CH Exam 2
A new client, who is Latin American, is getting settled in the hospital. She is expecting her family to arrive soon. A physician enters and informs the client that she requires surgery and asks that she sign the necessary documents. The client refuses and becomes agitated. Which is the most likely cultural reason for the client's reluctance to sign the documents? A) Client is reluctant to have the surgery. B) Decision of importance is typically made by the family as a group. C) Client does not feel comfortable with the surgeon. D) Client is medicated and is having difficulty making a decision.
B) Decision of importance is typically made by the family as a group.
The nurse identifies the specific indicators and focal areas needed to establish immunization and well-child clinics in a low-income neighborhood. What actions are needed to meet the health outcomes of the project? A) Identify the need in the community for the clinic on the basis of subjective data. B) Develop a plan to meet the costs and promote the benefits of the project. C) Consider the identified neighborhood's need for healthcare compared with that of other low-income neighborhoods by interviewing the members of the neighborhood. D) Assume that the neighborhood will welcome the institution of a well-child and immunization clinic.
B) Develop a plan to meet the costs and promote the benefits of the project.
Nursing students in an enclosed classroom begin to become ill with a gastrointestinal illness. The public health department identifies this occurrence as an emerging epidemic and isolates the population that is ill. According to microbial adaptation, those who survive the illness will then do which of the following? A) Recover with adaptive organism reintroduction into the environment B) Develop improved defenses against reinfection C) Become hosts to the organism, which is symbiotic in nature D) Become carriers of the infection, ultimately leading to an epidemic
B) Develop improved defenses against reinfection
An immigrant from Guatemala, age 47, is admitted to the coronary care unit with congestive heart failure. This is the fourth admission for this client, and the physician believes that the client's inability to adhere to his diet and medication regimen is the reason for his frequent admissions. The physician refers the client to the local community health nurse, on discharge from the hospital. Which would be most appropriate for the nurse to include in this client's plan of care? A) Insisting that the client adhere to his diet B) Developing culturally relevant and gender-sensitive interventions C) Teaching the family to adapt their cultural dietary plans to the client's diagnosis D) Assessing the client's financial needs and obtaining financial assistance as needed
B) Developing culturally relevant and gender-sensitive interventions
During a conference after rounds, a nurse states, "They are in the United States now; you would think that they would act like us." This nurse is exhibiting: A) Cultural humility B) Ethnocentrism C) Cultural competence D) Cross-cultural nursing
B) Ethnocentrism
Which best illustrates systems theory? A) School systems in two different counties each setting up their own independent afterschool exercise programs B) Father being challenged to stop smoking because his daughter learned of the hazards of smoking from a smoke cessation program at her middle school C) Hospital requiring all of its nurses to wear an identification badge while on duty D) Physician in one state deciding to stop accepting Medicaid clients, while another physician in another state begins accepting Medicaid clients
B) Father being challenged to stop smoking because his daughter learned of the hazards of smoking from a smoke cessation program at her middle school
The clinic clients respond negatively to the need for a yearly flu shot. They ask why the medical communities don't just create one shot that will last for several years. Which explanation should the nurse give? A) Genetic changes in the bacteria that cause the flu require a rotating course of antibiotics. B) Genetic changes make the flu virus resistant to the flu shot from year to year. C) There is more than one strain of the flu virus and you must be protected from all of them. D) The shots last only for 3 to 6 months and must be renewed on a yearly basis.
B) Genetic changes make the flu virus resistant to the flu shot from year to year.
Community assessment is a critical process for the future because it can: A) Identify the need for a community commission B) Identify a method to improve the health of at-risk clients C) Provide a means of grant funding for clinics D) Provide a client base for at-risk neighborhoods
B) Identify a method to improve the health of at-risk clients
There are 12 students with confirmed cases of the H1N1 flu in grades 6 to 8 at the local middle school in the community. The community nurse advises the caregivers of the ill children to keep the children home for a minimum of 5 to 7 days. Which should be the nurse's next step? A) Recommend closing the school for 6 weeks B) Implement education in the school setting regarding respiratory and hand hygiene C) Require each child in the school to undergo a physical evaluation by the school nurse D) Initiate a system of discipline in the school setting for improper hand washing
B) Implement education in the school setting regarding respiratory and hand hygiene
The nurse is approached by the health department to investigate and assess the rise in developmental disabilities in an isolated section in the community. To begin the assessment, the nurse should gather objective data from which source? A) Client interview—aggregate data B) Internet—aggregate data C) Internet—Wikipedia D) Direct observation of the area
B) Internet—aggregate data
The nurse is present when a mother begins cupping her child. She states that it will help to heal the child's respiratory tract infection. The nurse understands that the cultural belief that cupping will aid in the healing process is a: A) Shared instinct B) Learned behavior C) Private idiosyncrasy D) Genetically programmed idea
B) Learned behavior
