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thecoleopterawithana · 5 years

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The Beatles and Dysfunctional Family Roles

Humans are social animals. When one lives in a group, each has a part to play. A role in this great play that is life, if you will.

All the worlds a stage,

And all the men and women merely players:

They have their exits, and their entrances;

And one man in his time plays many parts.

— William Shakespeare, As You Like It, Act II, Scene VII.

These sets of adequate behaviors are determined by the expectations of everyone around us, eventually becoming internalized through socialization. This means that the role we play is also context-dependent, and should change and adapt according to different times and spaces. It’s only when we become too fixed in certain dynamics that there is a problem.

Humans are master profilers. We have to quickly know what role our scene-partner is playing, after all. Furthermore, we also have a tendency to generalize. To forget that these are merely parts and others and ourselves are much more complex than the character they present at any given situation.

Thus, humans are masters at creating tags (long before the ‘hash’ prefixed it). Each Beatle member has been attributed, from their very first days under the public gaze, a very specific part: the Smart One, the Cute One, the Quiet One and the Funny One.

Like most labels, they are informative to a degree, which becomes limiting when one assumes that’s all there is to know. And even though there were infinitely complex individuals behind these fan nicknames, it’s curious how even within the band, in the privacy of their hotel rooms, these four young men fell into a very structured dynamic with very specific roles (which with time became stifling).

But it is wise to remember that the Beatles were more than a band.

They were a family.

This was something that they always identified with very keenly. They were brothers. (Of course, on top of this dynamic, John and Paul had the added complexity of also feeling like they were married.)

But for now, let’s look upon them as the children that they were: four brothers in one big adventure. It probably pays to follow their self-denomination and examine what part each member played in this dynamic. And because I used the word “dysfunctional” in the title, let’s first establish what it entails.

One of the main distinguishers between healthy and dysfunctional family dynamics is just how fixed these structures are.

In any given family the individual members fulfill and act out roles….

While in healthy, functional families these roles are generally fluid, change over time, in different circumstances, at particular events and are age and developmental appropriate, in dysfunctional families the roles are much more rigid.

In a healthy family members are integrated and various parts may surface at different times at no threat to the family system. In functional families the roles are interdependent.

The various roles in a healthy family are parts of every person….

Healthy families in general retain functionality when individual members ‘leave’ the family system through ‘moving out’, starting their own families or even death of an individual member.

By contrast,

In dysfunctional families the roles are almost a form of continuity or stability of the family system, stifling development….

Members must submerge parts of their personalities and take on a role so they are less of a threat to the family system that must be kept in place. In the case of a dysfunctional family all the roles are characterized as co-dependent.

In a dysfunctional family each member takes a role, and/or is assigned one, to make up the whole which is the family. Rather than a family of fully (yet age appropriate) persons, the family system gears to create just one: the family itself.

In dysfunctional family systems when an individual member leaves, this creates an (almost) irreparable hole in the existing system… This is why dysfunctional families are often so enmeshed. The system needs all members to function as a unit, not as a community.

— “Healthy vs Dysfunctional Family Roles”, Out Of The Storm.

It displeases me to dish out a diagnosis, for the line between healthy and unhealthy is often quite subtle.

But it’s hard not to argue that at times the Beatles tended towards the rigidity of a dysfunctional family. They have the resulting tensions and fallouts to prove it. Just the simple premise that the stability and continued existence of the family unit (the band) was more important than the wants and needs of its individual members is a sign of how prone they were to imprisoning themselves for the good of the whole.

In 1981 Weischeider identified five archetypes that children are assigned, originally relating to her work with alcoholic families. Since then the terms have evolved to cover other types of dysfunctional family systems: including the presence of other kinds of addictions; untreated mental health illnesses; sexual or physical abuse; fundamentalism or rigid dogmatism.

But what are these Dysfunctional Family Roles?

The Golden Child (The Hero)

This family member devotes his/her time and attention to making the family look “normal” and without problems. The Hero can mask or make up for the dysfunctional home life. Over-responsible and self-sufficient they are often perfectionistic, are over-achievers and look very good - on the outside. The parents look to this child to prove that they are good parents and good people. Their goal in life is to achieve “success”, however that has been defined by the family; they must always be “brave and strong”. The Hero’s compulsive drive to succeed may in turn lead to stress-related illness, and compulsive over-working. They learn at a young age to suffer the sadness of a parent and become a surrogate spouse or confidante.

While The Hero saves the family by being perfect and making it look good, the golden child may struggle to live up to his status. In a Narcissistic Personality Disordered (NPD) family, The Golden Child is the recipient of all the narcissistic parent’s positive projections, and is their favourite child. The golden child is usually victim of emotional and (covert) sexual abuse by the narcissistic parent. (S)He is also witness to, and sometimes takes part in, the other children’s abuse. Many specialists believe that witnessing your sibling’s abuse is as damaging as receiving it.

The Caretaker (The Enabler)

Another descriptive word for this type of codependent family role is “the Caretaker.“ This is also a role a child can fulfill, especially in case the other parent/caregiver has not resigned to enable the dysfunctional Addicted or Narcissististic parent. The Enabler feels like they have to keep the family going. Over and over they take on the addict’s problems and responsibilities.

The Enabler is the martyr of the family, and often supports not only the dysfunctional behavior, but also a prime enforcer of the codependent roles that everyone else is required to play.

