COMPREHENSIVE NURSING ASSESSMENT: DEVELOPMENT, FUNCTIONAL
ABILITY, FAMILY DYNAMICS, AND CULTURE ACROSS THE LIFESPAN – QUIZ,
ANSWERS & FLASHCARD SET
QUIZ & FLASHCARD SET: UNIT 1 CONCEPT 1 (DEVELOPMENT)
Multiple-Choice Questions (MCQs)
1. A nurse is explaining the shift in healthcare delivery models to a new nursing student. Which
statement best describes the current patient-centered model?
A. Healthcare providers direct all care decisions based on clinical evidence.
B. Patients are informed of the treatment plan developed by the provider.
C. Patients and families actively participate in care decisions and planning.
D. Care is focused primarily on disease management and clinical outcomes.
Answer: C. Patients and families actively participate in care decisions and planning.
Explanation: It emphasizes active patient and family partnership in care.
2. The concept of Development is best defined as:
A. The physical growth and increase in size of an individual over time.
B. A static characteristic that is determined solely by genetic factors.
C. The sequence of physical, psychosocial, and cognitive changes over the life span.
D. The emergence of adult-like physical characteristics and behaviors.
Answer: C. The sequence of physical, psychosocial, and cognitive changes over the life
span.
Explanation: Development is a lifelong sequence of integrated changes.
3. A 4-month-old infant can hold her head steady when upright but cannot yet roll from back to
stomach. The nurse recognizes this as an example of:
A. Developmental delay in the motor domain.
B. Cephalocaudal progression of motor development.
C. A lost developmental milestone requiring intervention.
D. Advanced development for the infant's chronological age.
Answer: B. Cephalocaudal progression of motor development.
Explanation: Motor skills develop from head to toe (cephalocaudal).
4. A school nurse notes that an 8-year-old child frequently struggles to follow multi-step
instructions in the classroom and often misinterprets questions. The nurse should initially
consider a potential delay in which developmental domain?
A. Motoric Development
B. Cognitive Development
C. Communication Development
D. Adaptive Development
Answer: C. Communication Development.
Explanation: Difficulty following instructions suggests a receptive language issue.
5. According to the text, what is a "developmental milestone"?
A. A genetic marker for specific developmental stages.
B. An ability most individuals accomplish in a certain age range.
C. The exact age when a specific skill must be achieved.
D. A theoretical construct from early developmental theories.
Answer: B. An ability most individuals accomplish in a certain age range.
Explanation: It is a skill achieved within a general age range.
6. A toddler who has been toilet-trained for 6 months begins having frequent daytime accidents
after the birth of a sibling. This is best described as:
A. Developmental arrest
B. Developmental delay
C. Developmental regression
D. Advanced development
Answer: C. Developmental regression.
Explanation: Loss of a previously attained skill is regression.
7. Which factor is considered a "social determinant of health" that can impact development?
A. Low parental education level
B. Premature birth
C. A congenital heart defect
D. The infant's birth weight
Answer: A. Low parental education level.
Explanation: It is a family/social risk factor affecting development.
8. A nurse uses the Denver Developmental Screening Test II (DDST II) during a well-child visit.
The nurse understands this tool is primarily used for:
A. Diagnosing specific developmental disorders.
B. Providing in-depth assessment of language skills.
C. Gross screening of developmental milestones.
D. Evaluating adolescent risk-taking behaviors.
Answer: C. Gross screening of developmental milestones.
Explanation: DDST II is a broad screening tool, not diagnostic.
9. Which developmental domain includes the acquisition of skills like dressing, eating, and
community safety?
A. Cognitive Development
B. Adaptive Development
C. Social/Emotional Development
D. Motoric Development
Answer: B. Adaptive Development
Explanation: Adaptive skills enable independence in daily life.
10. A nurse is assessing a 2-year-old. Which finding would be most indicative of a potential
gross motor delay?
A. Using 2-word phrases
B. Inability to jump with both feet
C. Stacking 4 blocks
D. Parallel play with peers
Answer: B. Inability to jump with both feet
Explanation: Jumping is a gross motor milestone typically achieved by age 2.
11. The "period of exuberance," a critical time for language development, typically occurs
between:
A. 1-6 months
B. 6-12 months
C. 18 months-3 years
D. 4-6 years
Answer: C. 18 months-3 years
Explanation: This is a critical period of rapid language expansion.
12. According to Erikson's theory, the primary psychosocial conflict for an adolescent is:
A. Trust vs. Mistrust
B. Initiative vs. Guilt
C. Identity vs. Role Confusion
D. Intimacy vs. Isolation
Answer: C. Identity vs. Role Confusion
Explanation: Erikson's stage for adolescence (12-18 years).
13. A child's ability to understand that others have different thoughts and feelings is part of:
A. Cognitive Development
B. Adaptive Development
C. Social/Emotional Development
D. Communication Development
Answer: C. Social/Emotional Development
Explanation: This is perspective-taking, a social/emotional skill.
14. Which screening tool is specifically designed to assess adolescent risk behaviors (Home,
Education, Activities, etc.)?
A. DDST II
B. HEADSS
C. ASQ
D. M-CHAT-R
Answer: B. HEADSS
Explanation: HEADSS assesses Home, Education, Activities, Drugs, Sex, Suicide.
15. A 5-year-old with autism spectrum disorder (ASD) likely demonstrates a primary delay
in which domain?
A. Physical/Physiologic Development
B. Motoric Development
C. Social/Emotional Development
D. Cognitive Development
Answer: C. Social/Emotional Development
Explanation: ASD is characterized by social communication deficits.
Multiple-Response / Select-All-That-Apply Questions
16. Which of the following are components of the definition of "Development"? Select all
that apply.
o A. It is a static process determined at birth.
o B. It involves integration of changes across multiple domains.
o C. It follows a predictable sequence from conception to death.
o D. Its pace is uniform across all individuals.
o E. It can be impacted by environment and experience.
Answers: B, C, E
Explanation: Development is dynamic, sequential, and influenced by genetics and environment.
17. A nurse identifies risk factors for developmental delay. Which are considered "prenatal"
risks? Select all that apply.
o A. Maternal smoking
o B. Premature birth
o C. Genetic conditions
o D. Bullying at school
o E. Congenital infections
Answers: A, C, E
Explanation: Prenatal risks occur before birth (e.g., toxins, genetics, infections).
18. Which assessments are part of a functional assessment for an older adult? Select all that
apply.
o A. Ability to prepare a meal (IADL)
o B. Tanner staging of puberty
o C. Ability to bathe independently (BADL)
o D. Abstract reasoning test
o E. Management of personal finances (IADL)
Answers: A, C, E
Explanation: Functional assessment evaluates BADLs and IADLs for independence.
True/False Questions
19. True or False: Developmental arrest refers to a temporary slowdown in skill acquisition.
Answer: False
Explanation: Arrest is a plateau or cessation of development, not a slowdown.
20. True or False: Fine motor development is contingent upon cognitive and neurologic
development.
Answer: True
Explanation: Fine motor skills require complex brain-body coordination.
Application / Scenario-Based Questions
21. A nurse is counseling the parents of a 6-month-old infant. The father is concerned
because his friend's baby of the same age is already sitting without support, but his infant
can only sit with propping. The nurse's best response is based on the understanding that:
A. This is a definite sign of motor delay and requires a specialist referral.
B. Developmental milestones must be met at exact chronological ages.
C. Development varies, and sitting independently typically occurs between 6-8 months.
D. The infant is showing advanced cognitive skills which compensate.
Answer: C. Development varies, and sitting independently typically occurs between 6-8
months.
Explanation: Milestones have age ranges; variation is normal.
Flashcards / Quick Recall
22. Q: What are the three interrelated processes within development?
A: Growth, differentiation, and maturation.
23. Q: Name the six overarching domains of development.
A: Physical/physiologic, motoric, social/emotional, cognitive, communication, adaptive.
24. Q: What does a "global developmental delay" mean?
A: Significant delay in two or more developmental domains.
25. A nurse is planning care for a hospitalized older adult. Understanding that development
continues across the lifespan, the nurse should prioritize assessing which domain that
may decline in later adulthood?
A. Physical growth in height
B. Secondary sexual characteristics
C. Emotional regulation abilities
D. Primitive reflexes
Answer: C. Emotional regulation abilities
Explanation: Social/emotional development can decline indeterminately with aging.
26. During a well-child visit, a nurse uses a screening tool that assesses auditory receptive
and expressive language. This tool is most appropriate for evaluating which domain?
A. Cognitive Development
B. Communication Development
C. Adaptive Development
D. Motoric Development
Answer: B. Communication Development
Explanation: Language assessment tools directly evaluate communication development.
27. According to Piaget's theory, a preschooler who engages in pretend play is likely in
which stage of cognitive development?
A. Sensorimotor
B. Preoperational
C. Concrete Operational
D. Formal Operational
Answer: B. Preoperational
Explanation: The preoperational stage (2-7 yrs) includes symbolic thought and pretend play.
28. A key distinction between a "developmental delay" and "developmental arrest" is that
arrest implies:
A. A slower-than-expected pace of progress.
B. A complete cessation of progress in a domain.
C. A loss of previously acquired skills.
D. An advancement beyond expected milestones.
Answer: B. A complete cessation of progress in a domain.
Explanation: Arrest is a plateau; chronologic age progresses but development does not.
Multiple-Response / Select-All-That-Apply Questions
29. Which of the following are classic theories of development discussed in the text? Select
all that apply.
o A. Bandura's Social Learning Theory
o B. Erikson's Psychosocial Theory
o C. Piaget's Cognitive Development Theory
o D. Watson's Behaviorism Theory
o E. Kohlberg's Moral Development Theory
Answers: B, C, E
Explanation: The text highlights Erikson, Piaget, and Kohlberg as classic theorists.
30. A 3-year-old is suspected of having a pervasive developmental disorder (PDD). Which
areas are typically affected? Select all that apply.
o A. Ability to socialize with others
o B. Gross motor skills like running
o C. Communication skills
o D. Use of imagination in play
o E. Physical growth metrics
Answers: A, C, D
Explanation: PDD often impacts socialization, communication, and imaginative play.
True/False Questions
31. True or False: The order of developmental task attainment is less important than the exact
chronological age at which they occur.
Answer: False
Explanation: The sequence of attainment is more important than the exact age.
32. True or False: "Differentiation" in development refers to the quantitative increase in cell
number and size.
Answer: False
Explanation: Differentiation is cells becoming specialized. Growth is the increase in
size/number.
Application / Scenario-Based Questions
33. A community health nurse is planning a prenatal education program. To address
developmental risk factors, which topic is most critical to include?
A. Infant CPR techniques
B. The dangers of prenatal exposure to environmental toxins
C. Strategies for introducing solid foods
D. Scheduling well-child visits after birth
Answer: B. The dangers of prenatal exposure to environmental toxins
Explanation: Prenatal exposure is a key risk factor that can disrupt typical development.
Flashcards / Quick Recall
34. Q: What term describes a period of greater susceptibility to positive or negative
influences on development?
A: A sensitive or critical period.
35. Q: What is the primary purpose of providing "anticipatory guidance" to parents?
A: To outline expected developmental gains and decrease parental anxiety.
36. Q: Name one tool used for gross developmental screening in young children.
A: Denver Developmental Screening Test II (DDST II) or Ages and Stages Questionnaire
(ASQ).
Multiple-Choice Questions (MCQs)
1. Which model of healthcare emphasizes patient and family participation in care decisions?
A. Disease-centered model
B. Provider-directed model
C. Patient-centered model
D. Evidence-based model
Answer: C. Patient-centered model
Explanation: Current care involves patients as active participants.
2. What is the core characteristic of human development?
A. It is a linear, uniform process.
B. It is a static, unchanging state.
C. It involves integrated, lifelong change.
D. It is determined solely by genetics.
Answer: C. It involves integrated, lifelong change.
Explanation: Development is a complex, integrative process from conception to death.
3. A nurse notes an infant gains head control before sitting. This illustrates which pattern?
A. Proximodistal
B. Cephalocaudal
C. Differentiation
D. Maturation
Answer: B. Cephalocaudal
Explanation: Development proceeds from head to toe.
4. Which domain involves learning to dress, eat, and manage personal safety?
A. Cognitive
B. Adaptive
C. Social/Emotional
D. Motoric
Answer: B. Adaptive
Explanation: Adaptive skills foster independence in daily life.
5. A toddler who used words stops talking after a trauma. This is called:
A. Developmental delay
B. Developmental arrest
C. Developmental regression
D. Global delay
Answer: C. Developmental regression
Explanation: Regression is the loss of a previously mastered skill.
6. According to Erikson, what is the primary conflict for a teenager?
A. Trust vs. Mistrust
B. Industry vs. Inferiority
C. Identity vs. Role Confusion
D. Intimacy vs. Isolation
Answer: C. Identity vs. Role Confusion
Explanation: Adolescents wrestle with forming a stable identity.
7. Which factor is a social determinant of health affecting development?
A. Premature birth
B. Poverty
C. Congenital infection
D. Genetic disorder
Answer: B. Poverty
Explanation: Poverty is an environmental/social risk factor.
8. The Denver Developmental Screening Test II (DDST II) is primarily used for:
A. Diagnosing autism
B. In-depth language assessment
C. Gross developmental screening
D. Assessing adolescent risks
Answer: C. Gross developmental screening
Explanation: DDST II is a broad screening, not diagnostic, tool.
9. What is a "sensitive period" in development?
A. A time of rapid physical growth
B. A stage of emotional sensitivity
C. A window of greater susceptibility to influences
D. The point when puberty begins
Answer: C. A window of greater susceptibility to influences
Explanation: Sensitive periods are times of heightened environmental impact.
10. Which theory focuses on stages of moral reasoning?
A. Freud's Psychosexual Theory
B. Erikson's Psychosocial Theory
C. Piaget's Cognitive Theory
D. Kohlberg's Moral Theory
Answer: D. Kohlberg's Moral Theory
Explanation: Kohlberg proposed stages of moral development.
Multiple-Response / Select-All-That-Apply
11. Which are domains of development? Select all that apply.
A. Physical/Physiologic
B. Financial
C. Cognitive
D. Spiritual
E. Communication
Answers: A, C, E
Explanation: Core domains are physical, motor, social/emotional, cognitive, communication,
adaptive.
12. Which are prenatal risk factors for developmental problems? Select all that apply.
A. Maternal alcohol use
B. Birth trauma
C. Genetic conditions
D. Bullying
E. Environmental toxins
Answers: A, C, E
Explanation: Prenatal risks occur before birth (toxins, substances, genetics).