The committee has established the need for a sick child clinic in an impoverished neighborhood. The demographic data have been collected, and the committee is ready to meet with a group of local businesspeople who are willing to support the project financially. The plan is for the committee and group to combine to facilitate the establishment of the clinic. Using a transtheoretical model, which level of readiness has the committee achieved? A) Contemplation B) Preparation C) Action D) Relapse
B) Preparation
After successfully implementing and managing a smoking cessation program in an inner-city neighborhood for 5 years, the group expands the efforts to include a nearby rural community. After a challenging first year, the nurse finds that with a few modifications the program is proving successful in the rural setting, as well. Which essential component of program design has been established by success in the rural community? A) Sustainability B) Program replication C) Clinical expertise D) Accountability
B) Program replication
The school nurse notifies the community nurse that there have been five confirmed cases of pertussis in the sixth-grade classes. In addition to responding to the cluster of cases, the community nurse should immediately: A) Recommend that the school be closed B) Research the vaccine compliance in the school C) Recommend that notes be sent home to the parents regarding a pertussis epidemic D) Consult with the infection control physician at the local hospital
B) Research the vaccine compliance in the school
The nurse works at community clinic that provides various types of health screenings for members of the community. One day, the nurse provides tuberculin tests for a group of new hospital employees. Which type of screening procedure is this? A) Mass screening B) Selective screening C) Multiphasic screening D) Case finding
B) Selective screening
Using the tenets of secondary prevention, the committee seeks to establish an HIV/AIDS clinic. The nurse states that it is important for the location of the clinic to be associated with the local hospital. The committee states that the cost of the clinic associated with the hospital is higher than one that is free standing. Which presents the best rationale for the nurse's suggestion? A) Third-party insurance will reimburse the clinic visits only if the clinic is attached to the hospital. B) The hospital can more easily implement programs of care for the clients. C) The hospital will cover the clients only if the clinic is approved by the hospital governance board. D) The hospital will have a vested interest in the success of the clinic
B) The hospital can more easily implement programs of care for the clients.
Three years after exposure to a virulent form of the flu, a population faces the same flu strain. The public health department recognizes that there are members of the population who have not been exposed to the flu strain. Which is most likely to happen? A) The unexposed population will contract the illness B) The unexposed population is not likely to contract the illness C) The unexposed population will contract the illness and reinfect others D) The flu will reach epidemic proportions and both populations will become ill
B) The unexposed population is not likely to contract the illness
Each employee in a small community hospital is informed that he or she needs a tuberculin skin test and of the date that the test is due. The kitchen employees tell the nurse that they don't need the test and never had to have it before. The nurse should respond with: A) The test does not need to be given if you do not have client contact. B) Tuberculosis guidelines require testing of an entire healthcare setting. C) The test will not hurt; we won't fire you if you test positive. D) The tuberculosis guidelines state kitchen workers are at risk.
B) Tuberculosis guidelines require testing of an entire healthcare setting.
The nurse conducts a community assessment. The community is large and the members range from affluent executives to poor migrant workers. To most accurately assess the community, the nurse should: A) Use a questionnaire written on a fifth-grade reading level B) Use multiple methods or perspectives C) Interview a subpopulation of each group represented D) Analyze census data
B) Use multiple methods or perspectives
The community health nurse works in a region where severe acute respiratory syndrome (SARS) has just been reintroduced into the environment. Which measure is imperative for the nurse to take to prevent spread of the disease? A)Prophylactic antibiotics B)Enhanced infection control measures C)Use of alcohol cleansers D)Report of clusters to CDC
B)Enhanced infection control measures
The nurse is caring for a client who is from a culture for which the nurse has a limited knowledge base. The nurse conducts the admission interview using cultural humility. Which should the nurse ask in the interview? (Select all that apply.) A) Yes or no questions B) About traditions C) Open-ended questions D) How the client has addressed the illness E) If the cause of the illness is spiritual
B,C,D
There is an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in the community. The nurse is responsible for the dissemination of the education plan adopted by the public health department. Key components of the plan should include: (Select all that apply.) A) Quarantining infected families in their homes B) Respiratory hygiene C) Hand hygiene D) Droplet precautions for visitors in contact with affected clients E) Contact precautions for all cases
B,C,D
Which characterize health inequities? (Select all that apply.) A) Necessary B) Unfair C) Resulting from social injustices D) Avoidable E) Natural
B,C,D
Following a hurricane, the disaster team chooses to use a collaborative model to assess the needs of the community. Each team member is given a community analysis and assigned the task to create a tentative plan of action. Why would the use of a collaborative model hamper the progress of the assessment and plan in a disaster? (Select all that apply.) A) Individual decision-making creates bias. B) Assessment is time-consuming. C) Approach to problem solving is linear. D) Approaches must be preestablished. E) Collaboration is limited.
