Chapter 25: Health Promotion in the Twenty-First Century

8. A nurse is providing care to HIV positive clients living in sub-Saharan communities in Africa. When discussing prevention of the transmission of HIV, which of the following statements should be made by the nurse? a. Alternative practices to traditional sexual cleansing should be considered after the death of a spouse. b. Traditional sexual cleansing should be performed with a cleanser who is known to not have HIV. c. Virgin cleansing is a safer option than traditional sexual cleansing. d. Traditional sexual cleansing can lead to further transmission of HIV.

ANS: A Although traditional sexual cleansing can lead to further transmission of HIV is a true statement, it is not the most culturally sensitive response by the nurse. The nurse should respect the cultural practices of the clients living in the sub-Saharan community and discuss that alternative practices may be a better option to traditional sexual cleansing.

18. Which of the following statements best explains priorities related to preventative health care? a. Global initiatives have been developed to respond to health care needs around the world. b. Health care initiatives are focused mainly on people in developed countries because of the access to medication. c. Health care initiatives are focused mainly on people in developing countries because of their great need. d. Public health agencies are leaders in health care development.

ANS: A Health care initiatives have a global focus and involve developing as well as developed countries. Nurses play a major role in this initiative.

2. A nurse is working at a clinic in a third world country and suspects a child has severe acute malnutrition (SAM). Which of the following assessment findings would be expected? a. Distended abdomen b. Bulging eyes c. Large tears when crying d. Lethargy

ANS: A Severe wasting is characterized by sunken eyes, visible ribs, and protruding shoulder blades. Children with severe wasting usually have a distended abdomen and general overall appearance in some way similar to an older adult. In general, these children are irritable, anxious, and cry easily; yet they will often have absence of tears while crying due to lachrymal gland atrophy.

14. Which of the following age groups is experiencing the greatest increase in suicide rates? a. 15 to 24 b. 25 to 39 c. 40 to 59 d. 60 to 70

ANS: A Suicide rates among people aged 15 to 24 have been increasing to such an extent that they are the second leading cause of death in this age group in some developed and developing countries.

21. A primary care clinic is being established in a rural county that recently experienced a hurricane severely damaging its infrastructure for medical care. Which of the following considerations would be the priority when planning for this clinic? a. The ability to provide mental health services to community members b. The ability to deliver primary care services to community members c. The ability to refer community members to other necessary services d. The ability to supply community members with daily necessities

ANS: A The priority in planning should be the ability to provide mental health services to the community members. In 2007, the Inter-Agency Standing Committee developed its Guidelines on Mental Health and Psychosocial Support in Emergency Setting. It emphasizes the importance of primary care clinics being able to provide mental health services to victims of the disaster.

1. Which of the following are classifications within the World Health Organizations (WHO) definition of malnutrition? (select all that apply) a. Obesity b. Micronutrients deficiencies c. Protein-energy malnutrition d. Water insufficiency

ANS: A, B, C Inadequate or excessive intake of protein and or vitamins and obesity are components of the WHOs definition of malnutrition.

2. Which of the following individuals would be susceptible to CA-MRSA? (select all that apply) a. 16-year-old student who plays football b. 48-year-old person who has taken antibiotics for sinus infections c. 36-year-old man serving 12 months in jail for robbery d. 22-year-old woman who shares a towel after a swimming meet

ANS: A, B, C, D CA-MRSA is spread by close skin-to-skin contact such as during contact sports, by sharing towels and clothing, and by those living in crowded conditions. People who take or who have been on antibiotic therapy are also susceptible to CA-MRSA.

4. A school nurse is planning an educational presentation for high school students about violence. Which of the following statements would be included in the presentation? (select all that apply) a. Violent behavior happens when someone bullies another person. b. Withholding food from a child as a punishment is violent behavior. c. Collective violence occurs during an argument between two people. d. Painting a racial slur on a building is violent behavior.