13. What does a functional assessment for an older adult evaluate? Select all that apply.
A. Abstract reasoning
B. Ability to bathe (BADL)
C. Pubertal stage
D. Managing medications (IADL)
E. Primitive reflexes
Answers: B, D
Explanation: Functional assessment evaluates BADLs and IADLs for independent living.
True/False Questions
14. Development progresses at the same pace in all domains simultaneously.
Answer: False
Explanation: Pace varies independently across different domains.
15. Fine motor development is dependent on cognitive and neurologic maturity.
Answer: True
Explanation: Coordinated small muscle use requires brain development.
Application / Scenario-Based Questions
16. A mother worries her 9-month-old isn't crawling. The nurse knows crawling is a milestone
typically achieved between 6-10 months. The nurse's best action is to:
A. Immediately refer to a neurologist.
B. Explain the normal age range and suggest activities.
C. Diagnose a gross motor delay.
D. Reassure her that walking is more important.
Answer: B. Explain the normal age range and suggest activities.
Explanation: Milestones have ranges; education and encouragement are first steps.
17. A child with ASD would most likely show initial deficits in:
A. Gross motor skills like running.
B. Social communication and interaction.
C. Growth in height and weight.
D. The ability to perform self-care.
Answer: B. Social communication and interaction.
Explanation: ASD core symptoms involve social/emotional and communication domains.
Flashcards / Quick Recall
18. Q: What are the three processes integrated in development?
A: Growth, differentiation, maturation.
19. Q: Define a developmental milestone.
A: A skill most achieve within a general age range.
20. Q: What does HEADSS assess in adolescents?
A: Home, Education, Activities, Drugs, Sex, Suicide (psychosocial risks).
21. A nurse is assessing a patient's functional ability. Which factor is most directly a
component of this concept?
A. The patient's genetic predisposition to disease
B. The patient's ability to perform activities of daily living
C. The patient's score on an intelligence test
D. The patient's family medical history
Answer: B. The patient's ability to perform activities of daily living
Explanation: Functional ability centers on capacity to perform BADLs and IADLs.
22. When assessing family dynamics, a nurse is primarily evaluating:
A. The genetic health history of all family members.
B. The patterns of interaction and relationships within the family unit.
C. The socioeconomic status of the household.
D. The cultural traditions practiced by the family.
Answer: B. The patterns of interaction and relationships within the family unit.
Explanation: Family dynamics refers to how family members communicate and relate.
23. A patient's cultural background influences health care primarily through:
A. Determining their genetic disease risk.
B. Shaping their health beliefs, values, and preferences.
C. Dictating their physiological response to medication.
D. Establishing their health insurance coverage.
Answer: B. Shaping their health beliefs, values, and preferences.
Explanation: Culture fundamentally influences an individual's perspective on health and
treatment.
24. The concept of "spirituality" in a health context is best defined as:
A. Adherence to organized religious practices and rituals.
B. A personal search for meaning, purpose, and connection.
C. A psychological state of happiness and contentment.
D. The absence of mental distress or existential worry.
Answer: B. A personal search for meaning, purpose, and connection.
Explanation: Spirituality is broader than religion, encompassing personal meaning.
25. A nurse is developing a plan to improve a patient's adherence to a medication regimen.
The most effective initial strategy is to:
A. Warn the patient of severe consequences for non-adherence.
B. Assess the patient's understanding and perceived barriers.
C. Simplify the regimen without discussing it with the patient.
D. Ask a family member to take full responsibility for administration.
Answer: B. Assess the patient's understanding and perceived barriers.
Explanation: Effective interventions must be based on understanding the individual's specific
challenges.
26. Which statement best describes "self-management" in chronic illness?
A. The physician provides all decisions and the patient follows orders.
B. The patient independently manages all aspects of care without support.
C. The patient engages in activities to manage symptoms and treatment.
D. It is only relevant for minor, short-term health conditions.
Answer: C. The patient engages in activities to manage symptoms and treatment.
Explanation: Self-management involves patient participation in daily health tasks.
27. Which attribute is most characteristic of "expected" development?
A. Skills are achieved exactly on schedule for chronological age.
B. Development progresses in a unique sequence for each individual.
C. Milestones are attained within a broad, normative age range.
D. Development occurs at a consistently rapid pace.
Answer: C. Milestones are attained within a broad, normative age range.
Explanation: Expected development is defined by ranges, not exact dates.
28. A "critical period" in development is significant because:
A. It is when discipline from parents is most effective.
B. Certain developments must occur or they may never fully happen.
C. It always corresponds with periods of rapid physical growth.
D. It is the only time learning can take place.
Answer: B. Certain developments must occur or they may never fully happen.
Explanation: Critical periods are windows of heightened sensitivity for specific skills.
29. In the context of development, "maturation" refers to:
A. The increase in number and size of cells.
B. The emergence of personal, behavioral, or adult-like characteristics.
C. The process of cells becoming specialized.
D. The social expectations for a given age.
Answer: B. The emergence of personal, behavioral, or adult-like characteristics.
Explanation: Maturation is a qualitative "ripening" towards optimal function.
30. Which screening tool is specifically designed for assessing autism risk in toddlers?
A. DDST-II
B. HEADSS
C. M-CHAT-R
D. CRAFFT
Answer: C. M-CHAT-R
Explanation: The Modified Checklist for Autism in Toddlers-Revised screens for ASD.
31. According to the text, the primary goal of early intervention for developmental delay is
to:
A. Cure the underlying condition causing the delay.
B. Maximize development and optimize future functioning.
C. Prepare the child for institutionalized care.
D. Provide respite services for the parents.
Answer: B. Maximize development and optimize future functioning.
Explanation: Intervention aims to enhance abilities and compensate for disabilities.
32. Failure to thrive (FTT) in an infant can be classified as "nonorganic," which typically
relates to:
A. A diagnosed gastrointestinal disease.
B. Inadequate caloric intake due to dysfunctional feeding practices.
C. A congenital heart defect.
D. A genetic metabolic disorder.
Answer: B. Inadequate caloric intake due to dysfunctional feeding practices.
Explanation: Nonorganic FTT is linked to psychosocial or environmental factors.
33. Which developmental problem originates from a genetic, X-linked recessive disorder?
A. Down Syndrome
B. Duchenne Muscular Dystrophy
C. Cerebral Palsy
D. Spina Bifida
Answer: B. Duchenne Muscular Dystrophy
Explanation: Duchenne Muscular Dystrophy is a specific X-linked genetic disorder.
34. The concept of "Family Dynamics" would be most relevant for a nurse planning care for
a:
A. Comatose patient in the ICU with no available family.
B. Teenager managing newly diagnosed Type 1 Diabetes.
C. Patient undergoing a routine outpatient blood draw.
D. Healthy individual attending a health fair.
Answer: B. Teenager managing newly diagnosed Type 1 Diabetes.
Explanation: Chronic illness management in a youth heavily involves and impacts the family
system.
35. When a nurse respects a patient's request to see a spiritual healer alongside medical
treatment, the nurse is demonstrating understanding of:
A. Adherence
B. Self-Management
C. Culture
D. Functional Ability
Answer: C. Culture
Explanation: Integrating cultural health practices is key to culturally competent care.
Multiple-Response / Select-All-That-Apply - Continued
36. Which statements are true about patient-centered care? Select all that apply.
o A. It is a disease-centered approach.
o B. Patients and families are active participants.
o C. Care is tailored to individual needs and wishes.
o D. The provider holds sole decision-making authority.
o E. It requires understanding unique patient attributes.
Answers: B, C, E
Explanation: Patient-centered care is collaborative, individualized, and based on understanding
the patient.
37. Which factors can significantly impact an individual's development? Select all that apply.
o A. Genetics
o B. Personal experiences
o C. Culture and family values
o D. Environmental factors
o E. All of the above
Answer: E. All of the above
Explanation: Development is shaped by an interplay of all these factors.
38. Which are examples of "toxic stress" that can affect development? Select all that apply.
o A. Winning a competition
o B. Chronic social isolation
o C. Child abuse and neglect
o D. Exposure to domestic violence
o E. A mild, temporary disagreement
Answers: B, C, D
Explanation: Toxic stress involves severe, prolonged adversity without adequate support.
39. What are components of a thorough developmental assessment? Select all that apply.
o A. Observation of skills
o B. Parent/caregiver report
o C. Standardized screening tools
o D. Assumption based on age alone
o E. Genetic testing for every child
Answers: A, B, C
Explanation: Assessment uses multiple methods: observation, report, and validated tools.
40. Which concepts have a reciprocal relationship with Development (affect and are affected
by it)? Select all that apply.
o A. Family Dynamics
o B. Mood and Cognition
o C. Nutrition
o D. Functional Ability
o E. Culture
Answers: A, B
Explanation: The text depicts Family Dynamics and Mood/Cognition as having two-way
relationships with Development.
True/False Questions - Continued
41. True or False: Adaptive development is independent of skills in other developmental
domains.
Answer: False
Explanation: Adaptive development requires complex integration of motor, cognitive, and
social skills.
42. True or False: Piaget's theory proposes that cognitive development progresses from
logical to illogical thinking.
Answer: False
Explanation: Piaget's theory states it progresses from illogical to logical thought.
43. True or False: "Adherence" and "Self-Management" are identical concepts.
Answer: False
Explanation: Adherence is following a regimen. Self-management is broader, involving daily
decisions and coping.
44. True or False: Spiritual needs are only relevant for patients who are terminally ill.
Answer: False
Explanation: Spirituality, the search for meaning, is relevant across the health-illness
continuum.
45. True or False: A developmental delay is diagnosed if a skill is not present when it is
found in 95% of same-age peers.
Answer: True
Explanation: Delay is often statistically defined as performance below a normative cutoff (e.g.,
2.5 standard deviations).
Application / Scenario-Based Questions - Continued
46. An older adult recently widowed has difficulty managing medications and grocery
shopping. The nurse identifies a decline in:
A. Physical maturation
B. Functional ability
C. Cognitive development
D. Moral reasoning
Answer: B. Functional ability
Explanation: Managing medications (IADL) and shopping are key components of functional
ability.
47. A patient from a culture that values family decision-making defers all questions to their
adult son. The nurse should:
A. Insist on speaking directly to the patient only.
B. Respect this cultural dynamic and include the son.
C. Question the patient's mental competence.
D. Cancel the appointment until the patient comes alone.
Answer: B. Respect this cultural dynamic and include the son.
Explanation: Culturally competent care respects family roles in decision-making.
48. A patient with heart failure states, "I don't take the water pill when I go out; I don't want
to use public restrooms." This is best understood as an issue of:
A. Cultural preference
B. Spiritual distress
C. Adherence
D. Family dysfunction
Answer: C. Adherence
Explanation: The patient describes a practical barrier to following the prescribed treatment
regimen.
49. A nurse is teaching a patient with diabetes about foot care. To promote self-management,
the nurse's best approach is to:
A. Provide a detailed written handout.
B. Ask, "What challenges do you foresee in checking your feet daily?"
C. Tell the patient to simply follow the instructions.
D. Schedule a nurse to perform foot care weekly.
Answer: B. Ask, "What challenges do you foresee in checking your feet daily?"
Explanation: Engaging the patient in problem-solving barriers fosters self-management skills.
50. During a well-child visit, a 4-year-old hides behind their parent and makes poor eye
contact. The nurse should initially:
A. Diagnose autism spectrum disorder.
B. Recognize this may be typical stranger anxiety.
C. Refer immediately to a psychiatrist.
D. Ignore the behavior as irrelevant.
Answer: B. Recognize this may be typical stranger anxiety.
Explanation: Shyness with strangers can be age-appropriate; assessment requires observing
multiple behaviors over time.
Flashcards / Quick Recall - Continued
51. Q: What are Instrumental Activities of Daily Living (IADLs)?
A: Complex skills for independent living (e.g., cooking, finances, shopping).
52. Q: Name one theory that views development as occurring in discrete stages.
A: Piaget's Cognitive Development Theory OR Erikson's Psychosocial Theory OR
Freud's Psychosexual Theory.
53. Q: What does the "CRAFFT" screening tool assess?
A: Substance use risk behaviors in adolescents/young adults.
54. Q: What is the difference between "speech" and "language"?
A: Speech is the physical act of talking. Language is the system of rules for
communicating ideas.
55. Q: Define "developmental task."
A: A skill or competency to be mastered at a certain life stage for effective coping.
56. Q: What is "proximodistal" development?
A: Development that proceeds from the center of the body (midline) outward to the
extremities.
57. Q: What is a "pervasive developmental disorder (PDD)"?
A: A significant delay in many basic skills that cross multiple developmental domains.
58. Q: What is the focus of "anticipatory guidance" in pediatrics?
A: Educating parents about upcoming developmental changes, needs, and safety
concerns.
59. Q: What does the "G" in GAPS (Guidelines for Adolescent Preventive Services) stand
for?
A: Guidelines.
60. Q: Which concept involves "growth, differentiation, and maturation"?
A: Development.
61. Q: What type of development includes "executive functioning"?
A: Cognitive Development.
62. Q: What is the primary risk assessed by the HEADSS tool?
A: Psychosocial and behavioral risks in adolescents.
63. Q: What does "cephalocaudal" mean?
A: Head-to-toe direction of development.
64. Q: What is "refinement" in motor development?
A: The progression from achieving gross motor skills to fine motor skills.
65. Q: Give an example of a Basic Activity of Daily Living (BADL).
A: Bathing, dressing, toileting, feeding/ eating, ambulating/transferring.
66. Q: What is the "period of exuberance"?
A: A critical period in early childhood (18 mos-3 yrs) of rapid language and frontal lobe
development.
67. Q: What is a "standardized" screening tool?
A: A tool administered and scored in a consistent, validated manner.
68. Q: What concept is informed by understanding a patient's health beliefs and practices?
A: Culture.
69. Q: What is the key difference between "delay" and "arrest"?
A: Delay is slow progress; arrest is a complete stop in progress.
70. Q: Name one interrelated concept that is a determinant of development.
A: Nutrition OR Culture OR Functional Ability (as per Fig. 1.3).
Unit 2 Concept 2: Functional Ability Quizzes, Answers and Flashcards
Multiple-Choice Questions (1-40)
1. According to the World Health Organization (WHO), how is health broadly defined?
A. The absence of physical disease.
B. A state of complete physical, mental, and social well-being.
C. The ability to perform basic self-care.
D. The successful management of chronic conditions.
Answer: B. WHO defines health as a state of complete physical, mental, and social well-being,
not merely the absence of disease.