B,D
Ten documented cases of West Nile virus (WNV) have occurred recently in the community. To reduce the transmission of the virus, the nurse should educate the members of the community to: (Select all that apply.) A) Avoid contact with birds B) Avoid contact with mosquitoes C) Avoid those with a confirmed diagnosis D) Eliminate standing water E) Avoid exposure to the environment during the daylight hours
B,D
15. A 27-year-old client comes from a background of physical and sexual abuse. Violence victimization continued with her partners until recently. She is currently in a support group for victims of abuse. The client's social background places her at risk for: (Select all that apply.) A)Increased safe sex behaviors B)Decreased safe sex behaviors C)Decreased risk for HIV/AIDS D)Increased risk for HIV/AIDS E)Increased risk of depression
B,D,E
Select the examples of social marketing. (Select all that apply.) A) Ad campaign for a new brand of toothpaste B) Brochure placed in obstetricians' offices promoting the benefits of breastfeeding C) Infomercial on television presenting the advantages of a piece of exercise equipment D) Billboard illustrating the dangers of texting while driving E) Posters placed in college dormitories encouraging condom use
B,D,E
A man who lives in a homeless shelter is diagnosed with active tuberculosis (TB). The shelter keeps a list of those who are assigned beds, and the majority of those sleeping there are regulars. Which finding would indicate a positive tuberculin skin test result using a two-step process? A) 4-mm induration B) 2-mm induration C) 6-mm induration D) 3-mm induration
C) 6-mm induration
The nurse enters a client's home to provide care to a wound and teach the client's wife how to care for the wound. The nurse is comfortable with the client's culture and the fact that it is matriarchal in nature. As teaching begins, the husband interrupts and states that the woman does not change bandages according to his culture. He asks if the nurse is familiar with his culture and then says that all members of his neighborhood follow its principles. The nurse should suspect that the client is a member of: A) A cult B) An orthodox religious group C) A subculture D) An occupation
C) A subculture
An 80-year-old client is being treated for chronic urinary tract infections. She has received multiple antibiotics in the past 6 months. The physician orders a urine culture. The results of the urine culture are as follows: Staphylococcus aureus >100,000 colonies and demonstrated resistance to sulfamethoxazole and trimethoprim (Bactrim), penicillin, methicillin, and erythromycin. The client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) on the basis of the findings of her urine test. Based on the client's history, a cause of the MRSA might be microbial: A) Rejection B) Assimilation C) Adaptation D) Stagnation
C) Adaptation
While completing a community assessment, the nurse notes that the computer companies in the community hire a disproportionate number of their employees from local suburban communities rather than the community in which the company is housed. To create an accurate assessment, the nurse should collect data on: A) All of the company's employees but count those living outside the community separately, as outliers B) Only the employees that live in the community, disregarding the others as statistically irrelevant C) All of the company's employees and include those living outside the community as part of the aggregate D) Only the employees that live in the community in your initial assessment; then collect data on the others as part of a separate assessment for the community in which they live.
C) All of the company's employees and include those living outside the community as part of the aggregate
The nurse is scheduling a follow-up appointment for a client who recently immigrated from Nicaragua. The client agrees to a 9:00-AM appointment on the following Wednesday. The nurse should anticipate that on the following Wednesday, this client will: A) Show up half an hour before the scheduled time B) Not return at all for the follow-up appointment C) Arrive late for the appointment, after completing whatever tasks the client feels need to be accomplished first D) Arrive exactly on time
C) Arrive late for the appointment, after completing whatever tasks the client feels
The nurse prepares community program objectives that are specific, measurable, achievable, relevant, and time bound (SMART) to help in planning interventions and establishing measurement systems to evaluate programs and outcomes. Which is a measurable objective? A) Program will reduce teenage obesity. B) Fewer teens will start smoking. C) Blood pressure for children aged 12 to 18 years in Marks School will be reduced by 5% after petting the dog for 1 day in March 2019. D) Number of older minority residents in Legacy Independent facility receiving a flu shot will triple.
C) Blood pressure for children aged 12 to 18 years in Marks School will be reduced by 5% after petting the dog for 1 day in March 2019.
Many in the community have developed cancer. The EPA has discovered a leak of biohazardous waste from a local factory that has leached into the water table. The area is decontaminated and cleaned. The community identifies the need for a local hospice for those with cancer who are dying. Area communities participate in the fund drive. This type of community effort may best be described as: A) Geopolitical community B) Epidemiologic model C) Community of solution D) Developmental model
C) Community of solution
The nurse conducts a well-child clinic in your community. The client population is culturally diverse, and, although the clinic is busy, it runs smoothly because it has an interpreter. In addition to the interpreter, it is important that the nurses treat each client that reflects his or her individual cultural needs. This is cultural: A) Bias B) Artwork C) Competence D) Beliefs
C) Competence
The nurse is caring for a client who is a refugee from Haiti. The client's family has been displaced because of an earthquake in their country. The client has healing fractures on his right arm as well as fractured ribs. He tells the nurse that, before care begins, the nurse must consult with his Voodoo healer. Which is the nurse's best response? A) Teaching the client that he is in the United States and should abide by Western medical practices B) Informing the physician that the client is noncompliant C) Consulting with the healer and updating the physician regarding treatment and any herbal medications that may be used D) Encouraging the client to use a complementary approach to his care
C) Consulting with the healer and updating the physician regarding treatment and any herbal medications that may be used
Which is the first step in developing a plan for evaluating a community-level intervention? A) Determine indicators or measures to answer evaluation questions B) Decide what method you will use to collect data C) Develop evaluation questions D) Decide how you will communicate your results
C) Develop evaluation questions