You often see this role in a family where the functioning of (one of) the parent(s) is impaired in some way, i.e. mental illness, substance abuse or a medical disability. This child will attempt function as the surrogate parent. They worry and fret, nurture and support, listen and console. Their entire concept of their self is based on what they can provide for others.

The Enabler protects and takes care of the problem parent so that the parent is never allowed to experience the negative consequences of his or her actions. The Enabler feels he or she must act this way, because otherwise, the family might not survive. The paradoxical thing about The Enabler’s behavior is that by preventing the dysfunctional parent’s crisis, he or she also prevents the painful, corrective experience that crisis brings, which may be the only thing that makes the dysfunctional parent stop the downward spiral of addiction…

[Note: The Caretaker is often the “intra-familial counterpart” of The Golden Child, which can overlap and be played by the same person.]

The Problematic Child (The Scapegoat)

The Scapegoat is the “problem child” or the “trouble maker”. This family member always seems defiant, hostile and angry. The Scapegoat is the truth-teller of the family and will often verbalize or act out the "problem” which the family is attempting to cover up or deny. This individual’s behavior warrants negative attention and is a great distraction for everyone from the real issues at hand. The Scapegoat usually has trouble in school because they get attention the only way they know how - which is negatively. They can be very clever, may develop social skills within his or her circle of peers, and become leaders in their own peer groups. But often the groups that they choose to associate with are groups that do not present healthy relationships. The relationships he or she experiences tend to be shallow and inauthentic.

The Scapegoat is sacrificed for the family. The Scapegoat will be the “identified patient”. Scapegoats come in many different flavors, but two common ones are: 1) the picked, weak or sick child; or, 2) the angry, rebellious problem child who is constantly getting into conflicts. They are often self-destructive, cynical and even mean.

In an NPD family, The Scapegoat, or no good child is the recipient of the narcissist’s negative projections. They can never do anything right. The name ‘rebel’ implies that the child has chosen this role, which is debatable. The Scapegoat is usually victim of emotional and physical abuse by the narcissistic parent.

The Quiet One (The Lost Child)

The Lost Child is usually known as “the quiet one” or “the dreamer”. The Lost Child is the invisible child. They try to escape the family situation by making themselves very small and quiet. (S)He stays out of the way of problems and spends a lot of time alone. The purpose of having a lost child in the family is similar to that of The Hero. Because The Lost Child is rarely in trouble, the family can say, “He’s a good kid. Everything seems fine in his life, so things can’t be too bad in the family.”

This child avoids interactions with other family members and basically disappears. They become loners, or are very shy. The Lost Child seeks the privacy of his or her own company to be away from the family chaos. Because they don’t interact, they never have a chance to develop important social and communication skills. The Lost Child often has poor communication skills, difficulties with intimacy and in forming relationships. They deny that they have any feelings and "don’t bother getting upset.” They deal with reality by withdrawing from it.

In an NPD family, The Lost Child just doesn’t seem to matter to the narcissist, and avoids conflict by keeping a low profile. They are not perceived as a threat or a good source of supply, but they are usually victim of neglect and emotional abuse.

The Clown (The Family Mascot)

The goal of The Family Mascot is to break the tension and lighten the mood with humor or antics. (S)He is usually “the cute one.” This child feels powerless in the dynamics which are going on in the family and tries to interrupt tension, anger, conflict, violence or other unpleasant situations within the family by being the court jester. The Mascot seeks to be the center of attention in the family, often entertaining the family and making everyone feel better through his or her comedy. They may also use humor to communicate and to confront the family dysfunction, rather than address it directly. They also use humor to communicate repressed emotions in the family such as anger, grief, hostility or fear. This behavior is lighthearted and hilarious, just what a family twisted in pain needs — but the mascot’s clowning is not repairing the emotional wounds, only providing temporary balm. The rest of the family may actually try to protect their “class clown”. The Mascot is often busy-busy-busy. They become anxious or depressed when things aren’t in constant motion. The Mascot commonly has difficulty concentrating and focusing in a sustained way on learning, and this makes school or work difficult. (Hence they also referred to as “The Slacker”.)

They often have case loads rather than friendships - and get involved in abusive relationships in an attempt to “save” the other person. They have very low self-worth and feel a lot of guilt that they work very hard to overcome by being really “nice” (i.e. people pleasing, classically codependent) people.

— “Dysfunctional Family Roles”, Out Of The Storm.

Since then a sixth type is sometimes also considered:

The Manipulator (The Mastermind)

The Manipulator takes their experience of their hostile environment and uses it to their advantage. They capitalise on the family situation and play family members against each other. This individual will quickly become adept at recognising what the actual problem the parent suffers from. They’ll understand which one is the enabler, and which one is co-dependent.

Manipulators exercise this knowledge to control and influence family members. They’ll do it covertly, not directly. They never want to get caught. Gradually, they’ll learn what triggers the parents and their siblings and they will take shots at all of them…

Manipulators can turn into bullies, those who harass people and get a kick out of it. They are unable to form healthy relationships. If they are in one, they will be controlling with a partner who has low self-esteem.

They will only think of themselves and what they can get out of others. They feel that the world owes them for their lousy childhood and will go about getting it by any means.

— “6 Dysfunctional Family Roles People Take without Even Knowing”, Learning Mind.

It is not always clear-cut what role each member has been assigned, and the positions can change over time (normally as a result of the loss of one of the members). But people are inherently complex and multi-faceted. They have within themselves bits of each archetype. The unhealthy factor derives from the attempt to fit and perform one single one-dimensional role.