ANS: A, B, D Violent behavior as defined by WHO is the intentional use of physical force or power, threatened or actual against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation. Collective violence is defined as the instrumental use of violence by a particular group of people for specific political, economic, or social objectives.

3. A nurse employed by the World Health Organization is working with HIV positive clients in Africa and is teaching them about ways to reduce transmission of this disease. Which of the following barriers should be considered when planning this education? (select all that apply) a. Culture-specific practices b. Unavailability of antibiotic therapy c. Lack of understanding about the transmission process d. Overcrowded living areas

ANS: A, C Culture-specific sexual practices such as sexual cleansing and a lack of understanding about how HIV is spread contribute to its transmission. HIV is a viral infection, not a bacterial infection. Simply living with someone who has HIV will not result in transmission unless the person comes into contact with blood or bodily fluid from the infected person.

6. A nurse is participating in disaster preparedness planning for the local community. Which of the following would be an appropriate responsibility for the nurse? (select all that apply) a. Completing a risk assessment in the community b. Implementing strategies to decrease posttraumatic stress disorder c. Coordinating meetings among multiple agencies and disciplines d. Evaluating the economic impact of the disaster

ANS: A, C The International Council for Nurses spells out its position on the role of the nurse concerning disaster preparedness to include risk assessment as well as management strategies bridging multiple disciplines and system levels. To coordinate health sector preparedness, regulatory meetings and frameworks across cultures will help nurses plan for and streamline health care responses to such mass events internationally.

15. Which of the following information about anthrax is correct? a. Anthrax is a viral infection. b. Anthrax can cause skin lesions or pneumonia. c. Anthrax is spread by person-to-person contact. d. Anthrax is treated by IV penicillin for 30 days.

ANS: B Anthrax is a bacillus that is not spread person-to-person. An anthrax infection is treated by using ciprofloxacin, levofloxacin, doxycycline, or penicillin for 60 days.

7. The school nurse has been asked to present a workshop on how to prevent CA-MRSA spread in the school. Which of the following interventions should be emphasized? a. Completing prophylactic antibiotic therapy for those in close contact with an infected person b. Using correct hand-washing technique c. Requiring those infected stay home from school until the infection has resolved d. Disinfecting all classrooms on a daily basis

ANS: B Hand washing is an effective way to prevent spread of the infection. In order to contract the infection, students must come into contact with a draining wound, etc.

5. Which of the following projects would most likely be administered by International Micronutrient Malnutrition Prevention and Control (IMMPaCT) Program? a. Researching best methods to preserve the freshness of foods b. Surveying various populations about consumption patterns c. Comparing the effectiveness of vitamin pills versus fresh fruit and vegetables d. Analyzing the relationship between BMI and cardiovascular disease

ANS: B IMMPaCt provides its skills and resources toward working to eradicate vitamin and mineral deficiencies around the globe. The IMMPaCT programs activities include conducting surveys; providing micronutrients to infants, young children, and women of childbearing age; and monitoring and evaluating intervention systems.

19. A nurse states that many community members are concerned about the increasing number of natural disasters that have been occurring in the United States. Which of the following would the community members be referring to? a. Fires and suicides b. Wildfires and hurricanes c. Traffic accidents and floods d. Tornadoes and food poisonings

ANS: B Natural disasters phenomena that occur through natural forces involving land, air, or water, and they often have large-scale negative impacts on humans who live in the affected areas. Examples of natural disasters include tsunamis, earthquakes, floods, landslides, mudslides, tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter weather, and others.

10. A nurse is using the four-step public health approach to address violence in the community. Which of the following actions would the nurse take first? a. Analyze a variety of data sources to determine the cause of the problem. b. Examine risk factors that have contributed to the violence. c. Develop an evidence-based program to address the problem. d. Train community members to discuss the problem within their neighborhoods.

ANS: B The WHO has proposed a four-step public health approach which includes: defining the problem; identifying risks and protective factors; devising and testing means of dealing with violence; and applying successful means on a large scale. Defining the problem is the first step in this process. Examination of different data sources are needed to understand the magnitude of the problem.