The community health nurse is responsible for the general health of the community on multiple levels. The nurse discovers an increase in the number of sick days used by children aged 7 to 11 years at the local elementary school in recent weeks. Research indicates that the families of asthmatic children tend to be less educated and less likely to comply with current treatment plans. Using the epidemiologic approach, the next step in the care plan should be to: A) Conduct a broad-based survey of all families with asthmatic children within several communities B) Determine trends that interfere with family problem-solving techniques C) Develop school-based education programs for both the children and their caregivers D) Submit a proposal to the town for neighborhood asthma clinics
C) Develop school-based education programs for both the children and their caregivers
A client, diagnosed with hypertension, is prescribed a no-added-salt, low-fat diet. He agrees and repeats the teaching principles. At the next visit, the nurse notices salted meat on the counter and the client shows the nurse his food diary. The diet in the past week does not reflect the physician's orders. What cultural component may have contributed to the noncompliance with the diet order? A) Diet may be too lean B) Wife cooks according to the husband's preferences C) Diet may not meet the cultural criteria for food choices D) Food tastes bland and unappetizing
C) Diet may not meet the cultural criteria for food choices
The nurse conducts a class on the basics of nutrition to a group of obese adults. The nurse counsels the audience, telling them that they need to change their behaviors. By the end of the class, the nurse has lost the audience. To enhance audience participation and learning in the next class, the nurse should: A) Use consistent methods of persuasion B) Offer advice while the participants are passive C) Encourage the group to participate in the decision making D) Encourage the group to continue ambivalent behaviors
C) Encourage the group to participate in the decision making
Which most accurately describes the purpose of force field analysis? A) Unfreezing the status quo B) Changing or moving to a new state C) Identifying the forces driving the change and those resisting it D) Refreezing to sustain the change or changes made
C) Identifying the forces driving the change and those resisting it
A 32-year-old African-American client is diagnosed with HIV. She is at her 6-month appointment following diagnosis and treatment. The client states that she has not revealed her diagnosis to her boyfriend because she is afraid that he will leave. She expresses feelings of anger because she must put her feelings and illness aside or be abandoned. The client's behaviors reflect: A) Denial of her disease process B) Noncompliance with her drug regimen C) Inability to advocate for herself D) Fear of financial insolvency
C) Inability to advocate for herself
Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. The nurse researches the problem and establishes a well-child clinic within walking distance to the neighborhood. The clinic is poorly attended. Which would be the nurse's best action to revise the program and improve attendance to the clinic? A) Determine whether the location of the clinic is not conducive to attendance. B) Discuss the problem of attendance at the next community council meeting. C) Interview members of the neighborhood to determine why they do not use the clinic. D) Discuss the problem with the local minister and request him to discuss the clinic at the next prayer service.
C) Interview members of the neighborhood to determine why they do not use the clinic.
The nurse assesses a client in the local neighborhood clinic. He exhibits signs and symptoms of tuberculosis (TB) yet has a negative tuberculin skin test result. The nurse suspects that the physician may further test the client because he: A) Visited Central America recently B) Is recovering from jet lag C) Is HIV positive D) Works in a factory setting
C) Is HIV positive
The nurse educator is responsible for conducting educational seminars for the staff. After the education component of the program, the group engages in discussion. It is important that nurses routinely attend educational programs related to cultural competence because: A) The information is lost when caring for clients in real life. B) One can't be competent at all times. C) Nurses can facilitate social change. D) Classes are necessary for regulatory compliance.
C) Nurses can facilitate social change.
A 43-year-old African-American client is HIV positive. She has a personal history of abuse, which ended when her husband died 2 years ago. When counseling the client about adherence to her treatment plan, the nurse finds her intelligent and goal oriented. In addition to her need for education and follow-up regarding her HIV diagnosis and treatment, which associated condition should the nurse most consider when caring for this client? A) Cardiac tamponade B) Chronic obstructive pulmonary disease C) Posttraumatic stress disorder D) Cirrhosis of the liver
C) Posttraumatic stress disorder
The community health nurse learns that there are statistically high levels of obesity and elevated cholesterol in the community. In addition, the community has a disproportionately high number of fast food restaurants, compared with surrounding communities. Which would be the most appropriate next step, based on these data? A) Gather support in the community to ban fast foods B) Gather further information regarding trans fats C) Target education and support programs D) Create local exercise programs
C) Target education and support programs
The new community health nurse introduces herself to the local minister and attends various neighborhood meetings. The nurse learns about the ethics, values, and culture of the neighborhood. The community is vocal about the need for public safety and the care of the homeless, especially in the winter. Which is the best rationale for considering all of the influences in the neighborhood affecting their health and well-being? A) The information can be used to obtain funds to create shelters for the homeless B) A neighborhood watch may be created with police support C) The information will help to effectively assess the community D) It will help the nurse create a controlled clinical environment
C) The information will help to effectively assess the community
To demonstrate true cultural sensitivity and awareness, the nurse must: A)Travel to other countries on occasion B)Become bilingual C)Become competent in his or her cultural heritage D)Know the practices of all major cultures in one's region of the country
C)Become competent in his or her cultural heritage
The nurse is in the process of forming a coalition to support a community flu shot program. Which step should the nurse take as part of this process? (Select all that apply.) A) Assign members of the coalition to tasks in a random manner. B) Seek out people with similar opinions and roles in the community. C) Consider how each member of the coalition and the organization or group represented will benefit from the work of the coalition. D) Understand group dynamics and members' motives for serving. E) Form a group that is heterogeneous but able to show mutual respect.