For example, John clearly acted up The Problematic Child publicly, but privately he also certainly had elements of The Dreamer; not only on the sense of being imaginative and introspective but also in his tendency for escapism and withdrawing from reality.

Also, when the fear and pain affected him the most, he became desperate enough to play The Manipulator. He did this from early on, but with the help of Yoko (who I now think, as a result of her particularly difficult childhood, became a “primary” Mastermind herself) he became even more effective at it from 1968 onwards.

JOHN: I did a job on this banker that we were using, and on a few other people, and on the Beatles.

Q: What?

JOHN: How do you describe the job? You know, you know, my job – I maneuver people. That’s what leaders do, and I sit and make situations which will be of benefit to me with other people, it’s as simple as that. I had to do a job to get Allen in Apple. I did a job, so did Yoko.

YOKO: You do it with instinct, you know.

JOHN: Oh. God, Yoko, don’t say that. Maneuvering is what it is, let’s not be coy about it. It is a deliberate and thought-out maneuver of how to get a situation the way we want it. That’s how life’s about, isn’t it, is it not?

— The “Lennon Remembers” interview, by Jann Wenner for Rolling Stone (8 December 1970).

In regards to the occupied archetypes, often one member has to fulfill more than one role. But because the structures are incredibly rigid, they can only perform one role at a time. This can cause even more internal stress as a result of not knowing which facet is being demanded of them at any given time.

Paul seems to have needed to balance being both The Golden Child and The Caretaker. This could explain his apparently parental role, alternatively characterized as masculine (Paul being a God/Father-Figure) or feminine (Paul being called the mother of the group). The gendered side of it relates more to society’s associations with these responsibilities (being “successful, brave and strong” = father’s job; taking care, “worry and fret, nurture and support, listen and console” = mother’s job), than I believe was ever consciously played by Paul himself. He just had a responsibility void to fill and he did it.

It is also crucial to understand that these dysfunctional dynamics are “transgenerational.” Meaning that “individuals reared in dysfunctional families tend to gravitate toward 'dysfunctional’ partners and create dysfunctional families of their own.”

This leads me to believe that it’s very likely that the Beatles replicated a dysfunctional family when they got together because they each individually came from dysfunctional families of their own. Or rather, one of the reasons why the Beatles got together in the first place was because they each came from dysfunctional families of their own, and thus were attracted to individuals who shared these patterns.

I loved my association with John and Paul because I had something in me which I recognized in them—which they must have or could have recognized in me, which is why we ended up together. And it was just great knowing there’s somebody else in life who feels similar to yourself.

— George Harrison, interviewed by Alan Freeman for BBC Radio 1 (6 December 1974).

Maybe this is why John, Paul, and George were such a strong front-line on their own but needed Ringo, and not Pete Best, to finally complete the set.

It may also be another factor as to why John and Paul bonded so tightly, as Paul knew how to “handle” John and John wanted to be taken care of. (There is of course much more to the dynamic; this is just one of its possible facets, which was at risk of becoming draining and a source of tension when to fixed in this co-dependent state.)

Again, it is hard to make an objective evaluation of the dysfunctionality of the Beatles’ biological families. There wasn’t so much awareness of the unhealthiness of some dynamics at the time, so many of the participants may even lack the words (or the will) to describe them. But the symptoms seem to be present. I believe that alone makes it worth looking for a potential cause.

Also, these attempts to create fixed dynamics for the stability of the family unit all seem to happen as a response to the inner inconstancy and instability of the forces governing the unit itself (normally the dysfunctional parental figure, but maybe can be extended to the life-circumstances themselves). For example, could severe financial instability be enough to create these patterns?

Either way, we can find in the Beatles’ childhood sources of dysfunction easily enough.

One that makes a common and expected appearance, in a liquor-filled Liddypool, was drinking, particularly in Ringo and John’s childhoods.

Ringo

Johnny Starkey would play a crucial role in the raising of his grandson, and by all accounts he was a full-on “wacker” (a much-used word for working-class Liverpool men and boys), being a drinker, laborer, gambler and brawler.

— On Ringo’s grandfather, John Starkey. In Mark Lewishon’s Tune In (2013).

Elsie, Harry, relations, friends and workmates would drink and sing through the evening until closing time, and then, well bevvied, tumble into Elsie and Richy’s tiny terraced house where the party carried on—more singing, more drinking, more swearing, Johnny and Annie Starkey on banjo and mandolin, the steam rising ever higher into the night… The boy would always remember singing at home “not in front of a coal fire but in front of a bottle of gin and a large bottle of brown,” emphasizing the point that, as many children have experienced down the years, the bond of good-time music and booze was significant. Years later, he would admit, “My parents were alcoholics and I didn’t realize it.”

— On Ringo’s childhood. In Mark Lewishon’s Tune In (2013).

Dingle people actually had much in common with cockneys. Both were poor and working-class, both were predominantly English/Protestant, both suffered terrible bombing at the hands of the Germans, and both liked a good drink and boozy sing-song. One big reason Harry fit right at home in Liverpool 8 was because he liked nothing better than to go to the pubs and clubs, get a few ales inside him and sing.

— On Ringo’s stepfather, Harry Arthur Graves. In Mark Lewishon’s Tune In (2013).

