Chapter 22: Health Risks Across the Life Span

A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a. Antialcohol program b. Antismoking program c. Careful driving program d. Safe sex program

Careful driving program Motor vehicle accidents are the leading cause of death among children and teenagers. The use of tobacco is a leading cause of preventable death among adults, but not among adolescents. Alcohol use and sexually transmitted diseases are not related to common causes of death among teenagers.

Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.) a. A 16-year-old who is legally emancipated b. A pregnant adolescent c. An adolescent requiring an emergency appendectomy d. An adolescent whose diagnosis of cancer has a serious prognosis e. A 15-year-old who overdosed on cocaine

-A 16-year-old who is legally emancipated -A pregnant adolescent - An adolescent requiring an emergency appendectomy -A 15-year-old who overdosed on cocaine Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the "mature minor doctrine." This allows youths of 15 years and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated. If an adolescent has a diagnosis that has a serious prognosis, parental consent will be needed as this is not a situation that involves emergency care, substance abuse, pregnancy, and birth control

Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.) a. Assess schools and day care centers for environmental "friendliness." b. Share nutritional information with all students in the school. c. Develop home and environmental assessment guides. d. Teach all school personnel how to use rescue inhalers. e. Work with community developing clear air policies.

-Assess schools and day care centers for environmental "friendliness." -Develop home and environmental assessment guides -Work with community developing clear air policies. Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day care centers for lack of asthma triggers. Sharing nutritional information is not related to the care of asthma patients. It is not necessary that all school personnel know how to use rescue inhalers, rather those who are in direct contact with the child with asthma.

After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older friend asks the nurse, "I'm really scared of getting cancer. What can I do to avoid that kind of cancer?" Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Avoid smoking or much alcohol. b. Choose poultry or fish as a protein source. c. Eat lots of fruits, vegetables, and fiber every day. d. Try to get at least 8 hours of sleep a night. e. Limit intake of red or processed meat.

-Avoid smoking or much alcohol. -Choose poultry or fish as a protein source. -Eat lots of fruits, vegetables, and fiber every day -Limit intake of red or processed meat Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer. Getting an adequate amount of sleep will not avoid any risk factors for the development of colorectal cancer.

A nurse's mother leans forward and says, "My best friend fell the other day and now she's in the hospital. I'm really worried about getting osteoporosis. What do you think I should do?" What should the nurse recommend? (Select all that apply.) a. Ask your doctor for hormone replacement therapy. b. Continue to abstain from alcohol. c. Eat foods high in calcium such as fortified skim milk. d. Eat lots of green leafy vegetables. e. Avoid tobacco products

-Continue to abstain from alcohol. -Eat foods high in calcium such as fortified skim milk -Avoid tobacco products. It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limit in alcohol consumption; and avoidance of smoking. Use of hormone replacement therapy and consumption of green leafy vegetables are not related to decreasing the risk of developing osteoporosis.

A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best assist the client with healing? (Select all that apply.) a. Advocating for increased support for elderly persons b. Eliminating signs and symptoms of disease c. Managing any chronic diseases to prevent complications and delay deterioration d. Maximizing self-care capacity e. Focusing on achieving quality of life

-Managing any chronic diseases to prevent complications and delay deterioration -Maximizing self-care capacity -Focusing on achieving quality of life With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity. It is probably impossible to eliminate signs and symptoms of the disease with a client who has a chronic disease. Advocating for increased support for elderly persons is not related to assisting the client with healing from the chronic disease.

Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager

A 1-year-old Children in their first year of life have the highest rate of victimization at 26.7 per 1000 children. A 6-year-old, 9-year-old, and teenager are not at high risk for being abused because they are older.

A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a. An advance directive b. A living will c. A durable power of attorney d. A Do-Not-Resuscitate (DNR) order

A durable power of attorney Durable power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so. Advance directives is a broad category that includes both living wills and durable power of attorney. A living will allow the client to express wishes regarding the use of medical treatments in the event of a terminal illness. A DNR order is a specific order from a physician not to use cardiopulmonary resuscitation.