2. A key goal of Healthy People 2030 that supports the expanded view of health related to
functional ability is:
A. Eliminating all infectious diseases.
B. Reducing healthcare costs by 20%.
C. Promoting healthy development and well-being across all life stages.
D. Increasing the number of specialty care hospitals.
Answer: C. Healthy People 2030 aims to promote healthy development, behaviors, and well-
being across life stages, aligning with functional ability.
3. Functional ability is best defined as the:
A. Diagnosis and treatment of physical impairments.
B. Cognitive, social, physical, and emotional ability to carry on normal life activities.
C. List of tasks a patient cannot perform independently.
D. Equipment used to assist with mobility.
Answer: B. Functional ability is defined as the cognitive, social, physical, and emotional
capacity for normal life activities.
4. The scope of functional ability is best visualized as a:
A. Circular model with overlapping domains.
B. Simple linear continuum from full function to disability.
C. Hierarchical pyramid of needs.
D. List of independent tasks.
Answer: B. The simplest view of functional ability is a continuum ranging from full function to
disability.
5. Within the disablement process framework, what does the term impairment specifically refer to?
A. The need for assistance with daily tasks.
B. The physical abnormality underlying functional limitations.
C. A person's inability to participate in social roles.
D. The use of adaptive equipment.
Answer: B. Impairment refers to the physical abnormality caused by disease that underlies
functional limitations.
6. For older adults, functional status typically refers to the safe, effective performance of:
A. Advanced technological skills.
B. Activities of Daily Living (ADLs) essential for independent living.
C. High-intensity exercise routines.
D. Complex financial management.
Answer: B. In older adults, functional status is commonly assessed through the performance of
basic ADLs.
7. An antecedent of functional ability is:
A. The use of a walker.
B. The development of physiologic processes like neural and musculoskeletal systems.
C. A score on the Mini-Mental Status Exam.
D. A diagnosis of arthritis.
Answer: B. Antecedents are prerequisites for functional ability, including the development of
physiologic processes.
8. A patient can dress themselves but requires extra time and uses a reacher tool. This best
illustrates:
A. A primary functional ability problem.
B. A gradation of capacity and performance.
C. Total functional disability.
D. An irrelevant clinical detail.
Answer: B. Functional ability involves gradations, considering assistance, time, and effort, not
just can/cannot.
9. Which nursing model uses 12 Activities of Daily Living as its central framework?
A. The Health Belief Model.
B. The Roper-Logan-Tierney Model of Nursing.
C. The Neuman Systems Model.
D. The Transtheoretical Model.
Answer: B. The Roper-Logan-Tierney model organizes care around 12 core Activities of Living.
10. The International Classification of Functioning, Disability and Health (ICF) framework
emphasizes:
A. A strictly linear progression from illness to health.
B. The dynamic interaction between health conditions, personal factors, and environment.
C. That disability is solely a medical problem.
D. The primacy of genetic factors over all others.
Answer: B. The ICF highlights the complex, dynamic interactions between body functions,
activities, participation, and contextual factors.
11. Which of the following is an Instrumental Activity of Daily Living (IADL)?
A. Bathing.
B. Feeding oneself.
C. Managing money.
D. Turning in bed.
Answer: C. IADLs are complex skills for community living, like managing finances, unlike
basic self-care ADLs.
12. A common eligibility criterion for long-term care services is needing assistance with:
A. One ADL.
B. A minimum of two or three ADLs.
C. All IADLs only.
D. Taking prescribed medications.
Answer: B. Functional impairment, defined as needing help with 2-3 ADLs, is a common
criterion for long-term care.
13. Risk recognition for functional decline is critical because functional deficits are associated with:
A. Improved long-term prognosis.
B. Decreased healthcare costs.
C. Poor health outcomes.
D. Higher patient satisfaction.
Answer: C. Early identification is key as functional deficits are linked to poor health outcomes.
14. Which factor has been repeatedly documented as a risk factor for functional impairment?
A. High socioeconomic status.
B. Younger age.
C. Advanced age.
D. Male gender.
Answer: C. Research consistently identifies advanced age as a major risk factor for functional
impairment.
15. Preclinical disability is defined as:
A. A complete inability to perform a task.
B. Task modification without reported difficulty performing it.
C. A diagnosed neurological disorder.
D. The need for full assistance from another person.
Answer: B. Preclinical disability involves modifying how a task is done before reporting
outright difficulty.
16. A sudden onset of functional decline in an older adult is often indicative of:
A. Successful aging.
B. Acute illness or worsening chronic disease.
C. Improved coping mechanisms.
D. A desire for more social support.
Answer: B. Acute functional decline is a red flag for conditions like infection or chronic disease
exacerbation.
17. Which type of functional assessment tool is generally preferred to avoid inaccuracies from self-
perception?
A. Self-report questionnaires.
B. Family member interviews.
C. Performance-based observation.
D. Review of medical records.
Answer: C. Performance-based tools involve direct observation, avoiding biases inherent in self-
report.
18. A patient overstates their ability to walk independently due to fear of losing their home. This is a
potential problem with:
A. Performance-based assessment.
B. Interprofessional collaboration.
C. Self-report measures.
D. Laboratory testing.
Answer: C. Self-report can be skewed by psychological factors like pride or fear, leading to
overstatement.
19. When scoring functional assessment tools, "partial assistance" is an example of a category
related to:
A. Diagnosis.
B. Dependency.
C. Difficulty.
D. Duration.
Answer: B. Dependency refers to the amount of assistance needed (none, partial, total).
20. The primary goal when managing a patient's functional ability is to:
A. Ensure complete dependence on caregivers for safety.
B. Achieve optimal independent function and prevent decline.
C. Focus solely on treating the underlying medical diagnosis.
D. Restrict activities to prevent any risk of injury.
Answer: B. Nursing care aims to maximize the patient's independent function and prevent
functional decline.
21. Early intervention for functional impairment is critical because:
A. It is always less expensive.
B. It usually leads to better outcomes.
C. It prevents the need for family involvement.
D. It cures the underlying condition.
Answer: B. Generally, the earlier the intervention for functional issues, the better the patient's
outcome.
22. According to the interrelated concepts model, which concept has a primarily unidirectional
relationship from functional ability?
A. Mobility.
B. Cognition.
C. Elimination.
D. Culture.
Answer: C. Functional ability impacts concepts like Elimination and Sexuality more than they
influence it.
23. A problem where the ability to perform a function never developed is classified as a:
A. Secondary problem.
B. Tertiary problem.
C. Primary problem.
D. Reversible problem.
Answer: C. Primary functional problems involve functions that never developed, often due to
early-life factors.
24. Cerebral Palsy is categorized as a primary problem in functional ability because it:
A. Occurs after a stroke in adulthood.
B. Results from a spinal cord injury.
C. Is caused by abnormal brain development early in life.
D. Is a common consequence of rheumatoid arthritis.
Answer: C. CP is caused by early brain insult, affecting the initial development of motor
function.
25. Which condition is listed as an exemplar of a secondary problem in functional ability?
A. Down syndrome.
B. Autism spectrum disorder.
C. Alzheimer disease.
D. Cerebral palsy.
Answer: C. Alzheimer's is a secondary problem as it causes a loss of function that was
previously attained.
26. Autism Spectrum Disorder (ASD) primarily affects functional ability in which domains?
A. Only physical mobility.
B. Social interaction and repetitive behaviors.
C. Cardiovascular endurance.
D. Visual and auditory acuity.
Answer: B. ASD is characterized by challenges in social communication and the presence of
repetitive behaviors.
27. In the provided case study, Mrs. Finney's difficulty opening jars is most directly related to which
functional assessment component?
A. Vision.
B. Cognition.
C. Mobility and hand function.
D. Nutrition.
Answer: C. Arthritis and lack of strength affect mobility and fine motor skills required for tasks
like opening jars.
28. For Mrs. Finney, which personal factor is a major asset supporting her functional ability?
A. Her need for chemotherapy.
B. Her fiercely independent attitude.
C. Her poor vision and hearing.
D. Her lack of immediate family nearby.
Answer: B. Her independence is a psychological asset that can motivate participation in her own
care.
29. What is a significant environmental risk factor for Mrs. Finney's safety at home?
A. Her daily phone call with her nephew.
B. The need to use stairs to access the laundry and garage.
C. Having friends in the neighborhood.
D. Taking Synthroid medication.
Answer: B. Stairs pose a fall risk, especially given her unsteady gait and recent surgery.
30. Which interdisciplinary team member would be MOST helpful in assessing Mrs. Finney's need
for assistive devices for jar opening and phone use?
A. Pharmacist.
B. Occupational Therapist.
C. Registered Dietitian.
D. Clinical Psychologist.
Answer: B. Occupational therapists specialize in assessing and facilitating performance of ADLs
and IADLs, often with adaptive tools.
31. The concept that functional ability depends on the interplay of physical, psychological, social,
and cognitive dimensions best supports which principle?
A. Reductionist care.
B. Holistic, patient-centered care.
C. Specialty-focused treatment.
D. Standardized protocols for all patients.
Answer: B. The multidimensional nature of function necessitates a holistic approach to patient
care.
32. The Functional Analysis Screening Tool (FAST) is designed to measure functioning in which
domain?
A. Renal function.
B. Social and behavioral functioning.
C. Cardiac output.
D. Nutritional status.
Answer: B. The FAST is a questionnaire that measures social and behavioral functioning.
33. A limitation noted for behavior-based functional assessment scales is that they:
A. Are too quick to administer.
B. May simply label behaviors without deeper analysis.
C. Provide objective physiological data.
D. Are only valid for pediatric populations.
Answer: B. Such tools risk merely labeling primary behaviors and should be part of a broader
assessment.
34. Screening for functional deficits in older adults should be:
A. Only done upon hospital admission.
B. A part of routine care.
C. Avoided to prevent anxiety.
D. Reserved for those with severe dementia.
Answer: B. Just as developmental screening is routine for children, functional screening should
be routine for older adults.
35. Which factor is NOT listed as a contributor to maintaining high-level functional ability?
A. Well-balanced nutrition.
B. Avoidance of tobacco.
C. Stress management.
D. Isolation from social activity.
Answer: D. Regular participation in meaningful activity is recommended, not isolation.
36. The statement "Functional ability may differ from functional performance" means:
A. What a person can do may not match what they actually do daily.
B. Performance is always better than ability.
C. Ability is irrelevant to nursing care.
D. The two terms are always synonymous.
Answer: A. Capacity (ability) and actual performance can differ due to environmental,
motivational, or other factors.
37. In the ICF model, "participation" refers to a person's ability to be involved in:
A. Only medical decision-making.
B. Laboratory tests.
C. Life situations like work and community events.
D. Cellular metabolic processes.
Answer: C. Participation is the ICF domain concerning involvement in life roles and situations.
38. Which of the Roper-Logan-Tierney model's 12 activities is most abstract or psychosocial in
nature?
A. Breathing.
B. Eating and drinking.
C. Expressing sexuality.
D. Eliminating.
Answer: C. Expressing sexuality encompasses psychosocial and relational dimensions beyond
physical activity.
39. A major predictor of independence 5 months after a stroke was found to be:
A. Pre-stroke income level.
B. Independence in ADLs at baseline.
C. Age younger than 50.
D. A history of smoking.
Answer: B. Research shows pre-stroke functional independence is a strong predictor of post-
stroke recovery.
40. For a patient with rheumatoid arthritis, the resulting joint deformity and pain primarily lead to
impairment in:
A. Gas exchange.
B. Functional ability and mobility.
C. Thought content.
D. Hormone production.
Answer: B. RA is a systemic condition, but its direct impact on function is through impaired
joint mobility and pain.
Multiple-Response / Select-All-That-Apply Questions (41-70)
41. Which of the following are overarching influences on the complex process between an
individual's health and disability? (Select all that apply.)
o A. Developmental and biologic factors.
o B. Psychological factors.
o C. Sociocultural and environmental factors.
o D. Politicoeconomic factors.
Answers: A, B, C, D. The disablement process is influenced by a wide array of developmental,
biologic, psychological, sociocultural, environmental, and politicoeconomic factors.
42. Which attributes are defining characteristics of functional ability? (Select all that apply.)
o A. The capacity to perform specific functional abilities.
o B. The actual or required performance of functional abilities.
o C. The presence of a chronic disease diagnosis.
o D. The patient's insurance coverage.
Answers: A, B. Attributes of functional ability include the capacity to perform and the actual
performance of functions.
43. According to the text, why is functional ability important to healthcare providers and financers?
(Select all that apply.)
o A. It can indicate the existence and severity of disease.
o B. It signals the need for services.
o C. It monitors success of treatment.
o D. It facilitates cost-effectiveness in care provision.
Answers: A, B, C, D. Functional ability is a key indicator for diagnosis, service needs, treatment
monitoring, and resource allocation.
44. Which of the following are considered Basic Activities of Daily Living (BADLs)? (Select all that
apply.)
o A. Managing money.
o B. Bathing.
o C. Using the telephone.
o D. Toileting.
o E. Dressing.
Answers: B, D, E. BADLs relate to personal care and mobility: bathing, toileting, and dressing.
Managing money and using the phone are IADLs.
45. Which of the following are risk factors or predictors for functional impairment? (Select all that
apply.)
o A. Young age.
o B. Low level of depression.
o C. Cognitive dysfunction.
o D. Preclinical disability.
Answers: C, D. Cognitive impairment and preclinical disability (modifying tasks) predict future
decline. Age is a risk, but advanced age, not young age. High levels of depression, not low, are a
risk.
46. A comprehensive functional assessment for an older adult is indicated when which of the
following are present? (Select all that apply.)
o A. Demonstrated loss of functional ability.
o B. Change in mental status.
o C. Multiple health conditions.
o D. Being a frail elder living in the community.
Answers: A, B, C, D. All are specific circumstances warranting a comprehensive functional
assessment in older adults.
47. Which statements about self-report functional assessment tools are TRUE? (Select all that
apply.)
o A. They provide the patient's perception of ability.
o B. They are preferred over performance-based tools.
o C. They can be skewed by a patient's pride or fear.
o D. They eliminate ambiguity through standardized wording.
Answers: A, C. Self-report gives the patient's perspective but is subject to bias. Performance-
based tools are generally preferred, and phrasing can still lead to ambiguous responses even in
self-report.
48. Management of impaired functional ability involves a multidisciplinary effort. Which services
could be part of early intervention? (Select all that apply.)
o A. Physical therapy.
o B. Occupational therapy.
o C. Nutritional consulting.
o D. Speech and language services.