Richy took the job because he still harbored hopes of joining the merchant navy… But the job also had another attraction: booze. Richy was now a confirmed drinker. Regular exposure to alcohol in and around the home was an influence, and it was what many boys did anyway, swear and smoke and drink at the first opportunity.

— On Ringo’s second job at the tramp steamer St. Tudno. In Mark Lewishon’s Tune In (2013).

John

He was an ale drinker, but once he started drinking he’d drink anything. If there was a bottle, he’d stay with it.

— On John’s father, Alf Lennon, as told by close friend Billy Hall. In Mark Lewishon’s Tune In (2013).

Alf Lennon didn’t begin the new decade very well either. The Dominion Monarch docked at Tilbury before Christmas, after which he tomfooled around London with a few shipmates, waiting for it to sail again in mid-January. Alcohol was surely a fixture, opening time to closing with bottles between sessions…

— On John’s father, Alf Lennon, as told by close friend Billy Hall. In Mark Lewishon’s Tune In (2013).

John’s time with Julia was also complicated by the presence of “Twitchy.” His relationship with Bobby Dykins was not all bad but neither was it particularly rosy. Pete Shotton isn’t the only person to recall him as an alcoholic…

— On John’s “step-father”, Bobby “Twitchy” Dykins. In Mark Lewishon’s Tune In (2013).

John, of course, had the added factors of possible mental illness in his mother, and the abandonment by his parental figures (Alf, Julia and Uncle George).

Paul

Paul also had the loss of his mother and all the upheaval it brought. I’ve talked before how I thought the suddenness of Mary’s death and Jim’s inability to be visibly strong enough in the face of it, made Paul feel like he could not rely on the people around him to always be there, and that he needed to protect himself and be independent.

But now I wonder if there weren’t other possible sources of instability, that made him feel the need to take on responsibility even more strongly:

Though given such a strong foundation, Jim could not be spared from a further vice. For Jim McCartney was something of a gambling man, fond of betting on the horses. He once got badly into debt, though for reasons that at least had motives other than selfishness; his mother, Florence McCartney, who was capable of coupling a strongly matriarchal role with a fondness for humor of a most prurient nature, was badly in need of a holiday.

— In Chris Salewicz’s McCartney (1986).

Jim McCartney also enjoyed a drink, but would never permit himself to become so intoxicated that he was no longer in control of his own actions. That he should always maintain his self-respect was one of the principles of his existence, and one which he later passed on to his sons.

— In Chris Salewicz’s McCartney (1986).

The McCartneys had money worries. After the war, Jim’s job at the armaments factory ended and he returned to the cotton exchange, as a salesman for A. Hannay and company, but the war had changed everything; the cotton market was in chaos, and lie was lucky to bring home £6 a week. It meant that Mary also had to work and it was always a cause of slight embarrassment that she earned a higher wage than he.

— In Barry Miles’ Many Years From Now (1997).

Yet the education that Jim McCartney offered his sons was not always conventional; they couldn’t help but notice his inability to pass a slot machine without putting a coin in it, or the way he would give quadruple measures of undiluted alcohol to guests. Later, when the boys were in their teens, he would show them how to get away with drinking underage in pubs, slipping them the cash to buy rounds of drinks.

— In Chris Salewicz’s McCartney (1986).

Mum was a working nurse. There wasn’t a lot of money around – and she was half the family pay packet. My reaction was: ‘How are we going to get by without her money?’ When I think back on it, I think, ‘Oh God, what? Did I really say that?’ It was a terrible logical thought which was preceded by the normal feelings of grief. It was very tough to take.

— Paul McCartney, in Ray Coleman’s McCartney: Yesterday & Today (1996).

The boys went to stay with Jim’s brother Joe and his wife Joan, while friends and relatives tried to calm their distraught father, whose first thought was to join his wife.

— In Barry Miles’ Many Years From Now (1997).

A Hard Day’s Night had its London premiere on July 6, 1964, the day before Jim McCartney’s birthday… Then, as midnight chimed, Paul drew his father over to him. “Happy birthday, Dad,” he said, and produced a painting—perhaps the one mentioned to the Telegraph magazine—of a horse, which he handed to Jim.

“Thank you, son. Very nice,” muttered the somewhat confused father. (Later he was to tell Thomas Gaule about it. “I thought, ‘It’s very nice, but couldn’t he have done a bit better than that?’”). Then Paul revealed that this was a painting of the £1,050 racehorse, Drake’s Drum, that he had bought his father.

“You silly bugger,” was Jim’s joyous reply.

“My father likes a flutter [bet],” Paul said. “He’s one of the world’s greatest armchair punters.”

— In Chris Salewicz’s McCartney (1986).

Again, it’s hard to definitely label a situation problematic, but the impact it has on a developing person is more relative to how the person experienced it than to the experience itself. But perhaps Jim’s gambling habits, the family’s financial insecurity, Mary’s death, Jim’s consequent suicidal depression and/or possible self-medication with alcohol, all lead to the creation of an unreliable enough parent that the son had to occupy such roles.

Also, it would be remiss not to mention the use of bodily punishment during their upbringing, which made enough of an impression on the McCartney brother’s that Mike would mention it often and Paul would never speak of it; until the early 2000′s, when he remarked how his father hit him across the face at 16/17 and he finally stood up to him and dared Jim to do it again. (I am getting ready a post specifically on it, so I hope to explore this subject further there.)

