse who demonstrates the right kind of health in personal self-care serves as a role model to parents and children alike. Case manager - Although case manager is a contemporary name for this role, it involves coordination and collaboration between a family and the health care system. The case manager has been formally empowered to be in charge of a case. For example, a family nurse working with seniors in the community may become assigned to be the case manager for a patient with Alzheimer's disease Family genogram - family tree format depicting relationships of family members over at least three generations

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    Family ecomap - Visual representation of how a family is connected to other individuals and social systems; uses circles, lines, and arrows to show family relationships and the strength and directional flow of energy and resources to and from the family. Key for ecomap Broken line Arrows Straight line w hash marks Straight line - Broken line: tenuous/distant relationship Arrows: direction of the flow of energy Straight line w hash marks: relationship with tension Straight line: strong/close relationship, thicker the line, stronger the relationship Family reasoning web - - An organizational tool to help analyze the family story, by clustering individual pieces of data into meaningful family categories Categories: family routines of daily living, communication, supports and resources, roles, beliefs, developmental stage, health knowledge, environment, stress management, culture, spirituality NURS 480 EXAM 2 STUDY THERAPEUTIC/MEANINGFUL COMMUNICATION WITH PATIENTS AND FAMILIES - What does the 2003 privacy rule do? - It was added to the 1996 HIPAA to regulate the use and disclosure of protected health information, which is any information held by the person seeking care that concerns health status, provision of health care, or payment

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    HIPAA - agencies can establish rules for ways in which they verify relationships, but this practice cannot be mandated Information can be shared by any method when others need to know/are involved in care Doesn't forbid family members staying past visiting hours even when room is shared 5 aspects of relationship-focused communication - Building trust Asking questions Listening Informing Giving feedback Presence - the gift of self Being with another person in a manner that recognizes the person's values, meanings and needs (physically and psychologically) Human presence can lessen suffering and distress of another through relationships and connections The presence of a supportive family member can minimize the distress of an illness situation and maximize the health and healing potential of nursing care Nursing presence is central to family focused practice and may be a means to improve satisfaction with care family presence - crucial to the wholeness of an individual Provides comfort Important during times of acute illness requiring lifesaving measures

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