Which of the following situations would most likely indicate elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparent's house breaking items. c. A young man repeatedly steals money from his grandmother. d. An elderly person demands that the family come for dinner.

A young man repeatedly steals money from his grandmother. Theft or mismanagement of money or resources is an element of abuse. A daughter refusing to visit, children breaking items, and an elderly person demanding that the family come for dinner are not situations that indicate elder abuse. None of these situations should cause alarm for the nurse as they all may normally occur within a family.

A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a. Accidents and injuries b. AIDS c. Childhood obesity d. Vaccine-preventable diseases

Accidents and injuries Injuries are the number one cause of death among children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable. Obesity, although a significant problem, is not a common cause of death in children. AIDS and vaccine-preventable diseases are not common causes of death among children.

A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a. Adult day health b. Home health c. Long-term care d. Senior center

Adult day health Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision. Typically, individuals return home to their caregivers at night. Adult day health serves as more of a medical model than the senior center. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems, and help would not be available.

Which of the following is the best way to ensure good nutrition in newborn infants? a. Breastfeeding only b. Feed them brand-name baby foods c. Feed them only homemade cereals d. Supplement breastfeeding with brand-name formulas

Breastfeeding only Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity. Feeding brand-name foods, homemade cereals, and supplementing with formula are not the best ways to ensure good nutrition in infants. Breastfeeding is the best option to ensure good nutrition.

A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse does not yet know the community, which of the following programs would be good to plan first? a. Alcohol and tobacco cessation programs b. Cancer screening programs c. Cardiac health education programs d. Exercise for life programs

Cardiac health education programs Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurse's second focus.

Toward whom is the TLC model targeted? a. Caregivers of older persons with health problems b. Community organizations that offer services for the elderly c. Elderly clients with health problems d. Nurses who care for older clients

Caregivers of older persons with health problems The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management. The TLC model is not focused on community organizations, elderly clients, or nurses, rather it focuses on caregivers and relieving caregiver burden.

A nurse has just met the parents of a 10-year-old child who has been diagnosed with a congenital heart defect. When interviewing the parents, which of the following would be a priority question for the nurse to ask? a. What are the learning needs of your child? b. What does your child eat on a typical day? c. Does your child have a good peer support network? d. Does your child have a medical home?

Does your child have a medical home? The use of a medical home, in which one provider or clinic has all of the child's records, is important for this population. Communication among all providers who are working with this child is essential in order for the child to achieve optimal health and functioning. Learning needs, nutritional needs, and peer relationships are important for a 10-year-old child. However, without having the coordination and consistency of a medical home to coordinate medical care, these other things may be insignificant.

A nurse is caring for a child who has been diagnosed with a chronic health condition. Which of the following conditions would the child most likely have? a. Heart disease b. Down syndrome c. Emphysema d. Arthritis

Down syndrome Common chronic conditions seen in children are Down syndrome, spina bifida, cerebral palsy, asthma, ADHD, diabetes, congenital heart disease, cancer, hemophilia, brochopulmonary dysplagia, and AIDS. Heart disease, emphysema, and arthritis are common chronic health conditions of adults, not children.

Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up

Early detection programs with referral to ongoing access to a care provider Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider. Education for women about breast cancer is not as effective as early detection programs. Screening must be completed which is accomplished through secondary, not primary prevention. Tertiary care does not occur until after diagnosis has occurred, and this is too late

A nurse is considering implementing interventions to address an increased interest in health and wellness promotion in the community's older adult population. What intervention should the nurse consider as the priority? Which of the following actions would the nurse most likely take? a. Educate a community group about hypertension control. b. Create a social group for those who have lost a life partner. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

Educate a community group about hypertension control While all options are appropriate interventions, educating the community about hypertension control is the priority since it contributes to the deterioration of health. Administering immunizations, promoting socialization, and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

Ensure the individual is educated to make an informed choice about reproduction. The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of preconceptual counseling

A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? a. Establish lifestyle improvement programs through local youth organizations. b. Evaluate the food intake of a group of children for a 48-hour period. c. Provide education programs to overweight expectant parents. d. Evaluate the body mass index of children at regularly scheduled well-child examinations.