George

George’s situation is a bit harder to tell. He seemed to be the one most aware and most averse to his title as The Quiet One. Maybe it’s because he felt it was ill-fitted. He wasn’t the quiet one after all, among his own family:

I found Harry reticent and quiet; Lou was loud, vivacious, not shy at all—there wouldn’t be silence in the room when she was there—and George was bubbly like his mum. They all bounced off each other and would do anything for anyone, and they all had a wonderful sense of humor, George especially. I threw a strop one day and threatened to walk to Budleigh Salterton. I stayed away a bit but all I really did was go to the loo and kill some time before coming back. After that, whenever George went to the loo he’d say, “I’m just off to Budleigh Salterton…”

— Jenny Brewers, a family friend. In Mark Lewishon’s Tune In (2013).

But maybe the silence was meant to be read as stoicism in his more public persona:

George was cool. He dressed as an individual and often to shock, to goad reactions—usually admiration from his peers and dismay from adults. He could be quiet, and sometimes grumpy, but he was always honest and never intimidated or afraid, standing up for himself verbally and physically. “He was cocky,” Paul would say, admiringly. “He had a great sense of himself. He wasn’t cowed by anything.”

— In Mark Lewishon’s Tune In (2013).

Whatever it was, George fit right in with the rest of them and easily slipped into his role, even if he was also the first to overtly buck against it. He clearly wanted to expand beyond these parts in a play they had created within the Beatles, these fixed dynamics for the greater good of the band, which he now felt stifled by:

Q: What was the conflict with Paul? I don’t understand.

GEORGE: It’s just a thing like, you know, he’d written all these songs for years and stuff, and Paul and I went to school together. I got the feeling that, you know, everybody changes and sometimes people don’t want other people to change, or even if you do change they won’t accept that you’ve changed. And they keep in their mind some other image of you, you know. Gandhi said, 'Create and preserve the image of your choice.’ And so different people have different images of their friends or people they see.

— George Harrison, interviewed by a New York City radio station (25 April 1970).

Perhaps the Beatles, the family unit, needed to collapse in order to free its members of the fixed dynamics they had built the band upon. Maybe it was time to grow and evolve beyond the images of the people they were when they met as teenagers. And because they were different, but their images of each other often didn’t match, there was tension.

Still, I don’t think this automatically means that it was impossible for them to ever be good friends again, work together again or even reform. Everything is possible if one just chooses so.

It would certainly be different. It would not be the same. But that would be good.

[This post was born out of conversations with the wonderful @ljblueteak and is an exploration of the concept introduced by Michael Gerber in the follow-up discussion to the Hey Dullblog entry “John and Paul, Friends and Rivals”.]

#We were a family #the beatles were just four guys that loved each other #johnny #macca #geo #ritchie #jim mccartney #mike mccartney #Alfred Lennon #introduction #elision #yoko ono #allen klein #meta #my stuff

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james1shields-blog · 7 years

Text

Test Bank Gerontological Nursing The Essential Guide to Clinical Practice 2nd Edition

For Order This And Any Other Test

Banks And Solutions Manuals, Course,

Assignments, Discussions, Quizzes, Exams,

Chapter 1

Principles of Gerontology

1.1 The nurse is reviewing the discharge plans for an 84-year-old man who is to leave tomorrow. Included is a plan for quitting smoking. In discussing this with a co-worker, the nurse states, “I don’t know why we need to do this, he has been smoking for years, and he isn’t going to stop now.” This statement by the nurse reflects the concept of

1. senescence.

2. reality orientation.

3. negative stereotyping.

4. character assessment.

Answer: 3

Rationale: Often people characterize the elderly in a negative way believing that after a certain age, things cannot be changed. This is the concept of stereotyping in a negative way. Senescence is the process of aging, reality orientation is a strategy to assist individuals when confused or delusional, and character assessment is a process of identifying aspects of an individual’s personality and character.

Implementation

Psychological Integrity

Analysis

1.2 You are preparing to conduct a blood pressure screening at a local senior citizen’s high-rise apartment building in the inner-city impoverished location. In anticipation of the clients you will care for, you will most likely find which of the following characteristics of the residents living at this location. (Select all that apply.)

1. older women.

2. married men and women.

3. widowed women.

4. less educated women.

5. residents living alone.

6. older men.

Answer: 1, 3, 4, 5

Rationale: Statistics indicate that women comprise the majority of people (55%) in all nations and 58% in developing countries. Unlike men, women are also more likely to be widowed, live alone, be less educated, and have less years of labor experience resulting in poverty.

Planning

Health Promotion and Maintenance

Analysis

1.2 The nurse is completing an admission assessment for a female adult client. When discussing the social history, the nurse identifies that the client is a smoker (one pack/day for 20 years) and has worked at a chemical plant operating a chemical packing machine. When reviewing this assessment, the nurse would consider this client at risk for

1. environmental and occupational hazards that may affect life expectancy.

2. increased life expectancy because she is female.

3. no difference in risk because of her social and occupational circumstances.

4. decreased fertility.

Answer: 1

Rationale: Exposure to environmental and occupational risk factors has been known to affect life expectancy in men and will have the same affect on women given similar circumstances. Given the limited information on the chemical exposures, it is inconclusive to consider any affect on fertility or to assume that there is no effect.