Answers: A, B, C, D. All listed services are potential components of a multidisciplinary
approach to functional impairment.
49. Which concepts have a clearly reciprocal (two-way) relationship with functional ability
according to the interrelated concepts model? (Select all that apply.)
o A. Development.
o B. Mobility.
o C. Stress and Coping.
o D. Elimination.
Answers: B, C. Mobility and Stress/Coping have mutual interactions with functional ability.
Development influences function, and function impacts Elimination.
50. Which conditions are listed as exemplars of primary problems in functional ability? (Select all
that apply.)
o A. Alzheimer disease.
o B. Cerebral palsy.
o C. Spinal cord injury.
o D. Down syndrome.
o E. Autism spectrum disorder.
Answers: B, D, E. These are conditions present from early development. Alzheimer's and spinal
cord injury are secondary problems (loss of attained function).
True/False or Short Answer Variants (71-105)
71. True or False: The WHO's definition of health focuses solely on the absence of physical disease.
Answer: False. WHO defines health as a state of complete physical, mental, and social well-
being.
72. True or False: Functional impairment and disability refer to the same degree of inability to
perform tasks.
Answer: False. They refer to varying degrees of inability, with disability often representing a
more negative or limiting aspect.
73. True or False: Functional ability remains static throughout an individual's life span.
Answer: False. It changes across the life span due to development, environment, lifestyle, and
health status.
74. What does the acronym ADL stand for?
Answer: Activity of Daily Living.
75. True or False: The Roper-Logan-Tierney model has a primary focus on treating illness.
Answer: False. It focuses on health and promotes care directed toward health promotion and
wellness.
76. What does the acronym ICF stand for?
Answer: International Classification of Functioning, Disability and Health.
77. True or False: Instrumental Activities of Daily Living (IADLs) are simpler than Basic ADLs.
Answer: False. IADLs are more complex skills required for independent community living.
78. True or False: Sudden functional decline in an older adult can be a sign of a urinary tract
infection.
Answer: True. Acute illness like a UTI can present as sudden functional decline.
79. What type of functional assessment tool involves observing a patient complete a standardized
task?
Answer: Performance-based assessment tool.
80. True or False: The SF-36 is an example of a tool designed to assess only physical function.
Answer: False. The SF-36 measures physical, mental, and social health domains.
81. In functional assessment, what does "dependency" refer to?
Answer: The amount of assistance (from devices or people) needed to perform a task.
82. True or False: The goal of nursing care related to functional ability is to make the patient
completely dependent for safety.
Answer: False. The goal is optimal independent function and preventing decline.
83. Name one concept that is depicted as a major influencing factor (determinant) of functional
ability.
Answer: Development, Cognition, or Culture. (Any one is correct).
84. True or False: A secondary problem in functional ability means the individual never developed
that function.
Answer: False. A secondary problem is a loss of a function that was previously attained.
85. True or False: Parkinson's disease symptoms typically improve over time without intervention.
Answer: False. PD is progressive; symptoms become more pronounced and interfere with
function over time.
Application / Scenario-Based Questions (106-140)
106. A nurse is assessing a 78-year-old man recovering from pneumonia. He states he can
"manage just fine" at home alone, but his daughter reports he has stopped cooking meals and his
house is unusually untidy. This discrepancy best illustrates a limitation of which assessment
method?
A. Performance-based evaluation.
B. Self-report.
C. Laboratory testing.
D. Physical examination.
Answer: B. This highlights a potential inaccuracy in self-report, where the patient may overstate
ability.
107. A 45-year-old woman with multiple sclerosis reports increasing fatigue and muscle
weakness. She now needs to sit on a shower chair and use a hand-held sprayer to bathe safely.
This change represents a:
A. Primary functional ability problem.
B. Secondary functional ability problem.
C. Developmental milestone.
D. Preclinical disability with no functional impact.
Answer: B. She is experiencing a loss of prior ability (to stand and shower) due to a progressive
disease.
108. During a home visit, a community health nurse notes throw rugs and poor lighting in the
hallway of an older adult with mild vision impairment and unsteady gait. The nurse's priority
action, based on risk recognition, is to:
A. Commend the patient on their decorative choices.
B. Educate the patient and family on fall risks and encourage removing rugs and improving
lighting.
C. Immediately recommend placement in a long-term care facility.
D. Focus only on the patient's medication regimen.
Answer: B. The nurse should address modifiable environmental risks to prevent falls and
functional decline.
109. An occupational therapist is working with a patient who had a stroke affecting their
dominant hand. The therapist provides a rocker knife and button hook. This intervention directly
addresses the functional ability attribute of:
A. Capacity, by restoring neurological function.
B. Performance, by enabling task completion with adaptive devices.
C. Antecedents, by changing the patient's developmental stage.
D. Scope, by redefining the continuum of disability.
Answer: B. The tools facilitate the actual performance of eating and dressing tasks, a gradation
of performance with assistance.
110. When planning discharge for a patient with new lower limb paralysis, the
interdisciplinary team's focus should be on evaluating functional outcomes and restoring ability.
This approach is most characteristic of which care setting's focus?
A. Acute emergency care.
B. Rehabilitation setting.
C. Hospice care.
D. Primary care clinic.
Answer: B. The rehabilitation setting specifically focuses on restoring function and evaluating
functional outcomes.
Flashcards / Quick Recall Items (111-140)
111. Q: What organization's definition broadened health beyond the absence of disease?
A: The World Health Organization (WHO).
112. Q: Name one of the four overarching goals of Healthy People 2030 related to functional
ability.
A: Promote healthy development, healthy behaviors, and well-being across all life stages.
113. Q: What is the difference between functional ability and functional performance?
A: Ability is the capacity to do a task; performance is what the person actually does daily.
114. Q: What are the two main dimensions used to describe the scope of functional ability?
A: Attributes (defining characteristics) and Antecedents (prerequisites).
115. Q: In the disablement process, what term describes the positive or neutral interaction
between health and activity?
A: Function.
116. Q: For infants and children, how is expected functional ability development typically
measured?
A: By achievement of developmental milestones.
117. Q: What must be developed before functional ability can exist (i.e., an antecedent)?
A: Physiologic processes (neural, cognitive, musculoskeletal, etc.).
118. Q: Which theory uses 12 Activities of Living as a framework for individualized nursing
care?
A: The Roper-Logan-Tierney Model of Nursing.
119. Q: What does the ICF framework emphasize is dynamic rather than linear?
A: The process between functional ability and disability.
120. Q: What type of daily living skill is "Managing transportation"?
A: An Instrumental Activity of Daily Living (IADL).
121. Q: What is a common eligibility criterion for long-term care based on functional ability?
A: Needing assistance with a minimum of 2-3 ADLs.
122. Q: What is the term for modifying a task without reporting difficulty doing it?
A: Preclinical disability.
123. Q: Name one personal reason an older adult might overstate their functional ability.
A: Fear of losing independence or being placed in long-term care.
124. Q: What is the "gold standard" self-report instrument for measuring physical, mental, and
social health in older adults?
A: The 36-Item Short Form (SF-36).
125. Q: In assessment scoring, does "a lot of difficulty" relate to dependency or difficulty?
A: Difficulty.
126. Q: What is the primary goal when planning care related to a patient's functional ability?
A: To achieve optimal independent function and prevent decline.
127. Q: Which interrelated concepts are considered major determinants of functional ability?
A: Development, Cognition, and Culture.
128. Q: Is a spinal cord injury considered a primary or secondary problem for functional
ability?
A: Secondary (it causes loss of attained function).
129. Q: What is the most common motor disability in childhood?
A: Cerebral Palsy.
130. Q: Which progressive brain disease is the most common cause of dementia in older
adults?
A: Alzheimer's Disease.
131. Q: What are the four primary motor symptoms of Parkinson's Disease?
A: Tremor, rigidity, bradykinesia (slowness), and impaired balance.
132. Q: In the case study, what is Mrs. Finney's reported limitation regarding walking?
A: She is uncertain walking outdoors, especially on uneven ground.
133. Q: What asset does Mrs. Finney possess that could be leveraged in her care plan?
A: Her fierce independence.
134. Q: Which team member would best assess Mrs. Finney's home for safety modifications?
A: An Occupational Therapist.
135. Q: What is the core argument for including functional ability in health definitions?
A: It is more inclusive of people with disabilities/chronic conditions and key to quality of life.
136. Q: What does the ICF domain "Activity" refer to?
A: The execution of a task or action by an individual.
137. Q: True or False: Functional assessment tools are only for the elderly.
A: False. They are used across the lifespan (e.g., developmental tools for children).
138. Q: What does FAST stand for?
A: Functional Analysis Screening Tool.
139. Q: What is a key distinction between primary and secondary functional problems?
A: Primary: function never developed. Secondary: loss of previously attained function.
140. Q: What is the main purpose of risk recognition in functional ability?
A: For early identification and intervention to prevent decline and poor outcomes.
UNIT 3 CONCPET 3: FAMILY DYNAMICS – COMPREHENSIVE ASSESSMENT SET
Multiple-Choice Questions (MCQs) – 20 Questions
1. A nurse is conducting a family assessment using the Calgary Family Assessment Model
(CFAM). Which action by the nurse best demonstrates understanding of a core principle of this
model?
A. Explaining to the family that the assessment will reveal the objective truth about their
function.
B. Focusing the assessment solely on the individual identified as the primary patient.
C. Recognizing that the assessment is one perspective based on nurse-family interactions at a
point in time.
D. Using the assessment primarily to diagnose psychopathology within the family system.
Answer: C.
Explanation: Wright and Leahy caution that a family assessment is based on the nurse's
perspective and interactions, not an absolute truth. The CFAM focuses on the family as a unit.
2. When applying Family Systems Theory in nursing practice, a nurse understands that a change
in one family member affects all members. This is best described by which characteristic of the
theory?
A. The family as a whole is greater than the sum of its parts.
B. Families maintain a balance between change and stability.
C. Circular causality explains family members' behaviors.
D. The family is part of a larger suprasystem.
Answer: C.
Explanation: Circular causality means a change in one member affects the whole family, and
the family's change, in turn, affects that individual, creating a circular pattern.
3. According to structural-functional theory, a family that establishes rigid boundaries and keeps
outsiders at a distance might experience which outcome during a crisis?
A. Enhanced resilience due to strong internal bonds.
B. Adequate resources from their extended social network.
C. Increased risk of inadequate resources and isolation.
D. Greater flexibility in adapting to new roles.
Answer: C.
Explanation: Rigid boundaries can lead to isolation, limiting access to external support and
resources during times of crisis.
4. A nurse is planning care for a family where the mother has recently been diagnosed with a
chronic illness. Using family stress theory, which factor is most critical for the nurse to assess to
predict the family's adaptation?
A. The genetic inheritance of the illness.
B. The family's perception of the stressor.
C. The age of the oldest child in the family.
D. The family's income level in isolation.
Answer: B.
Explanation: How the family perceives the stressful event is a primary variable influencing
whether they adapt or deteriorate.
5. During a developmental assessment using the CFAM, a nurse is reviewing the family life
cycle. Which concept is crucial for the nurse to understand about this framework?
A. It describes the concurrent development of each individual in the family.
B. It outlines the typical trajectory followed by most families.
C. It focuses exclusively on unpredictable crises within the family.
D. It is used to diagnose developmental delays in children.
Answer: B.
Explanation: The family life cycle describes typical stages families pass through, used to
organize developmental assessment.
6. A nursing student states, "A family must include parents and children living together." Which
response by the instructor is most accurate based on the contemporary definition?
A. "You are correct; that is the traditional nuclear family structure."
B. "That is one configuration, but a family is defined by its self-identified members."
C. "Only families related by blood or marriage constitute a true family unit."
D. "That definition applies only to married-parent families."
Answer: B.
Explanation: A contemporary, helpful definition is that family consists of two or more
individuals who depend on one another for support, with members being self-defined.
7. A nurse observes a family where one child is consistently blamed for conflicts. This pattern is
most aligned with which attribute of dysfunctional family dynamics?
A. Clear communication among all members.
B. Behavioral traits such as scapegoating.
C. Shared leisure time and rituals.
D. Flexible and adaptable roles.
Answer: B.
Explanation: Dysfunctional dynamics include behavioral traits like blaming, criticizing, and
designating a scapegoat.
8. Which nursing intervention is considered a "core intervention" for supporting family
dynamics, applicable by all nurses?
A. Conducting formal family therapy sessions.
B. Providing palliative care and hospice referrals.
C. Facilitating conversations among family members.
D. Prescribing medication for family conflict.
Answer: C.
Explanation: Core interventions include facilitating conversation, providing education,
enhancing understanding, sharing observations, and validating feelings.
9. When a nurse uses "circular questions" during a family intervention, what is the primary
intent?
A. To gather linear cause-and-effect information about a problem.
B. To direct the conversation toward the nurse's predetermined goal.
C. To uncover the family's explanation of problems and differences in relationships.
D. To provide immediate advice and solutions to the family.
Answer: C.
Explanation: Circular questions aim to reveal the family's understanding of problems and
relational differences, moving beyond simple cause-and-effect.
10. The concept of "Family Dynamics" is most directly interrelated with which other concept
when considering the impact of a family member's spinal cord injury?
A. Reproduction
B. Functional Ability
C. Culture
D. Spirituality
Answer: B.
Explanation: The functional ability of a member affects self-concept and places stress on
caregivers, directly impacting family dynamics.
11. In the case study, Erin's relationship with her parents is described as strained. Which factor
from the scenario is a key contributor to this dysfunctional dynamic?
A. Erin's parents provide frequent financial support.
B. Erin's parents openly favor her brother's children.
C. Erin's parents live in a different community.
D. Erin's parents encouraged her to marry Andrew.
Answer: B.
Explanation: The perception of favoritism (liking the brother better) and criticism of Erin's
parenting contribute to negative dynamics.
12. A nurse is constructing an ecomap for a family. What is the primary purpose of this
assessment tool?
A. To diagram genetic inheritance and health history.
B. To provide a visual depiction of the family's social and personal relationships.
C. To list the instrumental activities of daily living for each member.
D. To diagnose specific family communication disorders.
Answer: B.
Explanation: An ecomap visually depicts social/personal relationships and available supports
outside the immediate family unit.
13. Which statement best describes the "scope" of family dynamics as presented in the text?
A. It is static and fixed based on the family's original structure.
B. It ranges on a continuum from positive/healthy to negative/dysfunctional.
C. It is solely determined by the family's socioeconomic status.
D. It is only relevant during times of acute family crisis.
Answer: B.