C,D,E
The client is diagnosed with Lyme disease. He states that he is not a hiker and does not remember being bitten by a tick. As part of the education plan, the nurse should state: A) "You must have been bitten by a tick and didn't recognize it as such." B) "Did you spend time in a brushy or grassy area in the last 90 days?" C) "Conduct a full-body tick check once a week during the summer." D) "A history of a tick bite is not required."
D) "A history of a tick bite is not required."
The nurse admits a client to the hospital with the diagnosis of Escherichia coli O157:H7. The client is dehydrated and febrile. During the history phase of the admission, the client states that he doesn't know how he could have gotten sick at the local county fair—the hamburger he bought was well done. Upon further discussion, the nurse suspects the transmission may have occurred because of: A) Use of a gas barbecue B) Improper cleaning of the cooking tools C) Use of wood instead of charcoal to cook the meat D) Animals roaming in the fair grounds
D) Animals roaming in the fair grounds
International health experts indicate that the avian flu is the virus most likely to cause the next pandemic. What may improve its transmissibility to the public? A) Increase in consumption of chicken B) Increase in autoimmune disease incidence C) Shift to zoonotic transmission D) Antigenic shift
D) Antigenic shift
The community health nurse works in a community recently devastated by a tornado. Many of the survivors are cared for in their homes. Care is needed for those who are ill, recovering, or in hospice. To provide the most holistic and effective care to the community, the nurse should: A) Refer the clients to an outreach center B) Consult with the hospice nurse and the social worker C) Provide care according to the physician's orders D) Collaborate with other health care workers and the clients
D) Collaborate with other health care workers and the clients
The nurse researches whether the community would benefit from monthly blood pressure clinics. Which system level would such an intervention address? A) Upstream B) Mainstream C) Sidestream D) Downstream
D) Downstream
Which type of assessment considers a configuration of behaviors that occur sequentially over time? A) Asset-based assessment B) Epidemiologic model C) Collaborative model D) Functional health pattern
D) Functional health pattern
14. A 47-year-old client and three members of his neighborhood have had their homes robbed and belongings scattered. The client contacts the police and, with their assistance, develops a neighborhood watch. The watch is organized and 24 families have been recruited to participate. The watch will be active throughout vacation months and as needed. This organization is representative of: A) Transtheoretical model B) Theory of reasoned action C) Social learning D) Relapse prevention model
D) Relapse prevention model
17. When the community collaborates in a plan to create services and education to enhance their health and well-being, the plan is most likely to: A) Create an environment that fosters change B) Have an increased rate of success C) Empower the community but diminish the rate of success D) Shift the focus from dependency to empowerment
D) Shift the focus from dependency to empowerment
Four employees at a local restaurant have positive purified protein derivative (PPD) tuberculin skin tests and have been diagnosed with latent tuberculosis (TB) infection. Which employee would be at the greatest risk for contracting active TB disease? A) Works two jobs B) Vacations in South America C) Cooks the food D) Takes immunosuppressants
D) Takes immunosuppressants
The nurse is responsible for the construction of an isolation unit during an H5N1 outbreak. The unit is designated for only those clients with a confirmed diagnosis of H5N1. Which unit would be easily adapted to client needs? A) 12-room unit with negative air pressure units B) 15-room unit with a portable supply of PPEs C) 8-room unit with four code carts D) 12-room unit with four to six air changes per hour
A) 12-room unit with negative air pressure units
A 34-year-old client is recovering from a below-the-knee amputation secondary to a motor vehicle accident. The nurse meets with the client to update his care plan, and client states that he knows that he will walk again. He asks for physical therapy schedules and timelines for prosthetics on the basis of his healing process. On the basis of knowledge of the theory of reasoned action, the client's behavior reflects: A) An enhanced ability to meet his goals on the basis of his intention and behaviors B) Goal setting that is unrealistic and irrational based on the client's diagnosis and behaviors C) A depression that will complicate the healing process D) Denial of the injury and part of the healing process
A) An enhanced ability to meet his goals on the basis of his intention and behaviors
During an ice storm, people in one neighborhood banded together and shared the home of a neighbor who still had power and heat. Other neighbors provided food, water, and bedding. In another neighborhood the neighbors did not know one another and weathered the storm alone. Both neighborhoods are part of the same community. What characteristic did the people in the first neighborhood share that made them a subculture that those in the second neighborhood lacked? A) Belief in the value of cooperation B) Religion C) Socioeconomic status D) Geography
A) Belief in the value of cooperation
A Mexican-American client arrives at the emergency department. He reports abdominal pain and has been vomiting for 5 days. The nurse notes that he is exhibiting symptoms of dehydration, and his vital signs and labs confirm this. The nurse asks the client why he waited so long to seek medical care. He states that he is being treated by the Curandero and wishes to continue while in the hospital. The nurse recognizes the different cultural assumptions regarding care. This situation is an example of: A) Cross-cultural nursing B) Ethnocentrism C) Cultural safety D) Transcultural bias
A) Cross-cultural nursing
A group of teens develop their own method of texting in a language that they feel is all their own. The change is subtle, but the meanings and the feelings associated with the text are known only to a select few. This behavior is an example of: A) Culture B) Cultural competence C) Cultural safety D) Ethnocentrism
A) Culture
Absenteeism due to illness has increased recently in the local middle school. The increase is noted to be related to exacerbation of asthma symptoms in the student population. Which would be the most effective approach in decreasing absenteeism among this population? A) Develop an asthma education and surveillance program that addresses students, families, and faculty members. B) Develop a policy to exclude students with a diagnosis of asthma from admission to the school. C) Create an asthma prevention plan within the school environment, based in the school nurse's office. D) Create an education program for faculty related to the prevention of exacerbation of asthma systems.