Assessment

Health Promotion and Maintenance

Analysis

1.4 The triage nurse is taking vital signs of a 59-year-old African American male who has arrived to be treated for a laceration in his right hand. His blood pressure is 180/104. The nurse applies a dressing to his hand and plans for continuation of his care for the laceration. When questioning the client about his blood pressure, he states he did not know if that was normal for him and that he was not on any medication. In analyzing the blood pressure, the nurse decides

1. this is normal for someone in pain from an injury.

2. this finding is abnormal and presents an opportunity to initiate secondary prevention to prevent the progression of illness.

3. the blood pressure may not be accurate, therefore, it does not need to be addressed.

4. this patient needs to have his pressure taken in a standing position.

Answer: 2

Rationale: Although some people may have a variation in vital signs because of pain, this blood pressure reading is not within the normal range. A good strategy to control chronic illness and prevent progression and disability is to identify opportunities to diagnose and treat chronic illnesses. This scenario provides the nurse the opportunity to develop and implement a plan of care for the treatment of the blood pressure. The other options do not address this strategy.

Assessment

Physiological Integrity

Analysis

1.5 A client stops at the desk of his doctor’s office to ask the nurse a few questions. He is a retired teacher who has just been diagnosed with diabetes and wants to know how to manage his care. While the nurse is going over glucose testing, he talks about how expensive his medications and healthcare have become. The nurse can best provide support to him by stating

1. “Don’t worry, I don’t think the total bill will be too much.”

2. “I don’t know anything about insurance.”

3. “You only need to do this once a day so the supplies should last you a long time.”

4. “I believe that some parts of Medicare will cover preventative care, such as diabetes monitoring.”

Answer: 4

Rationale: Although Medicare does not pay for routine physical examinations, Medicare Part B does cover preventative services, such as diabetes monitoring. The client is stating concern so telling him not to worry or assuming that even one day of costs is affordable is inappropriate. Stating you don’t know anything about insurance offers no support to the client.

Implementation

Psychological Integrity

Application

1.6•A nurse is caring for an 89-year-old woman who was admitted to the hospital for generalized weakness and a cough. The client describes in her assessment that she has to go to the bathroom frequently and manages this by monitoring her fluid intake, especially before going to bed. She has no pain or discomfort with voiding. The nurse may consider this finding

1. normal for a woman that age.

2. indicative of a urinary tract infection.

3. a sign of diabetes.

4. that the patient is drinking too many fluids.

Answer: 1

Rationale: Changes occur normally through the aging process. One of which is a reduction in bladder capacity. Given this is her only symptom, it is unlikely the client has a urinary tract infection, diabetes, or that her fluid intake is inappropriate.

Assessment

Health Promotion and Maintenance

Analysis

1.7•You are answering questions of a 92-year-old man’s family who has been admitted for the treatment of pneumonia. His 32-year-old granddaughter asks you why her grandfather became so sick so quickly with the disease. She further states that she had pneumonia last winter and was never even hospitalized. Your best response to her questions would include

1. your grandfather must have chronic illnesses that put him at risk.

2. all elderly have decreases in the ability to restore balance to the body systems when challenged by trauma or infection.

3. there are some differences between men and women and illness.

4. I don’t think you can compare your grandfather to yourself.

Answer: 2

Rationale: The loss of organ reserve that can occur with aging can lead to the concept of homeostenosis or inability of the body to restore homeostasis after even minor environmental challenges, such as trauma or infection.

Implementation

Health Promotion and Maintenance

Application

1.8•A client tells you during her admission assessment that she is taking several herbs and supplements. She states she read a theory about how this would help slow down the aging process. She asks you if you believe in this approach. In preparing to respond to her question, you would consider which of the following theories of aging?

1. cross-link theory

2. error theory

3. free radical theory

4. nutritional theory

Answer: 3

Rationale: The cross-link theory states that cross-linked proteins resulting from binding of glucose to proteins causes various problems associated with nutrition. Error theory is a category and not a theory itself, and nutritional theory is not one of the theories of aging. The free radical theory states that accumulated damage caused by oxygen radicals causes cells, and eventually organs, to lose function and organ reserve. The use of antioxidants and vitamins is believed to slow this damage.

Implementation

Health Promotion and Maintenance

Application

1.9•While making rounds on the unit, you find a 90-year-old client sitting in his chair looking out the window. He seems sad and depressed and talks about how his health has declined over the years. He was planning to do a lot of things after his retirement and now, with his recent surgery, he feels he cannot do anything. You respond to him by helping him to understand that these changes are often a challenge for the elderly with which to cope and adapt in order to age successfully. This response incorporates what type of aging theory?

1. biological

2. psychological

3. sociological

4. spiritual

Answer: 2

Rationale: Psychological theories advance that, as a person ages, various coping or adaptive strategies must occur in order to age successfully. The biological theories focus on physiological changes, the sociocultural focus on roles and relationships, and spiritual aging is not related to this client’s concerns.

Implementation

Psychological Integrity

Application

1.10•A 62-year-old former professional football player is in the hospital for a total knee replacement as a result of osteoarthritis. In discussing the disease with the patient during preoperative teaching, you may consider the incorporation of the error theory of aging to help the client understand how the disease has affected him. The specific theory that applies in this case is

1. cross-link theory.

2. somatic DNA damage theory.

3. free radical theory.

4. wear and tear theory.