Establish lifestyle improvement programs through local youth organizations. Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.

A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a. Patient Self-Determination Act b. Personal Responsibility and Work Opportunity Reconciliation Act c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA)

Family and Medical Leave Act (FMLA) The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member. The Patient Self-Determination Act requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. The Personal Responsibility and Work Opportunity Reconciliation Act is commonly known as "welfare reform." This law created the TANF program. The Temporary Assistance for Needy Families program is a work program that mandates that women heads of households find employment to retain their benefits.

A nurse is conducting a screening for type 2 diabetes for children attending a local school. In addition to an elevated BMI, which of the following risk factors should the nurse consider? a. Caucasian descent b. Family history of type 2 diabetes c. Birthweight greater than 9 pounds d. Poverty

Family history of type 2 diabetes Screening for type 2 diabetes mellitus is recommended for children with a BMI from the 85th to 95th percentile with two or more for the following risk factors: family history of type 2 diabetes in a first- or second-degree relative; Native American, African American, Latino, Asian American, or Pacific Islander descent; signs of insulin resistance or conditions associated with insulin resistance; or maternal history of diabetes or GDM during the child's gestation. Native American, African American, Latino, Asian American, or Pacific Islander descent is a risk factor, not Caucasian descent. Elevated birthweight and poverty have not been identified by the American Diabetes Association as significant risk factors that indicate the need for additional screening.

A nurse is providing preconceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a. Iron b. Calcium c. Folic acid d. Vitamin C

Folic acid Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects. A recommendation was made that women capable of or planning a pregnancy take 400 mcg of folic acid daily (USDHHS, 2010). Iron, calcium, and vitamin C are not used as routine prenatal supplements.

Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a. HRT does not prevent heart disease. b. Use of HRT is recommended to prevent osteoporosis. c. When used with complementary therapies, HRT is most effective. d. HRT is a contributing cause of breast cancer

HRT does not prevent heart disease. HRT does not prevent heart disease. To prevent heart disease, women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active. HRT is not recommended to promote osteoporosis. HRT is not a contributing cause of breast cancer. There is no evidence that HRT is most effective when used with complementary therapies

Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent b. Has not had a PSA test c. Has a father or brother who has had prostate cancer d. Has benign prostatic hypertrophy

Has a father or brother who has had prostate cancer Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer. African-American males have a mortality rate from prostate cancer that is nearly twice as high as any other group. The PSA test is not accurate in terms of sensitivity or specificity. This blood test produces many false-positive results because many factors can elevate the PSA. There is no relationship between benign prostatic hypertrophy and the development of prostate cancer.

An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice

Hospice Hospice would be the best form of care for a person in the last stages of dying. The other options are not specifically designed for persons in the last stages of dying. Home health provides care in the home, but is not specific to meet the needs of the dying patient and his or her family. Assisted living relates to a living situation where the client receives different amenities depending on the level of care needed. This type of living arrangement is not specific to care for the dying patient. Nursing homes provide long-term care and are not specific to care needed for a dying patient

A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be most effective? a. Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b. Increase nutrition programs in schools that teach children to make healthy food choices. c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d. Provide after-school and summer camps that focus on diet and exercise.

Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant. Changes need to be made at a more direct level, such as by working with the family, to establish a change. Community-level changes may not impact what is happening within the family in regard to diet and exercise.

A mother says, "My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and other activities. Do you think I should let him have a car?" Which of the following statements would be the best response by the nurse? a. "Absolutely, it will help him recognize the cost of gas and maintenance." b. "Certainly, most young men want their own car, and peer pressure can be painful." c. "It depends on whether you trust your son to drive safely." d. "No, adolescent males cannot be trusted with an automobile."

It depends on whether you trust your son to drive safely." Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality among adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son. The incorrect responses do not take into account the individual risk factors that the nurse should encourage the mother to consider. The nurse should encourage the mother to think about the risky behaviors specific to this population and how they apply to her son.