Explanation: Family dynamics are fluid and changeable, existing on a continuum from healthy
to dysfunctional.
14. When a couple has their first child, the family dynamics change because the relationships
become more complex. This increase in complexity is best explained by the shift from a:
A. Suprasystem to a subsystem.
B. Dyad to a triad.
C. Nuclear family to an extended family.
D. Functional system to a dysfunctional system.
Answer: B.
Explanation: Dynamics in a triad (three people) are more complex than in a dyad (two people),
as illustrated in the text.
15. A key defining attribute of family dynamics is that interactions among members are:
A. Fixed and unchangeable based on family roles.
B. Fluid, flexible, and changeable.
C. Always positive and growth-producing.
D. Solely determined by cultural background.
Answer: B.
Explanation: A defining attribute is that interactions are dynamic—fluid, flexible, and
changeable.
16. In the context of family dynamics, what is the primary risk when a family designates one
member as the "scapegoat"?
A. It promotes clear communication within the family.
B. It creates a detrimental reciprocal relationship.
C. It enhances the family's problem-solving abilities.
D. It strengthens alliances among other members.
Answer: B.
Explanation: Structural-functional theory notes that some reciprocal relationships, like
scapegoating, can be detrimental to family functioning.
17. Which exemplar from the text is categorized as a positive family dynamic?
A. Intimate partner violence
B. Sibling rivalry
C. Respite care for a caregiver
D. Marital infidelity
Answer: C.
Explanation: Providing respite care is an example of supportive, positive family dynamics.
18. A nurse is using the Family Adaptability and Cohesion Evaluation Scales (FACES IV). What
is the primary purpose of this tool?
A. To provide a medical diagnosis for family members.
B. To assess the dimensions of cohesion and flexibility in a family.
C. To conduct a genetic risk assessment for inherited conditions.
D. To determine the legal custody arrangements for children.
Answer: B.
Explanation: FACES IV is a self-report scale designed to assess the cohesion and flexibility
dimensions of the Circumplex Model.
19. During a functional assessment of a family, a nurse asks about meal preparation and laundry.
The nurse is assessing which aspect of family functioning?
A. Expressive functioning
B. Instrumental functioning
C. Developmental functioning
D. Structural functioning
Answer: B.
Explanation: Instrumental aspects of family functioning include routine activities of daily living
like meal preparation.
20. According to the text, what is a fundamental reason why nurses must understand family
dynamics?
A. To legally define who constitutes a family for insurance purposes.
B. Because family dynamics influence the delivery of healthcare to individuals.
C. To replace the need for individual patient assessments.
D. Because nurses are responsible for solving all family conflicts.
Answer: B.
Explanation: Families act as a support system or lack thereof, directly influencing patient health
and care, making understanding dynamics essential for nurses.
Multiple-Response / Select-All-That-Apply – 20 Questions
21. A nurse is assessing a family using the Circumplex Model of Marital & Family Systems.
Which dimensions should the nurse evaluate? (Select all that apply.)
A. Family Cohesion
B. Genetic Inheritance
C. Family Flexibility
D. Socioeconomic Status
E. Communication
Answer: A, C, E.
Explanation: The Circumplex Model's core dimensions are family cohesion, flexibility, and
communication.
22. Which factors are identified as influences on family dynamics? (Select all that apply.)
A. Family configuration
B. Number of children
C. Parental presence or absence
D. The nurse's personal beliefs
E. Culture and socioeconomic status
Answer: A, B, C, E.
Explanation: The text lists these as specific influences. The nurse's beliefs are not an influence
on the family's intrinsic dynamics.
23. Which traits are associated with positive and healthy family dynamics? (Select all that
apply.)
A. Shared rituals and traditions
B. Power struggles among members
C. Support, respect, and trust
D. Triangulation in relationships
E. A strong sense of right and wrong
Answer: A, C, E.
Explanation: Positive traits include shared rituals, support/respect/trust, and a strong sense of
right and wrong. The others are dysfunctional traits.
24. According to family systems theory, which statements are accurate? (Select all that apply.)
A. A family system is composed of many subsystems.
B. Linear causality best explains family member behaviors.
C. A change in one member affects all members.
D. The family can balance change and stability.
E. The family is lesser than the sum of its individual members.
Answer: A, C, D.
Explanation: Key characteristics include subsystems, change in one affects all, and balance.
Circular causality, not linear, is used. The whole is greater than the sum of parts.
25. Which tools or models are specifically designed to assess family dynamics? (Select all that
apply.)
A. The Calgary Family Assessment Model (CFAM)
B. Maslow's Hierarchy of Needs
C. The Family Adaptability and Cohesion Evaluation Scales (FACES IV)
D. The Dyadic Adjustment Scale
E. The Chinese Family Assessment Instrument (C-FAI)
Answer: A, C, D, E.
Explanation: These are all listed models/tools for assessing family dynamics. Maslow's theory
is not specific to family assessment.
26. Which of the following are considered "advanced interventions" for dysfunctional family
dynamics? (Select all that apply.)
A. Providing basic patient education
B. Facilitating a conversation between siblings
C. Making a referral for family therapy
D. Conducting a linear questioning interview
E. Coordinating palliative care services
Answer: C, E.
Explanation: Advanced interventions require specialized expertise and include referrals for
therapy, psychiatric care, palliative care, etc. A, B, and D are core or basic assessment
techniques.
27. What are the three major categories assessed in the Calgary Family Assessment Model
(CFAM)? (Select all that apply.)
A. Structural
B. Medical
C. Developmental
D. Financial
E. Functional
Answer: A, C, E.
Explanation: The CFAM's three major categories are structural, developmental, and functional.
28. A nurse is conducting a risk recognition assessment for family dysfunction. Which situations
should alert the nurse to increased risk? (Select all that apply.)
A. The birth of a new child
B. Consistent financial stability
C. A severe illness of a member
D. The death of a family member
E. Maintenance of rigid family roles
Answer: A, C, D.
Explanation: Situations that place families at risk include expansion (new child), severe illness,
and death. Financial stability is protective. Rigid roles are a characteristic, not necessarily a
situational risk factor listed.
29. In the case study, which findings are indicative of negative or dysfunctional family dynamics
involving Andrew? (Select all that apply.)
A. He provides consistent, reliable child support.
B. He openly verbalizes frustration with his children.
C. He has a part-time job delivering pizza.
D. He caused bruises on his daughter Monica.
E. He spends most of his free time with friends.
Answer: B, D.
Explanation: Verbalizing frustration with "whiny girls" and causing physical injury (bruises) are
clear indicators of negative, dysfunctional dynamics.
30. Which concepts are identified as interrelated with Family Dynamics in the text? (Select all
that apply.)
A. Development
B. Gas Exchange
C. Culture
D. Reproduction
E. Clotting
Answer: A, C, D.
Explanation: The interrelated concepts specifically listed are Development, Functional Ability,
Culture, Spirituality, Reproduction, and Stress and Coping.
31. Which of the following are defining attributes of the concept "Family Dynamics"? (Select all
that apply.)
A. A family, however defined, is involved.
B. The group has relational obligations.
C. Communication among members occurs.
D. Interactions are static and fixed.
E. It only applies to traditional nuclear families.
Answer: A, B, C.
Explanation: Defining attributes include family involvement, relational obligations,
communication, and fluid/dynamic interactions. D and E are incorrect.
32. When assessing the "quality of relationships" within a family, which observations would
suggest positive dynamics? (Select all that apply.)
A. Interactions are loving and respectful.
B. A parent consistently berates a child.
C. Siblings squabble and place blame.
D. Family members support and nurture each other.
E. A husband denigrates his wife.
Answer: A, D.
Explanation: Positive dynamics are characterized by loving, respectful, supportive, and
nurturing relationships. B, C, and E are examples of negative interactions.
33. Which statements about "family roles" are supported by the text? (Select all that apply.)
A. Roles are fixed at birth and never change.
B. Healthy families can adapt to changing roles over time.
C. Roles can include nurturer, disciplinarian, or scapegoat.
D. Understanding role changes is easy for all family members.
E. Changes in roles can affect the balance of family relationships.
Answer: B, C, E.
Explanation: Roles are varied and can change; healthy families adapt. Changes affect relational
balance. Roles are not fixed, and understanding changes can be difficult, especially for children.
34. Which exemplars are listed under "Negative/Dysfunctional Family Dynamics"? (Select all
that apply.)
A. Family reunions
B. Child abuse
C. Celebrating birthdays
D. Intimate partner violence
E. Supportive in-laws
Answer: B, D.
Explanation: Child abuse and intimate partner violence are listed negative exemplars. The
others are positive exemplars.
35. What are the two basic aspects of family functioning assessed in the CFAM's functional
category? (Select all that apply.)
A. Instrumental
B. Financial
C. Expressive
D. Genetic
E. Spiritual
Answer: A, C.
Explanation: Functional assessment addresses instrumental (activities of daily living) and
expressive (communication, roles, beliefs) aspects.
36. Which variables are identified as key to influencing family dynamics? (Select all that apply.)
A. The quality of relationships among members
B. The specific diagnosis of any medical condition
C. The roles of family members
D. The evolving complexity of the family
E. The brand of car the family owns
Answer: A, C, D.
Explanation: The text specifies three key variables: relationship quality, family roles, and
evolving family complexity.
37. A nurse using the Family Dynamics Measure II (FDM II) would assess which dimensions?
(Select all that apply.)
A. Individuation versus enmeshment
B. Serum electrolyte levels
C. Flexibility versus rigidity
D. Clear versus distorted communication
E. Arterial blood gas results
Answer: A, C, D.
Explanation: The FDM II assesses dimensions like individuation/enmeshment,
flexibility/rigidity, and communication clarity. B and E are biomedical measures.
38. In the context of the family stress theory's external context, which factors are included?
(Select all that apply.)
A. The family's philosophical beliefs
B. The economic state of society
C. The family's structure
D. The historical time period
E. The genetic inheritance of members
Answer: B, D, E.
Explanation: The external context includes factors the family cannot control: economic state,
historical time, and genetic inheritance. A and C are part of the internal context.
39. Which statements regarding the use of interventive questions are true? (Select all that apply.)
A. Linear questions focus on gathering cause-and-effect information.
B. Circular questions aim to uncover the family's explanation of problems.
C. Applying these questions effectively requires no special skill.
D. They are intended to elicit change in cognitive, affective, or behavioral domains.
E. Only physicians should use interventive questions.
Answer: A, B, D.
Explanation: Linear and circular questions have distinct purposes and are part of a systematic
approach to elicit change. Their effective application is a skill developed with experience and
can be used by trained nurses.
40. Which of the following are common changes within a family that may occur during a crisis
like job loss due to addiction? (Select all that apply.)
A. Changes in roles and relationships
B. Changes in living arrangements
C. No change in financial obligations
D. Changes in family priorities
E. Increased stability in all areas
Answer: A, B, D.
Explanation: Disruptions can lead to changes in roles, living arrangements, finances, and
priorities. Stability is disrupted, not increased.
True/False – 20 Questions
41. True or False: A genogram is a useful tool for outlining a family's internal and external
structure.
Answer: True.
Explanation: Genograms and ecomaps are tools used in structural assessment to depict family
relationships and structures.
42. True or False: Family dynamics are static and do not evolve over time or with changing
circumstances.
Answer: False.
Explanation: Family dynamics are fluid, flexible, and changeable (dynamic), evolving with
growth, time, and circumstances.
43. True or False: The Calgary Family Intervention Model includes the use of interventive
questions, such as linear and circular questions.
Answer: True.
Explanation: Interventive questions (linear and circular) are a systematic approach within the
Calgary models to introduce questions intended to elicit family change.
44. True or False: "Codependency" is characterized as a positive and supportive pattern of
problem-solving within a family.
Answer: False.
Explanation: Codependency is a dysfunctional pattern of living that occurs in settings of
addiction, abuse, or other pain-causing dysfunctions.
45. True or False: In family systems theory, the behavior of a family member is best understood
by looking for a single, linear cause.
Answer: False.
Explanation: Family systems theory views behaviors through circular causality, where multiple
influences interact in a loop, not a simple linear cause-and-effect.
46. True or False: The "Functional Ability" of family members is an interrelated concept
because its presence or absence can place stress on the family system.
Answer: True.
Explanation: Functional ability affects self-concept and caregiving demands, directly
influencing family dynamics and stress levels.
47. True or False: The purpose of a family assessment using the CFAM is to definitively label a
family as either "healthy" or "dysfunctional."
Answer: False.
Explanation: The assessment provides one perspective at a point in time to understand function,
not to apply a definitive, judgmental label.
48. True or False: "Sibling rivalry" is always a negative exemplar of family dynamics and
indicates serious dysfunction.
Answer: False.
Explanation: Sibling rivalry is common and can be healthy, encouraging excellence. It becomes
a negative exemplar when it involves persistent animosity.
49. True or False: The "Family Life Cycle Theory" suggests that a family's main value lies in its
irreplaceable relationships, not just its roles and functions.
Answer: True.
Explanation: This theory posits that while families have roles, their primary value is in the
unique, irreplaceable relationships among members.
50. True or False: A nurse can assume that a same-sex family will naturally receive strong
support from their families of origin.
Answer: False.
Explanation: The text states same-sex families may not be accepted by or may be estranged
from their families of origin, which can preclude support.
51. True or False: "Validating information, perceptions, or feelings" is listed as a core
intervention for nurses supporting families.
Answer: True.
Explanation: Validation is one of the five core interventions listed in Box 3.1.
52. True or False: The "evolving complexity of the family" decreases when the first child is
born, simplifying relationships.
Answer: False.
Explanation: Complexity increases when moving from a dyad (couple) to a triad (couple +
child), as dynamics become more complex.
53. True or False: A family's "instrumental functioning" includes their communication patterns
and belief systems.
Answer: False.
Explanation: Instrumental functioning refers to routine activities of daily living.
Communication and beliefs are part of expressive functioning.
54. True or False: The absence of an extended family due to geographic mobility can create a
void in social support for a young family.
Answer: True.
Explanation: Absent extended family limits practical help, childcare, and the passing on of
traditions, creating a support void.
55. True or False: The "Family Stress Theory" considers only the internal resources of a family,
not external factors like community support.
Answer: False.
Explanation: Family stress theory explicitly includes the availability and accessibility of
resources (which can be external) as a variable affecting adaptation.
