ch 19 environmental health
The nurse visits the home of client in a low-income community and notices that paint is flaking off the walls and forming a dust in the corners of some rooms. The nurse asks the client when the house was built, and she responds that it was built in 1959. Which contaminant should the nurse expect to find in this home? A) Lead B) Radon C) Asbestos D) Pesticide
A Feedback: Contaminants in the environment, such as asbestos, lead, or radon, influence human health. For example, lead was used in paint until the 1970s and is often found in houses built earlier. As the old paint breaks down, lead can be found in dust and old paint chips in homes. In communities with older, deteriorating housing, children can be exposed to lead. In many cases, such housing is found in poorer communities. There are no indications of the other contaminants being present.
The nurse applies the nursing process to a case in which a client has been exposed to an environmental contaminant. The nurse considers the question, "Has the exposure pathway been interrupted?" This question would be considered during which phase of the nursing process to examine the impact of the environment on human health? A) Assessment B) Planning C) Intervention D) Evaluation
D Feedback: An evaluation, not assessment or planning, is performed for any intervention to decide whether the intervention has achieved its goals and whether improvements or changes need to be made.
Which is an example of a radiological contaminant? A) Lead B) Mercury C) Ricin D) Radon
D Feedback: Generally, contaminants can be thought of in three categories: chemical (lead, mercury, volatile organic compounds), biological (mold, anthrax, ricin), and radiological (radium, radon).
Which exemplify environmental media and transport mechanisms within an exposure pathway? (Select all that apply.) A) Mercury B) Groundwater C) Pond D) Air E) Subsurface soil
B, C, D, E Feedback: Environmental media include groundwater, surface water (lakes, ponds, and rivers), air, surface soil, subsurface soil, sediment, and biota (plants and animals). The environmental medium that the contaminant is in helps determine who is exposed and how they are exposed. Mercury is an example of a contaminant, or source of contamination.
In the United States, most citizens have access to clean water and sanitation services and often take these services for granted. Worldwide, however, clean water and sanitation are not standard. How many people worldwide in 2010 lacked access to improved water sources? A) 7 million B) 78 million C) 783 million D) 7.8 billion
C Feedback: According to the WHO, in 2010, 783 million people lacked access to improved water sources.
There are different methods for conducting risk assessment for environmental contaminants. Which formula determines the amount of risk? A) Hazard = exposure × risk B) Exposure = risk × hazard C) Risk = contaminant presence × exposure D) Risk = hazard × exposure
D Feedback: A key concept for assessing risk is that the amount of risk equals the hazard times the exposure (risk = hazard × exposure). The presence of a hazard alone does not determine the amount of risk the hazard poses.
Bioavailability is the amount of the contaminant that: A) Is absorbed into the body and becomes available at the site of physiological activity B) Initially escapes a container and becomes available for contact with living organisms C) Is airborne and available for inhalation D) Is waterborne and available for skin contact
A Feedback: Bioavailability is the amount of a substance or contaminant that is absorbed into the body and becomes available at the site of physiological activity.
The nurse asks a client, "Do you wear the clothes you wear at work to home?" This is an example of which subject on the exposure history? A) Present work B) Past work C) Home/residence D) Concerns
A Feedback: "Do you wear the clothes you wear at work to home?" is an example of present work on the exposure history, not past work, home/residence, or concerns.
Children may be more vulnerable to environmental exposures than adults. There are several factors that increase children's vulnerability. Which factors should be considered with children? (Select all that apply.) A) Their body systems are still rapidly developing. B) They eat less, drink less, and breathe more in proportion to their body size than do adults. C) Their bodies may be less able to break down and excrete contaminants. D) Their behaviors can expose them to more contaminants. E) Their breathing zone is further from the ground.
A, C, D Feedback: Children may be more vulnerable to environmental exposures than are adults. Several factors increase children's vulnerability, including the following. Children's body systems are still rapidly developing. Children eat more, drink more, and breathe more (not less) in proportion to their body size than adults. Children's breathing zone is closer to (not further from) the ground than adults'. Children's bodies may be less able to break down and excrete contaminants. Children's behaviors can expose them to more contaminants.
Changes to water supplies and increased flooding, which are believed to result from climate change, may make some areas more vulnerable to diseases. Which diseases are expected to become more prevalent as a result of climate change? (Select all that apply.) A) Asthma B) Lung cancer C) Diarrhea D) Malaria E) Dengue fever
A, C, D, E Feedback: Changes to water supplies and increased flooding may make some areas more vulnerable to diarrheal diseases. Experts predict that common vector-borne diseases such as malaria and dengue fever will affect larger geographic areas as the vectors that carry the diseases find agreeable climates in expanding areas. Climate change will also affect air quality. The WHO estimates that 300,000 million people have asthma and will face increased disease burden from climate change. There is no association of increased incidence of lung cancer with climate change.
The information gained from environmental epidemiologic studies can be very helpful in trying to identify whether an exposure or what particular exposures have made people ill. Major challenges to most environmental epidemiology studies include: (Select all that apply). A) Resource intensive in terms of personnel and money B) Period between exposure and illness can be very short C) Weak ability to identify outbreaks of infectious disease D) Limited availability of data on many contaminants and their effect on people's health E) Time consuming to perform
A, D, E Feedback: Major challenges to most environmental epidemiology studies include the following: limited availability of data on many contaminants and their effect on health, limited understanding about how exposures to multiple contaminants may sicken people, latency between exposure and illness that can be very long, time-consuming to perform, resource intensive in terms of personnel and money, and inconclusive in determining whether X contaminant caused Y illness.