Answer: 4

Rationale: Osteoarthritis is characteristic of disc degeneration that results from joint usage. This disease is characteristic of the aspects of the wear and tear theory, which states that there is a “master clock” that controls all organs and cellular functions, which becomes less efficient over time. Abusing one organ or bodily system through repeated injury that occurs with contact sports may result in premature aging and diseases such as osteoarthritis. The cross-link theory is related to the accumulation of cross-linked proteins causing disease, the somatic DNA damage theory states that genetic mutations occur and accumulate with increasing age, and the free radical theory states that cell damage is a result of accumulation of oxygen radicals.

Implementation

Health Promotion and Maintenance

Application

1. 11•A nursing student is preparing a program for her peers covering health concerns for seniors. When planning the program, which of the following statements should be included in the presentation?

1. The rate of heart disease death for senior citizens is demonstrating an increase in rate.

2. Heart disease is the leading cause of death for senior citizens.

3. Cancer is the leading cause of death in the senior citizen population.

4. Decreases have been shown in the rate of Alzheimer’s disease.

Answer: 2

Rationale: Heart disease is the leading cause of death in the senior population. The rate of heart disease is on the decline. Cancer is among the top causes of death but is not the number one cause of death. Alzheimer’s disease rates remain consistent.

Planning; Health Promotion; Reduction of Risk Potential; Comprehension

1.12•The nurse is teaching a client about the need to take the flu and pneumococcal vaccines. The client states he is too old and there is little reason to waste the solutions. Which response by the nurse is most therapeutic at this time?

1. “You are likely to get this disease if you do not take the vaccines.”

2. “I will report your concerns to the physician.”

3. “It is never too late in life to begin health promotion activities.”

4. “I understand your feelings.”

Answer: 3

Rationale: Taking the vaccines is a form of health promotion. The client should be advised that age should not restrict health-saving activities. While the client has an increased likelihood of developing the diseases if the vaccines are not taken, stating this does little to meet the client’s voiced concerns. Telling the client you understand is not the most therapeutic response.

1.13•The nurse is working in a long-term care facility that embraces the Continuity Theory of Aging. The nurse is charged with developing client activities that will promote this theory. Which of the following activities will meet the criteria?

1. Develop a family night for clients to invite members of their family to the facility to eat with their loved ones.

2. Encourage the clients to begin exercise programs.

3. Plan a relaxing movie night for residents.

4. Arrange for a group of children to visit the residents.

Answer: 1

Rationale: The Continuity Theory of Aging promotes successful aging by maintaining previous values, habits, preferences, and family ties. Encouraging family involvement will promote this theory. Not all clients may have had a past interest in exercise. The movie night does little to promote relationships. The visit from children will not increase the clients’ relationships with their previous values, habits, preferences, or family members.

Planning; Psychological Integrity; Analysis

1.14•A recent nursing school graduate is hired at an assisted living facility. During orientation, she reports she is nervous about working with the older adult because of the personality changes she has heard ensue with aging. What response by the nursing preceptor is indicated?

1. “The personalities of the elderly do undergo some significant changes after the eighth decade of life.

2. “The losses many elderly experience understandably will impact their personality.”

3. “After retirement, feelings of disuse cause many elderly to begin demonstrating personality changes.”

4. “Personality is relatively stable throughout life.”

Answer: 4

Rationale: There are few changes in personality during the life cycle. Lifestyle changes, retirement, and death have limited impact on personality.

Implementation; Psychological Integrity; Application

1.15•A client voices concerns about her physical appearance despite diligently following a healthy diet. Which of the following age-related changes can best explain these changes?

1. Body weight increases after middle age.

2. Body fat increases until middle age.

3. Fat is redistributed to the hips after middle age.

4. The changes associated with body fat promote a pear-shaped appearance for aging women.

Answer: 2

Rationale: Body fat typically increases until middle age and then stabilizes until late life, when weight tends to decline. With aging, fat is redistributed to the abdomen rather than to the hips. This promotes an apple shape rather than a pear shape.

Diagnosis; Physiological Integrity; Application

1.16•A 60-year-old client in good health has asked the nurse about what steps can be taken to build muscle mass. What information should be provided to the client?

1. Exercise can slow the loss of muscle mass.

2. Muscle mass declines by 40% between the ages of 30 and 70.

3. Increasing protein and fat intake will increase muscle mass.

4. There is little that can be done to reduce the loss of muscle mass associated with aging.

Answer: 1

Rationale: Between the ages of 30 and 70 years, there is a loss of 22% to 23% of muscle mass. Exercise can slow this loss. Calories are burned more slowly during aging, and adding fats can promote fat build-up, not an increase in muscle mass.

Implementation; Health Promotion and Maintenance; Application

1.17•The nurse is planning a presentation concerning the Immunological Theory of Aging. When reviewing items for inclusion in the program, which of the following should be considered?

1. Hormones control the pace of aging, and their reduction will result in a decrease in immunity.

2. Some individuals are genetically programmed to have a markedly reduced immune system.

3. Reduced immune function leads to an increase in vulnerability to illness, aging, and death.

4. Anti-oxidants are linked to a bolstered immune system and improved response to aging.

Answer: 3

Rationale: According to the Immunological Theory of Aging, a programmed decline in the immune system results in an increase in vulnerability to illness and ultimately death. Hormones are a strong consideration in the Endocrine Theory of Aging. The influence of genetics is a part of the Programmed Longevity Theory of Aging. The Free-Radical Theory supports the influence of anti-oxidants.