56. True or False: The "Dyadic Adjustment Scale" is a self-report questionnaire administered to
both members of a couple.
Answer: True.
Explanation: This scale is designed to measure adjustment within a dyadic (couple)
relationship.
57. True or False: In the provided case study, the bruising on Monica is not a concern for family
dynamics as it was an isolated incident.
Answer: False.
Explanation: Physical punishment resulting in bruises is a significant indicator of negative
dynamics and potential abuse, requiring attention.
58. True or False: A fundamental purpose of a family, related to the concept of Reproduction,
can involve adoption or blending families, not just biological birth.
Answer: True.
Explanation: The addition of children by birth, adoption, or blending increases family
complexity and is linked to the concept of Reproduction.
59. True or False: According to the text, "family development" and the "family life cycle" are
identical concepts.
Answer: False.
Explanation: Family development considers both predictable and unpredictable events in living
together. The family life cycle describes the typical trajectory.
60. True or False: When conducting a family assessment, the nurse should ask every question in
the CFAM during the first interview.
Answer: False.
Explanation: The text states not all questions are asked at the first interview, and not all are
appropriate for all families.
Application / Scenario-Based Questions – 20 Questions
61. A nurse is caring for a hospitalized patient who is the primary income earner for a family
with three young children. The patient expresses worry about the family's finances and his wife's
ability to manage everything. Using family stress theory, which nursing action is most
appropriate initially?
A. Contact social work immediately to apply for disability.
B. Educate the patient extensively about his medical prognosis.
C. Assess how the patient and his family perceive this illness as a stressor.
D. Tell the patient to stop worrying so he can heal faster.
Answer: C.
Explanation: A core tenet of family stress theory is that the perception of the stressor is key.
The nurse should first assess this perception to understand its impact on adaptation.
62. A community health nurse visits a new mother experiencing postpartum fatigue. The
mother's sister has been staying for two weeks, cooking meals and helping with night feedings.
The husband is adjusting his work schedule. Which assessment of family dynamics is most
accurate?
A. The family is demonstrating dysfunctional enmeshment.
B. The family is demonstrating positive, supportive dynamics.
C. The family has rigid boundaries, refusing external help.
D. The family roles are in conflict, causing stress.
Answer: B.
Explanation: The extended family (sister) and partner are providing nurturance and shared
responsibilities, which are traits of positive, healthy family dynamics.
63. During a clinic visit, a nurse observes a father repeatedly interrupting and answering for his
teenage daughter who has diabetes. The daughter looks at the floor and says nothing. This
interaction best illustrates which concept related to family roles?
A. Clear communication and mutuality
B. Adaptability in changing roles
C. A potential detrimental reciprocal relationship
D. A well-defined generational boundary
Answer: C.
Explanation: The pattern where one member speaks for another, diminishing their voice, can
create a detrimental relationship, potentially fostering dependence or resentment.
64. A nurse using the CFAM is constructing an ecomap with a young couple. The couple lists
their jobs, their healthcare clinic, the wife's mother (who lives nearby), and a close-knit group of
friends. What is the nurse assessing?
A. The family's internal developmental stage
B. The family's structural boundaries and supports
C. The family's expressive communication patterns
D. The family's instrumental problem-solving skills
Answer: B.
Explanation: An ecomap visually assesses structure by mapping relationships and connections
outside the immediate family, showing social supports and boundaries.
65. A family with two school-aged children is struggling after the recent death of the children's
grandfather, who lived with them. The mother says, "The kids are fighting constantly, and my
husband is just withdrawn." Based on family systems theory, how should the nurse interpret this
change?
A. Only the children are affected by the loss; the parents are coping fine.
B. The change in one member (the grandfather's absence) is affecting all members and their
interactions.
C. This is a normal phase of the family life cycle and requires no intervention.
D. The mother is overreacting and causing the family dysfunction.
Answer: B.
Explanation: Family systems theory states a change in one member (including loss) affects all
members and the interactions between them, often disrupting previous dynamics.
66. A nurse plans to use "circular questions" with a family where a child has asthma. Which
question is the best example of a circular question?
A. "What is your child's asthma medication schedule?"
B. "Who in the family is most worried when the child has an asthma attack, and why?"
C. "When did your child first develop asthma?"
D. "Do you understand how to use the inhaler?"
Answer: B.
Explanation: Circular questions explore differences in relationships and the family's
understanding/perceptions ("who...and why?"), rather than seeking linear facts.
67. In the provided case study, the nurse practitioner must respond to Erin's disclosure about
Andrew hurting Monica. What is the nurse's priority legal and ethical action?
A. Advise Erin to simply keep the girls away from Andrew.
B. Validate Erin's feelings but take no further action as it's a family matter.
C. Follow mandatory reporting guidelines for suspected child abuse.
D. Schedule a follow-up appointment in one month to reassess.
Answer: C.
Explanation: Bruises on a child from parental action constitute suspected physical abuse.
Nurses are mandated reporters and must follow legal protocols to ensure child safety.
68. A nurse is discussing healthy aging with a family where the 78-year-old father is beginning
to need assistance with transportation and medication management. The adult son says, "I'll
handle it all; it's my job." The nurse, considering family dynamics, should initially:
A. Praise the son for his responsible attitude.
B. Assess the son's perception of this role and its potential impact on other family relationships.
C. Immediately refer the family to a home health aide service.
D. Tell the daughter in the family that she needs to do more to help.
Answer: B.
Explanation: A sudden assumption of a major caregiver role can strain relationships and the
individual. Assessing perceptions and potential impacts aligns with understanding role changes
and family dynamics.
69. During a family assessment, a nurse learns that a recently immigrated family adheres to a
cultural norm where all health decisions are made by the eldest male. A teenage daughter
disagrees with a treatment plan. The nurse understands that:
A. The nurse should override the cultural norm to respect the daughter's autonomy.
B. Culture is an interrelated concept that directly affects family dynamics and health behaviors.
C. Cultural beliefs are irrelevant to providing medically correct care.
D. The family is clearly dysfunctional due to this hierarchical structure.
Answer: B.
Explanation: Culture is a key interrelated concept that shapes family roles, decision-making,
and health behaviors, which the nurse must understand and respect while providing care.
70. A couple is experiencing significant stress after a preterm birth. They blame each other for
the early delivery and are arguing in the hospital room. This is an example of which negative
exemplar of family dynamics?
A. Positive family support
B. Caregiver role strain
C. Placing blame for a preterm birth
D. Healthy conflict resolution
Answer: C.
Explanation: Placing blame for the birth of a preterm infant is specifically listed as a
negative/dysfunctional family dynamic exemplar.
71. A nurse is working with a "married-blended family" where each parent has children from a
previous relationship. The parents report tension between the stepsiblings. The nurse knows that,
according to the text, this family configuration:
A. Is mutually exclusive from other classifications like "cohabiting-parent family."
B. Naturally has less complex dynamics than a nuclear family.
C. Can also be represented by other classifications, such as "married-parent family."
D. Is not considered a true family because they are not related by blood.
Answer: C.
Explanation: Family configurations are not mutually exclusive. A married-blended family with
children also fits the classifications of married-parent family.
72. A nurse wants to assess the "affective domain" of family functioning using an interventive
question. Which question best targets this domain?
A. "Who usually takes out the garbage?" (Behavioral)
B. "What do you believe caused this problem?" (Cognitive)
C. "How did you feel when that happened?" (Affective)
D. "When did you last see the doctor?" (Linear)
Answer: C.
Explanation: A question asking about feelings directly targets the affective (emotional) domain
of family functioning.
73. A family is being assessed because their adolescent son was diagnosed with depression. The
mother states, "This is just a phase; he needs to toughen up." The father says nothing but looks
away. This demonstrates a potential issue with which aspect of family functioning?
A. Instrumental functioning—they are not preparing meals correctly.
B. Expressive functioning—there may be unclear communication and denial.
C. Structural functioning—the family has too few members.
D. Developmental functioning—they are in the wrong life cycle stage.
Answer: B.
Explanation: Minimizing the problem ("just a phase") and lack of verbal engagement suggest
issues with expressive functioning, which includes communication and problem-solving.
74. Using the structural-functional theory, a nurse observes that a family facing unemployment
has redefined roles: the teen now works a part-time job, and the spouse who lost their job handles
all household chores. The nurse interprets this as:
A. A failure to maintain equilibrium, leading to dysfunction.
B. A healthy adaptation to maintain family equilibrium and function.
C. A sign of enmeshment and poor boundaries.
D. An example of circular causality in action.
Answer: B.
Explanation: Structural-functional theory focuses on roles maintaining equilibrium. Adapting
and adjusting roles in response to a crisis is a sign of healthy functioning to restore stability.
75. A nurse is counseling a family where one adult child is the primary caregiver for a parent
with dementia. The caregiver sibling expresses resentment that their other siblings are not
helping. This situation best illustrates the interrelated concept of:
A. Reproduction, due to the family's genetic link.
B. Functional Ability, as the loss of ability in one member stresses others.
C. Culture, as it dictates caregiving norms.
D. Spirituality, as it provides the only coping mechanism.
Answer: B.
Explanation: The parent's decline in functional ability places stress on the caregiver sibling, and
the unequal sharing of this burden can lead to resentment and dysfunctional dynamics.
76. After a family assessment reveals high conflict and poor communication, the nurse and
family set a goal: "Family members will practice using 'I feel' statements during one discussion
per day." This intervention is best categorized as:
A. An advanced intervention requiring a psychiatric nurse.
B. A core intervention aimed at facilitating communication.
C. An inappropriate intervention that oversimplifies the problem.
D. An intervention focused solely on instrumental functioning.
Answer: B.
Explanation: Facilitating and improving communication is a core nursing intervention
applicable across practice areas to support positive dynamics.
77. A nurse reads in a chart: "Family dynamics assessment via FACES IV indicates low
cohesion and rigid flexibility." The nurse anticipates the family may exhibit which traits?
A. Strong emotional bonding and adaptable role relationships.
B. Emotional distance and difficulty changing roles or rules.
C. Clear communication and shared decision-making.
D. High levels of expressed affection and consensus.
Answer: B.
Explanation: Low cohesion means weak emotional bonding. Rigid flexibility means difficulty
changing leadership, roles, or rules.
78. During a home visit, a nurse notices that a child with chronic illness receives excessive
attention, while a well sibling's achievements are ignored. The nurse identifies this as a risk for
which issue?
A. Enhanced self-esteem in the well sibling.
B. Sibling rivalry and potential resentment.
C. Improved coping in the ill child.
D. Stronger parental alliance.
Answer: B.
Explanation: Unequal attention and perceived favoritism are classic precursors to sibling rivalry
and can foster long-term resentment.
79. A nurse is using the "Family Dynamics Measure II (FDM II)." The family scores high on
"individuation" and "mutuality." This suggests the family likely has:
A. Enmeshed relationships and isolation.
B. Clear personal boundaries alongside caring connections.
C. Role confusion and conflict.
D. Unclear and distorted communication patterns.
Answer: B.
Explanation: High individuation means members maintain a sense of self (not enmeshed). High
mutuality means caring, interconnected relationships (not isolated). This is a healthy
combination.
80. A new nurse says, "If a family is dysfunctional, my job is to tell them what to do to fix it."
How should the preceptor respond based on best practice in family nursing?
A. "Yes, being directive is most efficient."
B. "No, we should avoid 'I know what's best' and instead collaborate with the family to set
goals."
C. "Only if the doctor gives you permission to give advice."
D. "Dysfunctional families rarely change, so minimal intervention is best."
Answer: B.
Explanation: Effective family nursing involves collaboration and avoiding a paternalistic
attitude. Goals are determined by the family with nurse support.
Flashcards / Quick Recall Items – 20 Items
81. Q: What is the simple, helpful definition of "family" offered by Kaakinen?
A: "Family refers to two or more individuals who depend on one another for emotional, physical,
and economic support. The members of the family are self-defined."
82. Q: Define "Family Dynamics."
A: The interrelationships between and among individual family members or "the forces at work
within a family that produce particular behaviors or symptoms."
83. Q: Name the three key variables that influence family dynamics.
A: 1. Quality of relationships among members. 2. Roles of family members. 3. Evolving
complexity of the family.
84. Q: What are the three major categories of the Calgary Family Assessment Model (CFAM)?
A: Structural, Developmental, Functional.
85. Q: What is the primary difference between "linear" and "circular" interventive questions?
A: Linear questions gather cause-and-effect information. Circular questions explore the family's
understanding of problems and differences in relationships.
86. Q: What are the five core interventions for supporting family dynamics?
A: Providing education, facilitating conversations, enhancing understandings, sharing
observations, validating information/perceptions/feelings.
87. Q: According to family systems theory, what is "circular causality"?
A: The idea that a change in one family member affects all members, and the family's change in
turn affects that individual, creating a circular pattern of influence.
88. Q: What is the focus of Family Stress Theory?
A: The way families react to stress, focusing on variables like perception of the stressor, existing
stressors, family resilience, commitment, and resources.
89. Q: What is "codependency" in the context of family dynamics?
A: A dysfunctional pattern of living where a person is controlled/manipulated by another who
has an illness or addiction.
90. Q: What tool provides a visual depiction of a family's social and personal relationships?
A: An ecomap.
91. Q: What are the two basic aspects of family functioning assessed in a functional assessment?
A: Instrumental (activities of daily living) and Expressive (communication, roles, beliefs,
problem-solving).
92. Q: In the context of family dynamics, what does "scope" refer to?
A: A continuum ranging from positive/healthy to negative/dysfunctional.
93. Q: What is a "genogram" used for in family assessment?
A: To outline/diagram the family's internal structure, including relationships across generations.
94. Q: Name one self-report tool designed to assess family cohesion and flexibility.
A: Family Adaptability and Cohesion Evaluation Scales (FACES IV).
95. Q: What interrelated concept involves beliefs passed through generations that affect health
behaviors and family roles?
A: Culture.
96. Q: What is "sibling rivalry"?
A: Competition or animosity between siblings.
97. Q: Which theory views the family as a social system with specific roles (e.g., mother, father)
that function to maintain equilibrium?
A: Structural-Functional Theory.
98. Q: What is a "detrimental reciprocal relationship" within a family? Give an example.
A: A harmful interactive pattern. Example: Designating one member as the family scapegoat.
99. Q: What is the primary goal of using the Calgary Family Intervention Model's interventive
questions?
A: To elicit change in the family's cognitive, affective, and behavioral domains.
100. Q: According to the text, what is the foundational reason nurses must understand family
dynamics?
