Chapter 13: Family Case Management

Test Bank

MULTIPLE CHOICE

1. Why do community/public health nurses focus on families?

a. Families will understand the higher cost of care if they are active participants.
b. Improving the health of a family improves the health of a community.
c. Nurses find such a focus much easier than trying to focus on the community.
d. Nurses allow family members to receive respite by providing this type of care.
ANS: B
When a nurse cares for a family, nursing practice is directed toward maximizing the health
and well-being of all individuals within a family system. Improving the health of a family
improves the health of a community.

DIF: Cognitive Level: Comprehension REF: p. 341

2. A community/public health nurse is visiting a family for the first time. Which of the following
should be the priority action for the nurse?
a. Assessing how the family is adjusting to the illness of the sick family member
b. Clarifying what insurance or third-party payer is reimbursing this care
c. Determining the problem or reason for the referral
d. Establishing a relationship with the family
ANS: D
Although all of the options are important aspects of planning care, the nurse’s ability to
establish a relationship in which the family’s rights and strengths are respected is more
important than any other task.

DIF: Cognitive Level: Application REF: p. 341

3. What is the primary goal of case management of families?

a. To ensure the care is given in the most cost-effective manner possible
b. To coordinate all of the community agencies involved in care of the family
c. To focus on communication, counseling, and teaching
d. To work to maximize the family’s self-care capabilities
ANS: D
Although nurses try to be cost-effective and to communicate, counsel, or teach, as well as
coordinate care, the ultimate goal of case management is to maximize the family’s self-care
capabilities.

DIF: Cognitive Level: Knowledge REF: pp. 341-342

4. A community/public health nurse is conducting a family assessment. Which source of data

would be most helpful?
a. Information from other cooperating health care agencies
b. Input from other professional health care providers
c. Observation and interaction with the family members
 d. Review of family members’ charts and medical record data
ANS: C
Sources of data can include, but should not be limited to, charts and written health records,
biologic data such as blood pressure measurements or specimens, telephone calls and
conversations with other health care team members, information from social service agencies
involved with the family, and environmental and community information. However, the most
accurate and complete information can be obtained only by observing and interviewing the
family itself.

DIF: Cognitive Level: Application REF: p. 342

5. A nurse met with a client before hospital discharge to make arrangements to visit the client at
home. Why would the nurse visit the client’s home when the assessment could be completed
while the client is still in the hospital?
a. The client may not realize all of the assistance that is needed until he or she returns
home.
b. The client needed time to consider the community resources that would be used in
the future.
c. The nurse wanted to include family and environmental conditions in the
assessment.
d. The nurse wanted to ask the client questions in a private setting.
ANS: C
Meeting families in their own environment is preferable because the nurse can observe
firsthand the physical and environmental conditions, as well as the way family members act
with each other in their home.

DIF: Cognitive Level: Application REF: p. 342

6. A home health nurse was making an initial visit to an elderly man. As the nurse began the
assessment, the man’s wife gave all of the information requested. Which of the following
actions should the nurse take next?
a. Agreeing on appropriate interventions with the family
b. Determining appropriate nursing diagnoses
c. Assessing the environment of the wider community
d. Confirming the information with the client
ANS: D
Having heard from only the wife, the nurse must attempt to validate the information with the
husband or recognize that all information was from only one perspective.

DIF: Cognitive Level: Analysis REF: p. 342

7. A nurse is assigned to care for a client who has just been discharged from the hospital. What
should be the nurse’s priority assessment after discovering that other family members
desperately need health care as well?
a. Focusing on identified problems and the person with the most problems
b. Reviewing the home and the immediate environment for external problems
c. Interviewing the family members to get an overall picture of family functioning
d. Providing care for the client who has been discharged from the hospital
 ANS: D
Typically, one member of the family is identified as the client who is to be the recipient of
nursing care. This client may have an identified health problem, a chronic illness, or a
potential problem. Adequate identification and collection of information about the client’s
response to these actual or potential health problems is the first priority in family assessment.