A) Develop an asthma education and surveillance program that addresses students, families, and faculty members.
The nurse cares for a client in a community health clinic. The nurse is uncomfortable because the client remains very close when communicating. This discomfort makes it difficult to concentrate on the interview. When the nurse backs away, the client stops speaking and leaves. This is an example of: A) Differing views of personal space B) Treatment limitation C) Aggressive behavior D) Cultural bias
A) Differing views of personal space
The physician approaches the client with a treatment plan for his cancer. The client states that his life is in God's hands and refuses conventional treatment. This is an example of: A) Fatalistic behavior B) Denial C) Anger D) Bargaining
A) Fatalistic behavior
The community health nurse explores pedestrian access to all healthcare facilities in the community. Which tool would be most helpful in performing this task? A) Geographic information systems B) Functional health pattern C) Epidemiologic model D) Developmental model
A) Geographic information systems
The nurse decided to use a learning model based on Skinner with a client with diabetes to improve compliance with dietary and blood glucose assessment requirements. Which would be the best way to implement this program? A) Give rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance. B) Eliminate the reward and punish the client when she fails to comply with dietary guidelines. C) Demonstrate positive reinforcement by decreasing dietary guidelines and blood sugar parameters. D) Institute a strict timeline to accomplish goals.
A) Give rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance.
2. The nurse conducts a community assessment in a town once supported by multiple paper factories. The factories closed 2 years ago and most of the population is now out of work. The school nurse notes that 68% of the students are behind schedule in their physicals and immunizations. On the basis of this community assessment, the nurse should recommend: A) Initiation of neighborhood clinics at low or no cost to the community B) Creation of a task force to assess the impact of low income on immunization compliance C) A formal petition to the local government to mandate immunizations by imposing monetary fines on parents whose children are not immunized D) A tax relief program for new companies wishing to settle in the community
A) Initiation of neighborhood clinics at low or no cost to the community
The community is concerned about public safety and the care of their elders living at home. When the nurse assesses the community, the nurse finds there is potential to solve their problems within the community setting without outside resources. The plans to meet the community needs are accepted by the members of the community. Which action has been most successfully demonstrated in your assessment of this community? A) Make the assessment process empowering to the community B) Assess the community through interview and share findings in a timely manner C) Involve the community when there is difficulty with the assessment D) Create an environment of change within the community
A) Make the assessment process empowering to the community
The client is admitted to the hospital for new-onset hypertension and chest pain. During the admission interview you ask the client if she takes over-the-counter medications, and she states no. She adds that she routinely visits a folk healer. The nurse's response should include: A) Obtaining a list of the herbs and folk medications that are taken and notifying the physician B) Requesting the client to stop the ingestion of the folk herbs C) Calling poison control with the list of herbs and folk medications D) Encouraging the client to continue to take the herbs and folk medications
A) Obtaining a list of the herbs and folk medications that are taken and notifying the physician
The local clinic is dedicated to the well adult and child. It has evening hours and offers varied programs for the community. The programs include immunizations and classes on fire safety, health education, and car safety, to name a few. How would the nurse explain the level of prevention used in this setting to your colleagues? A) Primary B) Secondary C) Tertiary D) Quaternary
A) Primary
The community health nurse assesses the neighborhood in which the clients live. When observing the physical environment, the nurse notes that most of the homes in the neighborhood are well kept and the children playing in the yards are wearing clean clothing. The children appear well nourished. The nurse determines that the neighborhood has little need for a well-child clinic. This assessment is based on: A) Subjective data B) Objective data C) Cognitive analysis D) Valid data
A) Subjective data
The nurse is reviewing the sources of funding for the local community health intervention program on smoking cessation. In the federal grant proposal, the nurse elaborates on all the various local organizations and private foundations that have pledged to support the program after initial funding from the grant ends. The nurse also explains the plan for ongoing fundraising efforts for the program for years to come. With these comments, the nurse is attempting to establish which essential component of funding? A) Sustainability B) Program replication C) Clinical expertise D) Accountability
A) Sustainability
As an advocate for leukemia research, the nurse along with many others succeeded in urging the U.S. Congress to debate and vote on a bill that significantly increases federal funding for this research. Which system level would such an intervention address? A) Upstream B) Mainstream C) Sidestream D) Downstream
A) Upstream
As the occupational health nurse in a factory finds that five employees out of 30 have positive tuberculin skin test results. One employee on the 3-to-11 shift has been diagnosed with active tuberculosis (TB). She asks if this means that the whole factory has been exposed. The nurse replies that the probability of infection depends upon: (Select all that apply.) A) Concentration of infectious droplet nuclei in the air B) Duration of exposure to the infected person C) Proximity to the infected person D) The use of safety gloves by employees E) Physical exertion required in the job
A,B,C