A nurse is providing nutrition counseling to the parents of a 4-year-old. Which of the following recommendations is the nurse most likely to provide? a. It is recommended that the child consume approximately 10 ounces of grains on a daily basis. b. It is recommended that the child consume approximately four cups of dairy on a daily basis. c. It is recommended that the child consume approximately four cups of fruits and vegetables daily. d. It is recommended that the child consume approximately 10 ounces of protein on a daily basis.

It is recommended that the child consume approximately four cups of fruits and vegetables daily It is recommended that children of 4 to 8 years consume 1-1.5 cups of vegetables and 1-1.5 cups of fruits on a daily basis. It is recommended that children of 4 to 8 years consume 5 ounces of grains on a daily basis. It is recommended that children of 4 to 8 years consume 2-2.5 cups of dairy on a daily basis. It is recommended that children of 4 to 8 years consume 4 ounces of proteins on a daily basis.

If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a. Alcohol b. Guns c. Lack of exercise d. Unprotected sex

Lack of exercise Heart disease is the leading cause of death in the United States. Routine physical activity has been found to prevent early death and chronic diseases, including coronary artery disease, stroke, type 2 diabetes mellitus, depression, and some types of cancer. Alcohol, guns, and unprotected sex are not related to common causes of unnecessary death among adults in the United States.

A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most likely use? a. Life expectancy b. Mortality rate c. Morbidity rate d. Health status

Life expectancy Life expectancy is a measure that is often used to gauge the overall health of a population. Health status indicators are the quantitative or qualitative measures used to describe the level of well-being or illness present in a defined population or to describe related attributes or risk factors. Morbidity rate is the frequency that a disease occurs within a population. Mortality rate is the number of deaths in a given area or period. Both morbidity and mortality rates are health status indicators.

A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? a. Developing lifestyle improvement programs for women at risk for diabetes b. Presenting lifestyle management presentations at women's conferences c. Monitoring blood glucose levels closely and modifying diet accordingly d. Screening glucose levels of women at risk for development of diabetes

Monitoring blood glucose levels closely and modifying diet accordingly Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes. Developing lifestyle improvement programs for women at risk for diabetes is an example of secondary prevention as this group is at risk for developing the problem. Presenting lifestyle management at women's conferences is an example of primary prevention, preventing the disease before it occurs. Screening glucose levels is an example of secondary prevention, as all screening tests are secondary prevention.

Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia is considered to have more medical complications than anorexia.

Most women with bulimia are concerned with the shape and weight of their body Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight; purging is associated with bulimia; and anorexia is considered to have more complications than bulimia.

Which of the following is of the greatest concern for the nurse who works with high-school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex

Motor vehicle accidents Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality among adolescents. Thus, this would be the greatest concern for the nurse working with high-school students. Alcohol use, sports-related injuries, and unprotected sex are not related to the major causes of morbidity and mortality among adolescents. So, although these topics may impact this population, they should not be the priority for the nurse.

Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty

Poverty Poverty is a strong and underlying current factor that affects all special groups. Ethnicity, education level, and lifestyle choices do not have as large of an impact on health disparities than income level related to poverty.

Which of the following behaviors results in men being less healthy than women? a. Concentration on sports, hunting, and other dangerous recreational choices b. Employment in stressful positions more so than women c. Preference to spend money on priorities other than health care d. Reluctance to visit health care providers

Reluctance to visit health care providers A major obstacle to improving men's health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of US men see a doctor, nurse practitioner, or physician assistant compared with 74% of women (AHRQ, 2010). Hobbies, employment, and preference on how to spend money may influence a man's decision to seek medical care. However, these have not been identified as major obstacles in comparison to overall reluctance to seek care.

A nurse advises a client diagnosed with HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

Tertiary prevention Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability. Primary prevention and health promotion both address the use of interventions before the disease occurs and to reduce the risk of developing the disease. Secondary prevention is aimed at detecting the disease early through screening programs and early intervention for at-risk individuals