Planning; Health Promotion and Maintenance; Application

1.18•A resident at the assisted living facility reports continued anger about the loss of her husband to a younger, more attractive woman 4 years ago. She further asserts this is responsible for both her physical and social decline. Which of the theories of aging is supportive of this position?

1. Jung’s Theory of Individualism

2. Erickson’s Developmental Theory

3. Disengagement Theory

4. Activity Theory

Answer: 1

Rationale: A key focus of Jung’s theory is the impact of an inability to accept past accomplishments and failures to promote successful aging. Erickson’s theory of aging suggests that ineffective meeting of the tasks of each stage of life will result in maladjustment. The Disengagement Theory considers the need of an individual to engage in society and maintain equilibrium. Activity Theory promotes the need for the older adult to stay active and engaged.

Diagnosis; Psychological Integrity; Analysis

1.19•An assisted living facility is targeting a group of residents at risk for cardiac problems. As part of the program, the residents are being offered blood pressure monitoring, BMD analysis, and referrals to a nutritionist for counseling to reduce cholesterol levels. These activities are examples of

1. primary prevention.

2. health promotion.

3. secondary prevention.

4. tertiary prevention.

Answer: 3

Rationale: Secondary prevention activities focus on the early diagnosis and prompt treatment of health problems. The activities planned are examples of this type. Primary prevention and health promotion are the same types of activities. Their focus is preventing the onset of illness. Tertiary prevention activities are geared toward restoration and rehabilitation.

Planning; Health Promotion and Maintenance; Analysis

1.20•A client reports she has just become eligible for Medicare. She has been reading about her coverage. Which of the following statements indicates an understanding of the health plan?

1. “My Medicare coverage will cover routine physical examinations.”

2. “I am required to have a ‘Welcome to Medicare’ examination.”

3. “Because I have a family history of heart disease, I can have a screening ultrasound.”

4. “My plan recommends I have a mammogram annually.”

Answer: 4

Rationale: Medicare services have been expanded to promote preventative services such as a mammogram. Medicare coverage does not cover routine physicals. The “Welcome to Medicare” examination is voluntary. The availability of the ultrasound for at-risk individuals requires the client meet a series of criteria.

Assessment; Health Promotion and Maintenance; Analysis

1.21•The nurse is preparing a care plan for an African American client at risk for colon cancer. Which of the following should be included in the plan of care?

1. Fecal occult blood screening every 2 years

2. Flexible sigmoidoscopy testing annually

3. Serum cancer marker testing every year

4. Colonoscopy every 2 years

Answer: 4

Rationale: Currently, colonoscopy screening is recommended every 2 years for those at high risk. Fecal occult blood screening is recommended annually. The flexible sigmoidoscopy is recommended every 4 years. Serum cancer markers are not indicated for this client given the information provided.

Planning; Health Promotion and Maintenance; Application

1.22• A recently hired graduate nurse questions her preceptor about the demographics on the unit. The preceptor reports that the clients and their diagnoses are consistent with nationwide demographics. Based upon your understanding, which of the following statements best supports this?

1. The African American clients have a lower incidence of hypertension than the Caucasian clients.

2. The Hispanic clients have a greater incidence of obesity than the Caucasian clients.

3. Diabetes is not a significant problem in the African American community.

4. The female clients with chronic disorders are more self-sufficient than men with similar ailments.

Answer: 2

Rationale: Obesity and diabetes are significant issues in both the African American and Hispanic communities. Hypertension is a common concern in the African American population. Female clients with chronic disorders are more likely to need assistance with ADLs than men having the same disorders.

Assessment; Physiological Integrity; Application

1.23•A group of nursing students is preparing a presentation for teens. Their focus is on healthful living. Which of the following statements by a participant indicates an inadequate understanding of the content?

1. The rates of disability are decreasing in the United States.

2. The majority of senior citizens have at least one chronic condition.

3. Respiratory disorders are one of the leading causes of disability in the United States.

4. The beginnings of chronic disease are noted in populations starting around age 30.

Answer: 4

Rationale: The onset of chronic disease begins in the second decade of life. The remaining statements are true.

Evaluation; Health Promotion and Maintenance; Analysis

1.24•The clinical facility has a unit that has a focus of tertiary prevention. Which of the following goals is consistent with this focus?

1. Clients with pressure ulcers will have whirlpool therapy as indicated.

2. Clients at risk for the development of pressure ulcers will be turned every 2 hours to prevent pressure ulcer development.

3. Clients will be assessed for the presence of factors that place them at risk for pressure ulcer development.

4. Clients will be taught to move in bed at least every 2 hours to prevent pressure ulcer development.

Answer: 1

Rationale: Tertiary prevention focuses on restoration and rehabilitation. Whirlpool therapy would be a means to heal the wound. The remaining options are examples of primary prevention.

Assessment; Health Promotion and Maintenance; Analysis

1.25•A recent graduate nurse wants to know what role he can play to reduce the gap between life span and healthy life span. What information can be provided to the graduate nurse? Select all that apply.

1. Provide education concerning modifiable risk factors.

2. Engage in tertiary promotion activities.

3. Encourage client participation in primary prevention activities.

4. Volunteer at a local senior citizen center.

Answer: 1, 2, 3, 4

Rationale: All of the responses are activities that can promote the health and wellness of the older adult.

Implementation; Health Promotion and Maintenance; Application

#Test Bank Gerontological Nursing The Essential Guide to Clinical Practice 2nd Edition

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