DIF: Cognitive Level: Application REF: p. 342

8. The community/public health nurse asks a married couple to review important family events.
What is the nurse accomplishing through this review?
a. Giving the family members an opportunity to emote about negative events
b. Recognizing how past events have changed their lives
c. Providing an opportunity to review how they interact with each other
d. Putting distance between past events and current reality
ANS: C
A chronology, or time line, of family events is often useful in helping people see relationships
between events and behavior changes. This allows the couple the opportunity to examine how
they have interacted with each other during these events (their behavior and the associated
event).

DIF: Cognitive Level: Application REF: p. 343

9. When a client’s wife asked whether the nurse would like a tour of the yard and her gardens,
the nurse agreed immediately. Considering the limited time the nurse had to spend with the
family, why did the nurse agree to tour the gardens?
a. Accepting the invitation encourages the wife to speak privately to the nurse.
b. Completing the environmental assessment will assist with drawing a genogram.
c. Examining of the environment helps identify potential health or safety problems.
d. Touring the grounds allows the nurse to learn more about the family.
ANS: C
Data about the family’s physical environment, such as the presence of accident hazards,
screens, plumbing, and cooking facilities, help the nurse (1) plan care that matches or
supplements family resources and (2) identify potential health problems. The nurse may also
be able to complete the other things suggested as responses; however, the main reason why
the nurse is touring the garden is to identify potential hazards. An environmental assessment is
not used for completing a genogram.

DIF: Cognitive Level: Application REF: pp. 343-345

10. A nurse asked quite a few questions about what each family member did during the day,
including school, work, and recreation outside the home. What was the nurse accomplishing
by asking these questions?
a. Assessing the community environment for possible community-wide problems
b. Creating a picture of the family’s relationships with outside agencies and resources
c. Looking for topics the nurse might have in common with a family member
d. Seeking an appropriate topic around which to establish rapport
ANS: B
 An eco-map can be used to help discover the interactions between the family and the outside
environment. The family’s relationships with significant community resources, activities, and
agencies are diagrammed. It helps family members visualize how relationships with external
systems are affecting their state of well-being.

DIF: Cognitive Level: Application REF: p. 344

11. The nurse used multiple assessment tools to gather data on the family, which resulted in the
nurse’s feeling overwhelmed. What action should the nurse take next?
a. Meet with the agency supervisor and review the data together.
b. Summarize all the data into five or six categories.
c. Talk to a colleague and share the information gathered.
d. Work with the family at the next visit to draw conclusions.
ANS: B
The information must be integrated and analyzed before decisions about the plan of care can
be made. Once the information is summarized and targets of care are identified, the process of
intervention is clearer for the nurse and the family. Asking others for input might be helpful,
but the nurse is still the one who performed the observation and assessment and should be
able to draw conclusions.

DIF: Cognitive Level: Application REF: p. 345

12. A mother was very upset and said to a nurse, “My mother would never have allowed such
behavior. I punish the baby for doing it, and she just does it again.” What conclusion can the
nurse make from this interaction?
a. The family should be referred to community resources such as a daycare center.
b. The infant may be developmentally delayed.
c. The family needs assistance with growth and development education.
d. The mother’s actions need to be reported to children’s protective services.
ANS: C
Families meeting normal growth and developmental challenges often benefit from
health-promotion and illness-prevention education or supportive contact as family members
master behaviors appropriate for their new stage of life. Mothers cannot know appropriate
childhood behaviors without an opportunity to know reasonable expectations according to the
child’s age and development. On the basis of the statement by the mother, it cannot be
assumed that the mother is abusing her baby.

DIF: Cognitive Level: Synthesis REF: p. 345

13. After a family and a nurse discussed the family needs, they began to discuss what each
member of the family might be willing to contribute. Which of the following would be the
most important variable in determining the probable success of the plan?
a. What is involved in the plan
b. When the plan is scheduled to be implemented
c. Where the plan will be implemented
d. Who agreed to implementing the plan
ANS: D
 Because families act as systems, an action applied to one member will influence the other
members. The most useful care plan will develop from the wishes of the family members who
will be responsible for implementing it. However, every assessment should include
identifying the most functional and most willing members because they will be the ones to
follow through.