A: Because family dynamics influence the delivery of health care to individuals; the family acts
as a support system or lack thereof.
UNIT 4 CONCPET 4: Concepts of Culture in Health & Illness – Quiz & Flashcard Set
Multiple-Choice Questions (MCQs) (20 unique questions)
1. A nursing student observes a patient experiencing uncontrollable trembling and shouting after a
family conflict. The student recognizes this cluster of symptoms as ataque de nervios. This is
best understood as an example of:
A) A strictly biomedical disease process.
B) A culture-bound syndrome.
C) A symptom of assimilation.
D) A genetic neurological disorder.
Answer: B) A culture-bound syndrome.
Explanation: Ataque de nervios is a specific cultural idiom of distress recognized within Latino-
Caribbean cultures.
2. A public health nurse aims to address the higher rates of untreated depression in a refugee
community. According to the interrelated concepts, which barrier is most culturally relevant?
A) Lack of available antidepressants.
B) Stigma associated with mental illness.
C) Over-reliance on technology.
D) Excessive health literacy.
Answer: B) Stigma associated with mental illness.
Explanation: Cultural values, including stigma about mental illness and reluctance to share
personal problems, create significant barriers to treatment engagement.
3. When using the RESPECT model, a nurse asks, "What do you fear most about the sickness?"
This question aligns with assessing which component?
A) Respect
B) Explanatory Model
C) Concerns and Fears
D) Therapeutic Alliance
Answer: C) Concerns and Fears
Explanation: This direct question aims to uncover the patient's specific anxieties related to their
illness.
4. In a culture characterized by high collectivism, a nurse planning discharge for an elderly patient
should prioritize:
A) Ensuring the patient can perform all self-care independently.
B) Arranging for individual home health services only.
C) Consulting with and incorporating the patient's extended family.
D) Focusing solely on the patient's personal goals for recovery.
Answer: C) Consulting with and incorporating the patient's extended family.
Explanation: Collectivist cultures value interdependence, and family roles are central to
caregiving and decision-making.
5. The theory that posits all illnesses are a form of social suffering shaped by cultural and political
institutions is the:
A) Leininger's Theory of Culture Care.
B) Interprofessional Theory of Social Suffering.
C) Health Belief Model.
D) Theory of Planned Behavior.
Answer: B) Interprofessional Theory of Social Suffering.
Explanation: This theory views illnesses like depression or AIDS as reflections of social
structures and inequities, not just individual pathologies.
6. A patient from a culture with a "long-term orientation" is most likely to:
A) Seek medical care only when symptoms are severe.
B) Value preventive screenings and health maintenance.
C) Prioritize immediate symptom relief over long-term treatment.
D) Reject new medical technologies in favor of tradition.
Answer: B) Value preventive screenings and health maintenance.
Explanation: A long-term orientation favors future planning and perseverance, aligning with
engaging in preventive health behaviors.
7. During an assessment, a nurse learns a patient uses herbal remedies purchased from a botánica.
The nurse's best response is to:
A) Discourage the use of all non-prescribed remedies.
B) Document this as non-adherence to the treatment plan.
C) Ask about the remedies in a non-judgmental way to understand the patient's complete health
practices.
D) Report the use to the primary care provider as a potential risk.
Answer: C) Ask about the remedies in a non-judgmental way to understand the patient's
complete health practices.
Explanation: This demonstrates cultural skill and respect for the patient's explanatory model and
health practices, which is foundational for collaborative care.
8. The process by which a dominant culture's values are imposed upon a less dominant group,
leading to a loss of original identity, is called:
A) Acculturation.
B) Enculturation.
C) Biculturalism.
D) Assimilation.
Answer: D) Assimilation.
Explanation: Assimilation involves being absorbed into a dominant culture, often without
choice, contrasting with the mutual change in acculturation.
9. A nurse is caring for a patient who consistently agrees with every recommendation without
asking questions. Considering cultural dimensions, this may indicate the patient comes from a
background with:
A) Low power distance.
B) High individualism.
C) High power distance.
D) A short-term orientation.
Answer: C) High power distance.
Explanation: In cultures with high power distance, challenging or questioning authority figures
is uncommon, which may be misinterpreted as agreement or understanding.
10. Which statement best reflects the "psychic unity" theory of human behavior?
A) Cultural differences are the primary drivers of human emotion.
B) All human social behavior is universally derived from evolution.
C) Genes and environment interact equally in all cultures.
D) Religion is the main force shaping cultural norms.
Answer: B) All human social behavior is universally derived from evolution.
Explanation: This theory posits universal, biologically-derived origins for behavior, historically
minimizing the role of culture.
11. When a nurse reflects on her own discomfort with a patient's alternative healing ritual, she is
engaging in which component of cultural competence development?
A) Cultural Knowledge
B) Cultural Skill
C) Self-Awareness
D) Cultural Desire
Answer: C) Self-Awareness
Explanation: Self-awareness involves examining one's own cultural identity, biases, and
reactions.
12. A key tenet of providing culturally competent care, according to the text, is to avoid:
A) Using medical interpreters.
B) Treating every patient exactly the same.
C) Documenting cultural preferences.
D) Asking about family structure.
Answer: B) Treating every patient exactly the same.
Explanation: Treating everyone the same ignores the societal factors and unique cultural
experiences that impact health and healthcare interactions.
13. In the context of health, "fatalism" most closely relates to which concept?
A) An internal locus of control.
B) A belief in personal responsibility for health.
C) An external locus of control.
D) High self-efficacy.
Answer: C) An external locus of control.
Explanation: Fatalism is the belief that outcomes are predetermined or out of one's personal
control, which is an external locus of control.
14. Which of the following is considered an "etic" approach to understanding culture?
A) Learning a healing practice from a community elder.
B) Applying a standardized depression screening tool to all patients.
C) Asking a family to explain their mourning rituals.
D) Participating in a traditional meal.
Answer: B) Applying a standardized depression screening tool to all patients.
Explanation: An etic approach applies external, often universal, constructs to a culture. A
standardized tool is developed outside the specific cultural context.
15. The concept that gender roles are distinct and valued differently across cultures is described by
Hofstede's dimension of:
A) Power Distance.
B) Individualism vs. Collectivism.
C) Masculinity vs. Femininity.
D) Long-term vs. Short-term Orientation.
Answer: C) Masculinity vs. Femininity.
Explanation: This dimension describes how cultures conceive gender roles and whether they
value traditionally masculine or feminine attributes.
16. Which action by a nurse best demonstrates "cultural desire"?
A) Memorizing common phrases in three languages.
B) Expressing curiosity about a patient's immigration journey.
C) Correcting a patient's misconceptions about disease.
D) Following a hospital's cultural assessment protocol.
Answer: B) Expressing curiosity about a patient's immigration journey.
Explanation: Cultural desire is the motivation and genuine interest to understand others'
experiences, which drives further learning and skill development.
17. A patient's belief that illness is a punishment from God falls under which category of causal
belief?
A) Natural
B) Biomedical
C) Social
D) Supernatural
Answer: D) Supernatural
Explanation: Supernatural causal beliefs involve deities, spirits, or metaphysical forces.
18. The nursing diagnosis of "compromised self-esteem" may be culturally biased because it:
A) Is only relevant for psychiatric patients.
B) Assumes a universal, independent concept of self.
C) Cannot be measured objectively.
D) Ignores physiological factors.
Answer: B) Assumes a universal, independent concept of self.
Explanation: In interdependent cultures, the self is defined by relationships, making an
independent "self-esteem" diagnosis potentially misaligned with the patient's worldview.
19. Which demographic trend underscores the necessity for cultural competence in U.S. nursing?
A) Decreasing overall population.
B) Aging of all ethnic groups at equal rates.
C) Increasing diversity, with non-Hispanic whites becoming a smaller percentage.
D) Uniform distribution of healthcare resources.
Answer: C) Increasing diversity, with non-Hispanic whites becoming a smaller percentage.
Explanation: The text highlights increasing diversity, projecting non-Hispanic whites to be 50%
of the population by 2050, making cultural competence imperative.
20. When a traditional healing practice directly contradicts a prescribed medical treatment, the
nurse's priority is to:
A) Forbid the traditional practice.
B) Acknowledge the conflict and facilitate a discussion between the patient, family, and
healthcare team.
C) Inform the provider so the treatment can be enforced.
D) Ignore the traditional practice as irrelevant.
Answer: B) Acknowledge the conflict and facilitate a discussion between the patient,
family, and healthcare team.
Explanation: This approach respects the patient's culture, promotes safety, and aligns with the
goal of creating a collaborative, therapeutic alliance.
Multiple-Response / Select-All-That-Apply (15 unique questions)
21. Which of the following are considered subcultures, as described in the text? (Select all that
apply.)
A) The nursing profession
B) People living in poverty
C) Teenagers
D) Only groups based on race or ethnicity
E) Persons with disabilities
Answer: A, B, C, E
Explanation: Subcultures include any group sharing roles, values, and norms, such as
professions, socioeconomic groups, age cohorts, and shared life experiences like disability.
22. Which factors are included in the "sociocultural context" component of the RESPECT model?
(Select all that apply.)
A) The pathogen causing infection.
B) Poverty and social support.
C) The patient's explanation of cause.
D) Stress levels.
E) The dosage of medication.
Answer: B, D
Explanation: Sociocultural context encompasses life factors like poverty, stress, and support
systems that influence health.
23. According to the text, which groups experience health disparities linked to cultural and social
factors? (Select all that apply.)
A) Racial and ethnic minorities
B) Persons with disabilities
C) Lesbian, gay, bisexual, or transgender persons
D) Only individuals with limited English proficiency
E) People living in poverty
Answer: A, B, C, E
Explanation: Health disparities adversely affect groups based on race, ethnicity, disability,
sexual orientation, socioeconomic status, and other characteristics linked to discrimination.
24. Which statements are true about the attribute "Culture is learned"? (Select all that apply.)
A) It occurs only in childhood.
B) It happens through families and group members.
C) It is synonymous with genetic inheritance.
D) It can occur through socialization into subcultures later in life.
E) It is a static process.
Answer: B, D
Explanation: Culture is learned through socialization/enculturation, primarily but not
exclusively in youth, and includes learning the norms of subcultures.
25. What are overt, visible attributes of culture? (Select all that apply.)
A) Values and beliefs
B) Language
C) Relationship to authority
D) Dietary practices
E) Manner of dress
Answer: B, D, E
Explanation: Overt attributes are readily apparent to outsiders and include language, dress,
food, and rituals.
26. Which concepts are identified as closely interrelated with Culture in Figure 4.2? (Select all that
apply.)
A) Health Disparities
B) Family Dynamics
C) Gas Exchange
D) Communication
E) Tissue Integrity
Answer: A, B, D
Explanation: The interrelated concepts diagram includes Health Disparities, Family Dynamics,
Ethics, Spirituality, Communication, Stress and Coping, Fatigue, and Mood and Affect.
27. Barriers to mental health treatment for racial/ethnic minorities include: (Select all that apply.)
A) Cultural matching with providers, which worsens outcomes.
B) Stigma about mental illness.
C) A value on self-sufficiency.
D) Lack of available effective treatments.
E) Reluctance to share personal problems outside the family.
Answer: B, C, E
Explanation: Cultural values like stigma, self-sufficiency, and keeping problems within the
family are noted as key barriers to treatment engagement.
28. In conducting a cultural assessment, which topics should be included under "Personal Beliefs
About Health, Illness"? (Select all that apply.)
A) Meaning and cause of illness
B) Use of folk remedies
C) Dietary preferences
D) Expectations for treatment
E) Place of birth
Answer: A, B, D
Explanation: Personal beliefs encompass meaning, cause, severity, control, treatment
expectations, and use of alternative remedies. Dietary preferences and origins are separate
categories.
29. Which exemplars fall under "Patient-Provider Communication"? (Select all that apply.)
A) Language preference
B) Dietary practices
C) Power distance
D) Nonverbal communication
E) Childrearing practices
Answer: A, C, D
Explanation: Patient-provider communication exemplars include language, nonverbal cues,
power distance, taboos, and expression of emotion.
30. What factors contribute to population migration as discussed in the text? (Select all that apply.)
A) Environmental catastrophes
B) Religious conflicts
C) Universal healthcare access
D) Economic changes
E) Regional overpopulation
Answer: A, B, D, E
Explanation: Migration is driven by "push" factors like overpopulation, economic hardship,
catastrophes, and conflict.
31. Which components are part of the "Data Collected as Part of Cultural Assessment"? (Select all
that apply.)
A) Origins and Family
B) Complete Blood Count results
C) Communication
D) Radiography findings
E) Personal Beliefs About Health
Answer: A, C, E
Explanation: The cultural assessment data categories are Origins and Family, Communication,
Personal Beliefs About Health, Illness, and Daily Practices.
32. True statements about "ethnicity" include: (Select all that apply.)
A) It is based on shared ancestry.
B) It is transmitted across generations by family.
C) It is defined by biological race.
D) It is a powerful determinant of identity.
E) It is unrelated to shared values.
Answer: A, B, D
Explanation: Ethnicity is a social concept based on common ancestry leading to shared values
and identity, transmitted through family and community.
33. Which actions help a nurse develop cultural "knowledge"? (Select all that apply.)
A) Reading novels from diverse authors.
B) Attending a professional conference on health equity.
C) Assuming all members of a culture think alike.
D) Visiting an ethnic grocery store.
E) Memorizing a list of stereotypes.
Answer: A, B, D
Explanation: Gaining knowledge involves immersive and respectful exposure to other cultures,
not stereotyping.
34. What does the "Power" component of the RESPECT model acknowledge? (Select all that apply.)
A) The patient and provider have equal control in the healthcare setting.
B) Patients are in a vulnerable position.
C) Providers have more access to resources and knowledge.
D) Power differentials do not affect communication.
E) Acknowledging power can enhance the therapeutic alliance.
Answer: B, C, E
Explanation: The model acknowledges the inherent power imbalance (vulnerability, resource
access) and that recognizing it can build trust.
35. Which are exemplars of "Family Roles" in the context of culture? (Select all that apply.)
A) Birth rituals
B) Decision-making structure
C) Symptom expression
D) Caregiver roles
E) Use of interpreters
Answer: A, B, D
Explanation: Family roles exemplars include birthrights, childrearing, gender roles, family
structure, decision-making, death rituals, and caregiver roles.
True/False or Short Answer Variants (25 unique questions)
36. True or False: The Western biomedical model defines illness strictly in terms of
pathophysiological changes.