Environmental justice is an important consideration when working with tribal communities. In which way is traditional tribal practices most often directly affected by contaminated land and water? A) Spiritual practices B) Dietary practices C) Work opportunities D) Exercise opportunities
B Feedback: Tribal communities often bear a disproportionate burden of impact from pollution on their tribal lands. Traditional tribal practices include eating traditional foods for either a majority or a portion of their diets, and contamination of the land or water has a direct effect on food sources.
The nurse conducts biomonitoring of residents of a community exposed to mercury vapor from a manufacturing facility nearby. Which form of biomonitoring is the method for the purpose of determining exposure to this contaminant? A) Measuring heart rate B) Collecting blood or urine C) Assessing respiratory rate D) Obtaining body weight and composition measures
B Feedback: Biomonitoring is the process of using medical tests such as blood or urine collection to determine whether a person has been exposed to a contaminant and how much exposure he or she has received. Measuring heart rate, respiratory rate, body weight, and body composition would not be as helpful as for determining exposure to a contaminant as would collecting blood and urine samples.
Which is the most accurate definition of an exposure pathway? A) The total amount of a contaminant that comes in direct contact with the body B) Factor that determines a person's level of exposure to a contaminant C) Method by which people are exposed to an environmental contaminant D) Process to determine whether exposure to an environmental contaminant has occurred
C Feedback: An exposure pathway is the method by which people are exposed to an environmental contaminant that originates from a specific source. Exposure is a measure of the total amount of a contaminant that comes in direct contact with the body. An exposure estimate is a method of determining a person's level of exposure to a contaminant on the basis of associated factors. An exposure history is a process to help determine whether an individual has been exposed to environmental contaminants.
Environmental justice is most accurately described as the belief that: A) Those who violate the environment should be required to pay significant fines or face extensive prison sentences. B) All the harms humans have committed against the environment will one day result in divine judgment. C) All people should have equal access to the environment. D) No group should suffer more from environmental health consequences than others.
D Feedback: Environmental justice is the belief that no group of people should bear a disproportionate share of negative environmental health consequences regardless of race, culture, or income.
The nurse travels to Nigeria with a humanitarian aid organization to assess and treat members of a remote community. The children all have high levels of lead in their blood, as a result of exposure to lead dust created by gold mining. Many children are dying. The nurse has never witnessed such a phenomenon in the United States. Which are the most likely reasons for this discrepancy? (Select all that apply.) A) Larger mining operations than in the United States B) Lack of environmental regulations or of their enforcement C) Lack of knowledge concerning environmental dangers D) Weaker immune systems than in the United States E) Need of the miners to earn a living and fewer work options
B, C, E Feedback: This situation is caused by a combination of limited environmental protections, lack of knowledge concerning environmental dangers by local community members, and the need to earn an income. The size of the mining operations is not relevant. The strength of the children's immune system is irrelevant, as the immune system is effective against invading microorganisms, not against lead.
Which most accurately describes environmental epidemiology? A) Focuses on the amount of a contaminant that is absorbed into the body B) Involves monitoring the results of medical tests to determine whether a person has been exposed to a contaminant C) Focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments D) Involves monitoring the number of adverse effects of chemical, physical, or biological agents on people, animals, and the environment
C Feedback: Environmental epidemiology is a field of public health science that focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments. Bioavailability is the amount of a contaminant that is absorbed into the body. Biomonitoring is the process of using medical tests such as blood or urine collection to determine whether a person has been exposed to a contaminant and how much exposure he or she has received. Toxicology is the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment.
Several important pieces of legislation have helped highlight the importance of environmental health and environmental protection. Which best describes Superfund? A) National program to control the damaging effects of air pollution B) Program that protects and enhances the quality of the nation's air by regulating stationary and mobile sources of air emissions C) Environmental program established to address abandoned hazardous waste sites D) Comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality
C Feedback: Superfund is the name given to the environmental program established to address abandoned hazardous waste sites. The Clean Water Act focuses on improving the quality of the nation's waters. It provides a comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality, including municipal and industrial wastewater discharges, polluted runoff from urban and rural areas, and habitat destruction. The Clean Air Act is a national program to control the damaging effects of air pollution. It protects and enhances the quality of the nation's air by regulating stationary and mobile sources of air emissions.
Which is the most accurate definition of a risk assessment? A) Assessment of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment B) Process to help determine whether an individual has been exposed to environmental contaminants C) Assessment of factors that determine a person's level of exposure to an environmental contaminant D) Determination of the likelihood of adverse effects in a group exposed to an environmental contaminant
D Feedback: Risk assessment is the process to determine the likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of an exposure to an environmental contaminant. Toxicology is the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment. Exposure history is the process to help determine whether an individual has been exposed to environmental contaminants. Exposure estimate is assessment of factors that determine a person's level of exposure to a contaminant.
The nurse visits a community along a creek where residents have begun to report upper respiratory illnesses and asthma. After investigating, the nurse learns that several miles upstream is a hazardous material disposal site. In addition, chemicals have leached through the soil into the creek water and have been carried downstream to this community. Although children are not allowed into the creek, they do often play along the bank. Which represents the route of exposure in this situation? A) Creek water B) Chemicals C) Bank of the creek D) Inhalation
D Feedback: The route of exposure is how the contaminant enters the body, such as inhalation. The point of exposure is the place where people come in contact with the contaminated medium, which in this case would be the bank of the creek. The source of contamination is used to describe what the contaminants are and where they originate, which in this case would be the chemicals. The environmental medium that the contaminant is in is the creek water.