DIF: Cognitive Level: Application REF: pp. 346-347

14. A community/public health nurse is teaching a family about how to care for an ill member of
the family. Upon which family member should the nurse focus on teaching?
a. Teach the family member with the most resilience and competence to do what
must be done to ensure that it gets done.
b. Teach the ill member what must be done because he or she is responsible for his or
her own care.
c. Teach the weakest family member what must be done because that will strengthen
his or her position in the family.
d. Teach the wife or mother what must be done because caring for others is a female
role and expectation.
ANS: A
For maximum effectiveness, the nurse should teach the strongest member, who is most able to
change. That member may be able to delegate some responsibilities to others in the family.

DIF: Cognitive Level: Application REF: p. 347

15. After assessment and discussion with a family, a nurse had a list of 12 areas of need, none of
which involved life-threatening issues. Which of the following needs should the nurse address
first?
a. The area in which the nurse is most expert
b. The area the family wants to address first
c. The area in which the nurse is most able to obtain resources to assist
d. The area that matches the agency’s current marketing plan
ANS: B
When working with families, the need that assumes top priority (after life-threatening
emergencies) is the need that the family itself identifies as most important.

DIF: Cognitive Level: Application REF: pp. 348-349

16. A community/public health nurse is providing care in the home of a family with children. The
father returned from the physician during the nurse’s visit and reported that the physician
wanted several diagnostic tests performed. The father believed that the physician had looked
quite serious. Which of the following actions would be most appropriate for the nurse?
a. Assisting both parents with recognizing and meeting their children’s needs
b. Discussing illness management skills with the father and mother
c. Sharing literature about hospice and family needs at the end of life
d. Helping the family deal with anxiety and uncertainty
ANS: D
 Because the father is confronting a possibly serious illness, he is in the early phase of
diagnosis, which necessitates preparation and cooperation with diagnostic testing. Both the
father and the family as a whole will have to deal with anxiety and uncertainty. The nurse can
help the family deal with anxiety and uncertainty by helping them to mobilize support while
they await the diagnosis.

DIF: Cognitive Level: Analysis REF: pp. 350-351

17. The father of a family was told he had metastatic pancreatic cancer too advanced for any
treatment. Which of the following is the most appropriate intervention for the nurse?
a. Assisting the family in finding a physician who can offer hope and possible
treatment
b. Helping the family deal with anxiety and uncertainty
c. Sharing information about hospice and family needs at the end of life
d. Trying to help the family find meaning in their situation
ANS: D
Families who are dealing with illness and loss may encounter experiences in which nothing
that they do will make the situation better. For example, a family may confront an irreversible
loss, and no actions will rectify the situation. In these circumstances, both the nurse and the
family often resolve the situation by searching for some meaning within what has happened.

DIF: Cognitive Level: Analysis REF: pp. 352-354

18. The teenage mother admitted to the nurse that sometimes she was sorry she had the baby, and
all she wanted was to be able to sleep all night. Which of the following is the most appropriate
action for the nurse to take?
a. Ask the grandmother if she could take the baby for a few nights so the teenager
could catch up on her sleep.
b. Assure the mother that her feelings were normal and that no one likes being
exhausted.
c. Call Children’s Protective Services as this mother is at high risk for child abuse.
d. Explain normal growth and development for toddlers.
ANS: B
It may help the mother to know that this situation is something all new mothers face and that
her feelings are normal. Explaining normal growth and development for infants, not
toddlers—including an expectation of when the baby might sleep through the night—would
be most appropriate at this time. This would emphasize that the baby will eventually sleep
through the night and the mother’s sleep will no longer be interrupted. In other words, there is
hope. Suggesting that the grandmother provide assistance may be helpful, but it will not allow
the teenager to recognize that these feelings are normal. Calling Child Protective Services is
not appropriate.