The nurse decided to approach local organizations for financial and in-kind support for a new community health initiative. On which local resources can the nurse draw? (Select all that apply.) A)Catholic church B)Branch of Bank of America C)Car dealership D)Community transformation grant E) The Bill and Melinda Gates Foundation
A,B,C
The nurse decides to use the health belief model for a wellness walking program for older adults. The walk is to begin each day at 8 PM. Each day a different participant is to start a chain of phone calls to other participants to remind all to attend. The nurse informs the clients in the clinic that walking will improve their overall health and well-being. Two older adults show up the first night and none the second. Which information should the nurse gather to explain the failure of the program? (Select all that apply.) A) The severity of the physical challenge related to the client population B) What stands in the way of taking action toward the goal of health promotion C) The presence or absence of cues needed for the program to achieve success D) The presence or absence of a strong team leader among the participants E) The need to increase persuasion when implementing the program
A,B,C
The nurse reviews the logic model and formal evaluation plan of a grant proposal on a community rabies program. Which requirements should be included in the plan to support accountability? (Select all that apply.) A) Regular communication about funds that were not used B) Details of program activities C) Report of areas where there is no progress toward program goals D) Proof that the program can be reproduced effectively in other settings E) Explanation of how the program will be funded after grant funding expires
A,B,C
The nurse is in charge of a local community program that uses a logic model as a planning and communication tool. Which key components are included in this model? (Select all that apply.) A) Milestones for completing a community health clinic B) Plan to conduct cholesterol screenings C) Need for a nurse practitioner to manage the clinic D) Malaria prevention programs for developing nations E) Possible locations for the health clinic
A,B,C,E
The nurse assesses a community undergoing change. Five years ago, a series of setbacks caused the local foundry to close. Through interviews, the nurse discovers that generations of families worked at the foundry. Research indicates that no other businesses have been able to provide work for those who no longer work at the foundry. Developmental data gathered through this research into the community's history will help the nurse: (Select all that apply.) A) Determine what resources were available before the foundry closed B) Determine what variables may have enhanced or detracted from community development C) Develop an understanding of the community's strengths and resources today D) Understand cultural changes within the community over time E) Identify where in the community health clinics are most needed
A,B,D
The nurse works in a facility that provides hospice care for clients with cancer diagnoses. The nurse recognizes that the care provided in this facility is tertiary in nature. The nurse develops a plan for the clients that would include the tenets of tertiary prevention. The plan would include: (Select all that apply.) A) Palliative care B) Pain control C) Isolation D) Supportive spiritual development E) Diminished involvement of significant others
A,B,D
Which aspects of Lewin's change theory will help people visualize and create needed change? (Select all that apply.) A) Unfreezing the status quo B) Changing or moving to a new state C) Enforcing the status quo D) Refreezing to sustain the change or changes made E) Increasing restraining forces
A,B,D
Which changes in the environment (second level from the bottom of the health impact pyramid) make the choice for a healthy behavior the default or easy choice? (Select all that apply.) A) Iodization of salt B) Restrictions on smoking in public places C) Community immunization programs D) Changing food manufacturing to eliminate trans fats E) Treatment of hypertension
A,B,D
A nurse is studying the Institute of Medicine's convergence model to learn how four types of interrelated and overlapping microbe-human interactions can lead to emerging/reemerging infectious diseases. These four types of interactions are: (Select all that apply.) A)Genetic and biological B)Physical/environmental C)Spiritual and psychological D)Ecological E)Social, political, and economical
A,B,D,E
The nurse prepares to enter the room of a client with suspected Ebola virus disease (EVD). Which pieces of personal protective equipment (PPE) should the nurse wear? (Select all that apply.) A) Fluid-resistant gown B) Gloves C) Respirator D) Mask E) Goggles
A,B,D,E
A 19-year-old client is diagnosed as HIV positive. Which behaviors might be indicators of noncompliance with her drug regimen and require further assessment? (Select all that apply.) A) Depression B) Indifference to self-advocacy in sexual relationships C) Goal-oriented attitude toward treatment plan D) Client's expression of concern for the health and well-being of her children E) Client's expression of concern regarding the ability to pay for her medications
A,B,E
The nurse is responsible for the directly observed therapy (DOT) program in the community. Which represent the best methods to ensure compliance with clients' drug regimens? (Select all that apply.) A) Social service support B) Housing assistance C) Hospitalization D) Isolation until treatment complete E) Treatment enablers
A,B,E
Which rationales are appropriate for performing community assessments in the school setting? (Select all that apply.) A) To learn about an outbreak of lice B) To assess effectiveness of children with type I diabetes managing insulin shots at school C) To stage a student's brain tumor D) To assess students for food allergies E) To provide education on preventing the spread of influenza
A,B,E
Tent communities are constructed in a rural community by the American Red Cross after a disaster. Because of overcrowding, surrounding states create accommodations for the displaced and homeless. The survivors are accommodated in the cities of four Southern states. Which factors may increase the possibility of disease emergence in the cities? (Select all that apply.) A) Poor hygiene B) Decreased socialization C) Poor sanitation D) Decreased viral load E) Increased violence