Answer: True
Explanation: The biomedical model focuses on disease as a physiologic malfunction, in contrast
to more holistic traditional models.
37. Fill in the blank: The process of acquiring new attitudes and behaviors from contact with
another culture, affecting both groups, is ________.
Answer: acculturation
38. True or False: Shenjing shuairuo is a biomedical diagnosis used primarily in Western
psychiatry.
Answer: False
Explanation: Shenjing shuairuo ("weakness of nerves") is a culture-bound syndrome described
in the Chinese Classification of Mental Disorders.
39. Fill in the blank: The belief that all people deserve quality health care is nursing's tenet of
________ ________.
Answer: social justice
40. True or False: "Cultural competency" and "treating everyone the same" are synonymous
concepts in nursing.
Answer: False
Explanation: Cultural competency requires recognizing and respecting differences, not ignoring
them by treating everyone identically.
41. Fill in the blank: The dimension of culture that deals with the acceptance of hierarchy is
________ ________.
Answer: power distance
42. True or False: According to the text, there are more genetic differences within a racially labeled
group than between different racially labeled groups.
Answer: True
Explanation: The text states there are more genetic differences among people labeled "black"
than between "blacks" and "whites," challenging biologic concepts of race.
43. Fill in the blank: A ________ is a forbidden action based on moral or religious beliefs within a
culture.
Answer: taboo
44. True or False: Spirituality and religiosity are identical concepts.
Answer: False
Explanation: Religiosity involves organized, institutional practices. Spirituality is an
individualistic connection to a higher power, which may exist outside organized religion.
45. Fill in the blank: In the case study, Mr. Wong's stoicism about pain and avoidance of mental
health talk was interpreted through his traditional ________ beliefs.
Answer: Chinese
46. True or False: Assimilation is always a voluntary and chosen process for the minority
individual.
Answer: False
Explanation: Assimilation often involves imposition of the dominant culture's values, not a free
choice about what aspects to adopt.
47. Fill in the blank: The acronym RESPECT stands for Respect, Explanatory model, Sociocultural
context, Power, Empathy, Concerns and fears, and Therapeutic alliance/________.
Answer: trust
48. True or False: A patient with an "interdependent self-concept" views their identity as separate
from their family and social environment.
Answer: False
Explanation: An interdependent self-concept is defined by relationships to others, not separation
from them.
49. Fill in the blank: Leininger's theory emphasizes that both ________ (insider) and ________
(outsider) perspectives are needed for holistic care.
Answer: emic, etic
50. True or False: Healthy People 2030 emphasizes the need to improve health literacy only for
English-speaking populations.
Answer: False
Explanation: It emphasizes improving health literacy and education specifically among non-
English-speaking populations.
51. Fill in the blank: The theory that genes interact with the environment to produce emotional
responses supports the idea that behavior is not ________-free.
Answer: culture
52. True or False: Rubin defines expert nursing as the ability to follow standardized protocols
without deviation.
Answer: False
Explanation: Expert nursing is defined as the ability to recognize qualitative distinctions
between patients, requiring empathy.
53. Fill in the blank: When symptoms like backaches and fatigue are expressed instead of low
mood, it is described as ________ of mental distress.
Answer: somatization
54. True or False: Cultural competence is only important for nurses working in foreign countries.
Answer: False
Explanation: Due to increasing domestic diversity and health disparities, cultural competence is
essential for all nursing practice.
55. Fill in the blank: A pivotal first step in cultural competence that involves personal motivation is
cultural ________.
Answer: desire
56. True or False: Biculturalism means an individual must choose one cultural identity over
another.
Answer: False
Explanation: Biculturalism involves maintaining a dual pattern of identification, choosing
aspects from both cultures to retain.
57. Fill in the blank: The concept that illness experiences are shaped by collective memories within
a group is part of the ________ Theory of Social Suffering.
Answer: Interprofessional
58. True or False: "Ethnic identity" and "race" are interchangeable terms.
Answer: False
Explanation: Ethnic identity is based on shared ancestry and culture. Race is a social construct
often mistakenly based on biology.
59. Fill in the blank: In Hofstede's dimensions, the United States is characterized as having a
________-term orientation.
Answer: short
60. True or False: Unconscious biases of healthcare providers have been shown to contribute to
treatment disparities.
Answer: True
Explanation: The text states that provider unconscious biases contribute to disparities, even
though providers may deny this factor.
Application / Scenario-Based Questions (15 unique questions)
61. A nurse is planning care for a patient from a culture where maintaining harmony is valued over
individual achievement. Which nursing intervention would likely be least effective?
A) Developing goals that promote family involvement in care.
B) Encouraging the patient to assert personal needs over family wishes.
C) Facilitating a family conference to discuss treatment options.
D) Asking the patient, "How can we best help your family support you?"
Answer: B) Encouraging the patient to assert personal needs over family wishes.
Explanation: This intervention contradicts the collectivist value of harmony and
interdependence, potentially causing distress.
62. A patient with limited English proficiency (LEP) is being discharged. The nurse has printed
instructions in English. What is the nurse's best next action?
A) Give the instructions and ask if they have any questions.
B) Provide the instructions and ensure a family member who speaks English is present.
C) Use a qualified medical interpreter to explain the instructions in the patient's preferred
language.
D) Tell the patient to call the doctor if they have trouble understanding.
Answer: C) Use a qualified medical interpreter to explain the instructions in the patient's
preferred language.
Explanation: This ensures accurate comprehension, promotes safety, and adheres to standards
for caring for patients with LEP.
63. During a cultural assessment, a patient states they believe their cancer is a punishment for past
sins. How should the nurse initially respond?
A) "That is a common misconception; cancer is caused by genetic mutations."
B) "Let's focus on the chemotherapy plan instead."
C) "Can you tell me more about what that means for you and your treatment?"
D) "You should discuss this with a hospital chaplain."
Answer: C) "Can you tell me more about what that means for you and your treatment?"
Explanation: This open-ended response acknowledges the patient's explanatory model without
judgment and seeks to understand its impact, building the therapeutic alliance.
64. A nurse is assessing a patient who uses a wheelchair. The nurse says, "I admire how you
overcome your disability every day." This statement primarily reflects:
A) Cultural competence.
B) A strength-based perspective.
C) An unconscious bias equating disability with suffering to be overcome.
D) Effective therapeutic communication.
Answer: C) An unconscious bias equating disability with suffering to be overcome.
Explanation: This assumes disability is a tragic deficit, which can be offensive. Many in
disability culture view it as a neutral identity, not a problem to overcome.
65. A Mexican-American patient requests a curandero visit alongside hospital care. The nurse's most
culturally competent action is to:
A) Explain that only hospital-provided services are allowed.
B) Facilitate a discussion between the curandero, the patient, and the healthcare team to
coordinate safe care.
C) Allow the visit but not document it to avoid conflict.
D) Request a psychiatric consult for delusional thinking.
Answer: B) Facilitate a discussion between the curandero, the patient, and the healthcare
team to coordinate safe care.
Explanation: This respects the patient's cultural practices, promotes holistic care, and ensures
safety through collaboration.
66. An elderly Korean patient is admitted. The nurse notices the patient's son answers all questions
directed at the patient. The nurse should:
A) Insist the patient answer for themselves to assess mental status.
B) Accept this as a potential cultural norm regarding respect for elders and family roles, and
address both respectfully.
C) Ask the son to leave the room to ensure patient confidentiality.
D) Document the patient as non-communicative.
Answer: B) Accept this as a potential cultural norm regarding respect for elders and family
roles, and address both respectfully.
Explanation: In many cultures, family members act as advocates and spokespersons. The nurse
should work within this structure while still engaging the patient.
67. A community health nurse notes low participation in a breast cancer screening program among a
particular cultural group. Applying the concept of "taboos," the nurse should first consider that:
A) The group has a genetic resistance to cancer.
B) There may be cultural stigma or modesty concerns around discussing or exposing the body.
C) The group lacks education about cancer.
D) The screening times are inconvenient.
Answer: B) There may be cultural stigma or modesty concerns around discussing or
exposing the body.
Explanation: Taboos can make certain illnesses or body-related procedures highly stigmatized,
deterring participation in preventive care.
68. A nurse is preparing to administer a pork-derived medication to a Muslim patient. The nurse
checks the ingredients, finds pork, and holds the dose. What should the nurse do next?
A) Administer it anyway, as it's medically necessary.
B) Hold the dose and immediately consult the pharmacist and provider to find an alternative.
C) Crush the medication and hide it in food.
D) Ask the patient if their religion is "really that strict."
Answer: B) Hold the dose and immediately consult the pharmacist and provider to find an
alternative.
Explanation: This action respects a major religious dietary prohibition (a potential taboo),
ensures ethical care, and maintains patient trust while addressing the medical need.
69. A patient from a high power distance culture is not taking their prescribed medication. The nurse
has already provided clear instructions. The best next approach is to:
A) Scold the patient for non-adherence.
B) Ask the patient, "Can you help me understand any concerns you have about this medicine?" in
a respectful manner.
C) Tell the patient the doctor will be angry if they don't comply.
D) Document as non-compliant and move on.
Answer: B) Ask the patient, "Can you help me understand any concerns you have about
this medicine?" in a respectful manner.
Explanation: A respectful, open-ended question from a position of authority (the nurse) may
elicit concerns the patient felt unable to voice initially due to the power dynamic.
70. A postpartum nurse cares for a Hmong patient who practices "mother roasting." The nurse
should:
A) Prohibit the practice due to infection risk from heated stones.
B) Provide a safe space for the practice, such as ensuring proper ventilation and monitoring for
burns, while integrating it into the plan of care.
C) Report the family for child endangerment.
D) Ignore it as it's not a medical treatment.
Answer: B) Provide a safe space for the practice, such as ensuring proper ventilation and
monitoring for burns, while integrating it into the plan of care.
Explanation: This demonstrates cultural accommodation—respecting a culturally important
healing practice while using nursing knowledge to mitigate any risks.
71. During report, a nurse says, "The patient in 402 is being difficult about pain meds; they keep
refusing even though they're in pain." Another nurse considers cultural influences. What question
should this nurse ask first?
A) "What is the patient's pain score?"
B) "What is the patient's cultural background?"
C) "Have you called the doctor?"
D) "Are they addicted to drugs?"
Answer: B) "What is the patient's cultural background?"
Explanation: Expression and management of pain are highly culturally influenced.
Understanding the cultural context is essential for appropriate assessment and intervention.
72. A nurse plans to use an online translation app to obtain a patient's full medical history. The main
problem with this plan is that:
A) Apps are too expensive.
B) Apps cannot translate medical terminology.
C) Apps lack the nuance for complex conversations and cannot ensure confidentiality or
accuracy like a qualified human interpreter.
D) It takes too much time.
Answer: C) Apps lack the nuance for complex conversations and cannot ensure
confidentiality or accuracy like a qualified human interpreter.
Explanation: For obtaining a history—a complex, nuanced interaction—a qualified interpreter is
the standard of care to ensure accuracy, cultural nuance, and confidentiality.
73. A nurse values punctuality and efficiency. Her patient, from a culture with a more flexible view
of time, arrives 30 minutes late for every appointment. The nurse feels frustrated. To provide
culturally competent care, the nurse needs to develop:
A) A stricter late policy.
B) Greater self-awareness about her own cultural values around time.
C) A referral for the patient to a more flexible clinic.
D) Disregard for appointment times altogether.
Answer: B) Greater self-awareness about her own cultural values around time.
Explanation: Recognizing one's own cultural values (like monochronic time) as not universal is
a key part of self-awareness, preventing bias from affecting the therapeutic relationship.
74. A Filipino patient frequently mentions "God's will" when discussing their chronic illness
prognosis. To build a therapeutic alliance, the nurse should respond by:
A) Reassuring the patient that modern medicine can control the disease.
B) Saying, "I understand that your faith is important to you. How can we work together within
your beliefs to manage your symptoms?"
C) Changing the subject to treatment plans.
D) Agreeing that nothing can be done.
Answer: B) Saying, "I understand that your faith is important to you. How can we work
together within your beliefs to manage your symptoms?"
Explanation: This validates the patient's spirituality (a key cultural dimension), integrates it into
care, and promotes collaboration.
75. A veteran with PTSD from combat avoids discussing his trauma, stating, "Real men don't talk
about that stuff." This reflects the intersection of culture and which concept?
A) Mood and Affect
B) Family Dynamics
C) Adherence
D) Stress and Coping
Answer: D) Stress and Coping
Explanation: His coping strategy (silent endurance) is shaped by cultural norms around
masculinity and suffering, directly relating to the concept of Stress and Coping.
Flashcards / Quick Recall Items (15 Unique ones)
76. Q: What are the three defining attributes common to all cultures?
A: Culture is learned, shared, and adaptive/changeable.
77. Q: What is the primary difference between disease and illness in Kleinman's model?
A: Disease is the biomedical malfunction; illness is the personal, social, and cultural experience
of being unwell.
78. Q: Name two causal belief categories for illness in non-Western explanatory models.
A: Natural, social, and supernatural. (Any two)
79. Q: What does the "R" in the RESPECT model stand for?
A: Respect.
80. Q: Define "ethnic identity."
A: The powerful sense of self derived from one's ethnicity (shared ancestry and culture).
81. Q: What demographic group is currently more likely to be a minority than white in the 0-9 age
range in the U.S.?
A: Children.
82. Q: According to the text, what are the two main processes that change culture?
A: Enculturation and acculturation. (Also adaptation, globalization, migration)
83. Q: What is the "culture of poverty" an example of?
A: A subculture based on shared socioeconomic experiences.
84. Q: In a cultural assessment, what does "Origins and Family" data include?
A: Place of birth, time in U.S., decision-making in family, cultural identification, social network.
85. Q: What is one consequence when suicide is outlawed in a country?
A: It creates an additional deterrent for individuals contemplating seeking treatment.
86. Q: What is the ultimate goal of Leininger's Theory of Culture Care?
A: To provide culturally congruent, meaningful, and holistic nursing care.
87. Q: What is the name of the syndrome characterized by fatigue, weakness, and dizziness in
Chinese culture?
A: Shenjing shuairuo (weakness of nerves).
88. Q: Which dimension of culture involves valuing thrift and perseverance for future rewards?
A: Long-term orientation.
89. Q: What is the term for the loss of power and control a patient may feel in a healthcare setting?
A: Vulnerability (addressed in the "Power" component of RESPECT).
90. Q: Name one interrelated concept that is influenced by how a culture defines self and
relationships.
A: Family Dynamics, Communication, or Stress and Coping. (Any one)