DIF: Cognitive Level: Synthesis REF: p. 354

19. A family had just moved to the city when the illness struck the father. The wife had always
been a stay-at-home mother with the three young children. The nurse developed a list of
short-term resources for the family. Which of the following actions should the nurse take
next?
a. Give the family the complete list, including the free transportation assistance
 program.
b. Involve the family with a local church where people could educate the family
about the community and be supportive.
c. Share with the family two resources that are the most immediate needs: namely,
housing and food.
d. Tell the family about all the resources and let the family decide what to do with the
list.
ANS: C
Many families have a need for multiple resources; identifying the one or two that are most
helpful to the need will help both the nurse and the family. The entire list may well be
overwhelming to the family when the family is already stressed and perhaps less able to make
good decisions. Feeding the family and getting them settled will reduce their stress enough
that they can then consider what would be most helpful.

DIF: Cognitive Level: Application REF: p. 354

20. A community/public health nurse is working with a family whose members are experiencing
an incredible amount of stress. Which source of social support should the nurse encourage the
family to use?
a. Family service workers from the agency
b. Close friends and neighbors
c. Family self-help groups
d. Mental health counseling centers
ANS: B
The nurse should first mobilize social support from inside the family or from informal support
networks such as friends, neighbors, and religious communities with which the family was
already involved. These relationships are more likely to be long lasting and to be the most
culturally appropriate.

DIF: Cognitive Level: Application REF: p. 354

21. The nurse has suggested that a family make several changes to make the care for their
technology-dependent child easier, more effective, and even faster. However, the family took
no action. Which of the following would explain the lack of response by the family?
a. The family did not like the nurse’s suggestions but were too polite to tell the nurse.
b. The family did not really understand the nurse’s suggestions.
c. The family lacked the resources necessary to implement the nurse’s suggestions.
d. All families have a tendency to resist change, even if it is helpful.
ANS: D
People have a tendency to want to stay the same, and so families usually resist change even if
the change would be a helpful one. The nurse must help the family decide what they want to
do.

DIF: Cognitive Level: Application REF: p. 354

 22. Two nurses were discussing a family that was undergoing two major crises simultaneously.
The nurse assigned to the family decided to work on helping the family learn better coping
mechanisms. The colleague asked why the nurse would try to create change when the family
was under so much stress at the moment. Which of the following responses would be the most
appropriate?
a. “At the moment, I don’t think the family will even notice I’m helping them
change.”
b. “I’m only focusing on one person because if I can get one member to change, the
others will change as well.”
c. “Now is when the family may recognize the need for change.”
d. “The family is under so much stress that one more stressor won’t matter.”
ANS: C
Families have difficulty changing during times of crisis or stress. However, this period is
often the best time to implement change because it is when the family sees the need for it.

DIF: Cognitive Level: Application REF: pp. 355-356

23. Which of the following interventions would a nurse use to keep a family interaction focused
on the problems that need to be resolved or improved?
a. Clarifying the consequences if the problems are not resolved
b. Emphasizing how many sessions the family may receive
c. Stressing the seriousness of the problems that are confronting the family
d. Demonstrating that there is no one else to help the family unless they act now
ANS: B
Formulating a contract with the family at the beginning of the interaction, having a definite
goal, and limiting the number of sessions help keep the interaction focused. It would not be
therapeutic to suggest there are no other sources of help or that the problems are serious or
have serious consequences (of which the family is probably already aware).

DIF: Cognitive Level: Application REF: p. 356

24. Which of the following actions best demonstrates the use of summative evaluation?
a. Explaining the goals of blood glucose control and the diabetic diet plan
b. Asking a diabetic client what he ate for the last three meals to see whether it fits
the diet plan
c. Reviewing the daily blood glucose levels each week with a diabetic client
d. Quizzing a diabetic client about his current diabetic medications before discharge
ANS: D
Summative evaluation is performed after the care is complete and the nurse–family interaction
is terminated. This is best demonstrated by quizzing a client about diabetic medications before
discharge. Formative evaluation is performed as care is being given during the course of the
family–nurse interaction to see whether instructions are understood and the plan is effective.
Asking about understanding, eating habits, and reviewing blood glucose levels weekly are
examples of formative evaluation.