A,C
A nurse, new to the community health agency, works in a culturally diverse area of the community. The nurse is responsible for providing holistic care to clients and to be culturally competent. The health agency requires the nurse to demonstrate which competency to exhibit cultural competence? (Select all that apply.) A) V alue diversity B) Adopt the client's cultural values C) Acquire cultural knowledge D) Adapt to diversity E) Speak the language of the client
A,C,D
At an international nurses' conference, nurses from all around the world make contact. The various communities represented at this conference most likely: (Select all that apply.) A) Vary significantly in composition B) Have no shared interests and goals related to health and safety C) Are challenged in their attempts to identify its members D) Thought of as members of a global community E) Do not need to assess their communities' needs because they are obvious
A,C,D
The nurse is called to make an unscheduled visit to a new client in her home. The purpose of the visit is to admit the client and treat an abdominal wound. The nurse discovers that the client is from a culture unfamiliar to her. In this situation, the nurse should demonstrate cultural competence and awareness by: (Select all that apply.) A) Being open to the client's ideas and way of life B) Obtaining objective data when caring for the client C) Exhibiting respect and patience D) Being aware of your own culture E) Assuming that you have enough knowledge to get by
A,C,D
The nurse reviews the job descriptions of the community health workers who work with community health nurses and other members of the program team. These workers are responsible for: (Select all that apply.) A) Serving as a cultural and language bridge to members of target population B) Performing minor surgical procedures C) Providing health education and outreach to community D) Offering assistance in accessing services E) Prescribing commonly used medications
A,C,D
Which environmental factors are likely to affect the life cycle of disease pathogens and their vectors and thus disease outbreaks? (Select all that apply.) A) Temperature B) Geology C) Precipitation D) Humidity E) Amount of daylight
A,C,D
The nurse researches the role of nurse-managed health centers in the city. Which are common characteristics of these centers? (Select all that apply.) A) Led by advanced-practice nurses B) Serve upper-income mothers and children C) Emphasize health promotion, disease prevention, and health education D) Provide clinical practice for nursing students and faculty E) Offer specialized programs to meet the needs of specific population aggregates
A,C,D,E
A client is admitted to the hospital. On admission, it is noted that the client does not speak English. It will take 20 minutes for the hospital interpreter to arrive. The nurse decides to wait for the interpreter rather than relying on the client's husband. Appropriate rationales for this decision include that the interpreter is: (Select all that apply.) A) More likely to be fluent in both languages B) More likely to be familiar with the client's symptoms C) Trained in ethics and will be better at explaining cultural differences D) More likely to understand the client's needs E) More likely familiar with technical healthcare terms
A,C,E
Health People 2020 (HP 2020) is a guidepost for nurses and interdisciplinary teams in community and public health. New focal areas for HP 2020 include: (Select all that apply.) A) Adolescent health B) Diabetes C) Genomics D) Nutrition and weight status E) Social determinants of health
A,C,E
Secondary HIV prevention or positive prevention is used when caring for African-American women living with HIV by addressing which behavioral risks? (Select all that apply.) A) Interpersonal mistrust B) Alcoholism C) Poor adherence to treatment D) Smoking E) Compromised self-advocacy in sexual relationships
A,C,E
Which are recommendations made by the World Health Organization's Commission on Social Determinants of Health (CSDH)? (Select all that apply.) A) Improve conditions under which all people are born, grow, live, work, and age B) Provide increased funding for research of genetic disorders C) Ensure more equitable distribution of power, money, and resources D) Instill a sense of personal responsibility for one's health in each person E) Expand knowledge of the social determinants of health
A,C,E
Which exemplify clinical interventions (the level just above the middle of the health impact pyramid)? (Select all that apply.) A) Administration of insulin injections for diabetes B) Restrictions on smoking in public places C) Community immunization programs D) Instruction provided by a nurse regarding proper nutrition E) Treatment of hypertension
A,E
The nurse is caring for a client who refuses the food as served. He states that the food is foreign to him and will make him ill. All food must be blessed. The personal care attendant is upset by this behavior and states that the client should eat the food anyway. The client's behavior is most likely a result of: A) Psychosocial deficit B) Cultural belief C) Allergies D) Hygiene
B) Cultural belief
A woman arrives at the clinic for a routine appointment. She has been HIV positive for 3 years and states she is doing well. She currently is involved in a relationship with a man who is HIV positive. She states that she is not consistent with safe sex practices due to her significant other's preferences and feels uncomfortable asking him to wear a condom. Which is the nurse's best response to promote the client's health? A) "You won't become pregnant as long as you are taking your drug cocktail." B) "You will not be protected against other strains of HIV or sexually transmitted infections (STIs)." C) "You will both be safe because you both already have HIV." D) "Let's have you both tested for STIs."
B) "You will not be protected against other strains of HIV or sexually transmitted infections (STIs)."
Which best defines program replication? A) Ability to replicate a successful program in the same community a second time B) Ability to reproduce a successful program within a different community C) Ability to replicate a successful program with a new sample aggregate D) Ability to implement a successful program with the same population aggregate
B) Ability to reproduce a successful program within a different community