DIF: Cognitive Level: Analysis REF: p. 358

MULTIPLE RESPONSE
1. A community/public health nurse is creating a family map. Which of the following
information would be included? (Select all that apply.)
a. The address of the family and observations about the home and neighborhood
b. All the family systems, including microsystems, macrosystems, and suprasystems
c. Interaction patterns such as family coalitions or conflict between members
d. Roles such as the family leader or the family communicator
e. Hierarchies and power structures in the family
f. The extended family for three generations, including marriages and births
ANS: C, D, E
A family map is used to diagram spatial and relationship qualities of a family system to
understand family hierarchies, roles, and power. Typically, such a map details the active
patterns, such as coalitions, conflict, and avoidance.

DIF: Cognitive Level: Application REF: pp. 358-359

2. A community/public health nurse is drawing a genogram about a client’s extended family.

Which of the following purposes would this serve? (Select all that apply.)
a. Beginning with such a neutral task can help establish rapport.
b. Connections between events and relationships may be more clearly perceived.
c. A genogram establishes medical history and possible genetic vulnerabilities.
d. A genogram helps decrease negative feelings about a relationship.
e. A genogram helps share the family’s perception of their own structure.
f. A genogram allows the family to reveal information about family secrets.
ANS: A, B, C, D, E
A genogram is a map of family relationships for at least three generations that helps the
family and nurse recognize important patterns and significant events in an objective way. The
process is a way to safely begin to establish rapport. The genogram demonstrates relationships
but also, in a calm and factual way, determines how the family members feel about other
family members during the process.

DIF: Cognitive Level: Application REF: p. 359

3. A nurse was assessing the family style. Which of the following should be a priority for the
nurse to assess? (Select all that apply.)
a. Approach to accomplishing daily household tasks
b. Characteristic processes used to process information and solve problems
c. Consistent patterns of behavior over time
d. Demonstrations of affection between family members
e. Extent to which family is amenable or resistant to environmental factors
f. Style of responding to emergency situations
ANS: B, C, D, E
Family style refers to the ways the family usually acts to process information, solve problems,
and open or close itself to the environment. Family style includes internal family interactions
and relationships to the outside world, both of which remain fairly consistent over time. Other
behaviors, such as how daily tasks are accomplished, are not part of family style.

DIF: Cognitive Level: Application REF: p. 360

4. Why is it necessary for a nurse to assess strengths when the primary reason for being in the
home is to assist with areas of need? (Select all that apply.)
a. Such assessment helps the family recognize their own assets.
b. It creates a forum for change as family perspective changes.
c. It allows the family to avoid becoming depressed about the situation.
d. It helps the family see problem behaviors as assets to be used.
e. It allows the nurse to identify resources that can be used to address areas of need.
f. It promotes use of strengths in a different context.
ANS: A, B, D, E, F
Nurses use the strengths of the family to address the areas of need, but strengths must first be
recognized or perceived by the family as assets. Even asking questions about strengths can be
therapeutic and can help families recognize their own abilities. Problem behaviors may be
reframed as areas of strength that might be very useful in a different context.

DIF: Cognitive Level: Comprehension REF: p. 360

5. What factors are involved in a nurse’s decision as to which responsibilities can be accepted
when a family’s needs and desires are overwhelming? (Select all that apply.)
a. External variables such as neighborhood environment
b. Family’s demands
c. Nurse’s competencies and preferences
d. Only needs related to health
e. Reimbursement rules
f. Resources such as time and energy
ANS: C, E, F
Families may make unreasonable demands of someone who might be able to help them, and
often no human could meet what they request. Furthermore, the needs of the family may be
beyond the scope of the nurse’s competence or energy, and time and resources become a
factor in making decisions about what a nurse can do. The agency and reimbursement
mechanisms also dictate the nurse’s role. A successful community/public health nurse will be
aware of personal strengths and preferences and try to use them whenever possible. Because
health is related to all aspects of life, excluding variables not related to health would not really
exclude many family desires. External variables in the neighborhood are typically beyond the
nurse’s ability to repair.

DIF: Cognitive Level: Comprehension REF: p. 360

6. A nurse left a home visit with a lengthy list of needs for which the family could use
assistance. Which of these needs should be the priority for the nurse? (Select all that apply.)
a. The area around the house was covered with trash hidden in the weeds.
b. The teenage daughter did not have daycare for her 8-month-old son.
c. The wife would not speak to her teenage daughter, who had recently had a child.
d. The wife was having difficulty caring for her ill husband.
e. The teenage daughter was not at all sure what to expect from her 8-month-old son.
f. The husband had a stroke 2 years ago.
ANS: C, D, E
 Nurses help with growth and development issues, coping with losses and illness, adapting to
the demands of or modifying the environment, strengthening inadequate resources and
support, and dealing with disturbances in internal dynamics. The nurse as a teacher could help
the teenage daughter understand normal growth and development of a very young child. As a
counselor, the nurse could help the wife, who was having problems with the teenage daughter
and the ill husband and seems to desperately need support. However, the husband’s stroke is a
chronic condition now inasmuch as it happened 2 years ago, and it does not take priority. The
teenage daughter’s not having daycare for her infant may cause additional stress for the
family, but it would not be a priority for the nurse at this time.

DIF: Cognitive Level: Synthesis REF: p. 361

7. What would be the most appropriate action for a nurse to take when helping a family who is
in crisis when the husband/father of the family died suddenly? (Select all that apply.)
a. Assisting the family in reaching out to friends and neighbors for help
b. Being an emotional support for the family
c. Helping the family identify, recognize, and use their coping skills
d. Suggesting to the extended family that prepared food would be helpful
e. Recommending funeral homes in the community to the family
f. Volunteering to watch the children while the adults attend the funeral
ANS: A, C
While being an emotional support, bringing food, and volunteering to help with the funeral
are all excellent community support tasks for a grieving family, the nurse’s responsibility is
more to help the family be aware of resources, including helping them ask for and be willing
to accept help during the crisis period. In crisis, the nurse can help the family identify its
typical coping behaviors and support or encourage their use. Although the other offers (such
as baby-sitting) might be helpful, the nurse must remain more a consultant than a direct
caregiver.

DIF: Cognitive Level: Analysis REF: p. 361

8. Which of the following actions should a nurse take to minimize the effort required in
evaluating the success of interventions with a family? (Select all that apply.)
a. Choose criteria for evaluation that will demonstrate the value of the nursing
interventions.
b. Evaluate care on the basis of the goals that the family and nurse together agreed
upon.
c. Gather all possible data throughout the intervention so the data will be available
for evaluation purposes.
d. Plan for evaluation while beginning assessment of the family.
e. Inform the family that they must contribute data for evaluation when it is
requested.
f. Use only short-term criteria so the data can be gathered before care is terminated.
ANS: A, B, D
 Even though evaluation is the final step of the nursing process, it is also a step that starts at the
beginning of the contact and occurs continually as the contact progresses. The word evaluate
means to determine worth. Many methods can be used to evaluate nursing care, but the key to
evaluation is to determine the correct criteria that demonstrate the value of the nursing
contact. Criteria for evaluating client outcomes are derived from the objectives developed
with the family. Only data relevant to the nurse’s intervention are collected. Because the
outcomes of nursing interventions occurring during one visit may not be apparent until later,
both long-term and short-term evaluative criteria should be developed. The family does not
have to contribute data unless they choose to do so.

DIF: Cognitive Level: Application REF: pp. 361-362

9. Before terminating care with a family, which of the following actions should a nurse
accomplish? (Select all that apply.)
a. Allow the family members to express their feelings and reactions to having to
terminate care.
b. Develop established criteria so the family knows when to seek care in the future.
c. Encourage crying or other actions to demonstrate their grief and loss.
d. Express the nurse’s feelings about having to end the relationship.
e. Remind the family of the date or goal accomplishment that represents the time for
termination.
f. Say goodbye for now, but plan to keep in touch with the family.
ANS: A, B, E
Careful planning, advance notice, and talking about the emotions and issues that arise are
helpful for everyone involved. The nurse may often address the issue of termination before the
client is ready to discuss it. Allowing clients to express reactions and helping families
perceive themselves as being able to master upcoming situations independently will help the
family make the transition to independence and termination. During the final visits, the nurse
begins to prepare the family by reminding them that the time together is limited. A date or
goal should be set that is understood as the marking point for termination. Criteria should be
established for the family to know when to seek health care again.

DIF: Cognitive Level: Application REF: p. 363