5. Which of the following individuals assessed by the nurse is experiencing interpersonal violence? (select all that apply) a. A 16-year-old female who hides in her apartment due to civil unrest in the country b. A 32-year-old male whose co-worker sends him insulting e-mails at work c. A 19-year old male who has attempted suicide d. A 78-year-old female living in a nursing home who is force-fed by aides

ANS: B, D Interpersonal violence is violence committed by an individual or a small group of people in a wide range of acts and behaviors (emotional, physical, sexual, and psychological). The violence can happen to people of any age and at any place. Self-directed violence occurs with self-abuse and suicide. Collective violence is defined as the instrumental use of violence by a particular group of people for specific political, economic, or social objectives.

13. The nurse is working at a crisis hotline center. Which of the following callers would be most at risk for suicide? a. A 16-year-old girl who broke up with her boyfriend b. A 26-year-old male who has been laid off from his job c. A 50-year-old female who has a history of alcohol abuse d. A 40-year-old male whose brother died suddenly

ANS: C Older adults have a greater risk of committing suicide than do younger people. Major factors contributing to suicide in Europe and North America include mental disorders especially depression and alcohol use disorders.

12. The school nurse is planning a workshop for high school students about interpersonal violence (IPV). Which of the following information would the nurse discuss as risk factors for IPV? a. Cultural norms b. Family support c. Drug and alcohol abuse d. Depression

ANS: C Risk factors for IPV may include a victims low self-esteem, low self-control, and personality/conduct disorders. Other risk factors are reported to be lack of social support, dysfunctional family structure, family history of violence, and drug and alcohol abuse.

17. A nurse is working in the emergency department (ED). Which of the following situations would cause the nurse to suspect bioterrorism? a. When two people out of twenty who ate at a restaurant come to the ED with nausea and vomiting b. When a worker in a lab comes to the ED complaining of a severe headache c. When thirteen people, aged 24 to 33, come to the ED with ascending flaccid muscle paralysis d. When five people come to the ED with an upper respiratory infection

ANS: C The other examples are common problems for which people seek health care. Flaccid paralysis is a symptom of botulism.

4. A nurse working on a post-partum unit of a large urban hospital has received a grant to begin a Baby-Friendly Hospital Initiative developed by WHO. Which of the following statements would the nurse most likely make when explaining the major premises of the initiative to the unit manager? a. This program is meant to encourage sibling visits in the early postpartum period, so the adjustment to a new baby is a smooth process. b. A major goal of this program is to ensure that all infant/pediatric units have implemented basic safety initiatives. c. Improving nutrition by promoting breast-feeding of newborns through four months of age is what this program is all about. d. The purpose of this program is to make sure that all health care providers who care for newborns and children up to the age of 18 really understand basic principles of growth and development.

ANS: C The purpose of the initiative is to improve newborn nutrition by promoting breast-feeding of newborns through age 4 months.

9. A nurse is working with UNAIDS to fight against HIV/AIDS at the global level. Which of the following activities would the nurse most likely be involved in? a. Determining prevalence rates of HIV/AIDS in African countries b. Administering antiretroviral medications to pregnant women who are HIV positive c. Providing treatment access for all HIV-positive individuals who need medication d. Reporting confirmed cases of HIV to the World Health Organization

ANS: C UNAIDS has outlined three strategic directions: revolutionizing HIV prevention; catalyzing the next generation for treatment, care, and support; and advancing human rights and gender equality in responses to HIV. Providing treatment access for all HIV-positive individuals who need medication meets the strategic direction of catalyzing the next generation for treatment, care, and support.

16. Which of the following statements about smallpox is accurate? a. Smallpox results in a rash that looks similar to the chickenpox rash. b. Side effects from a smallpox vaccine include acute renal failure. c. The last case of smallpox occurred in 1997. d. The rash associated with smallpox is most prominent on the face and extremities.

ANS: D A rash from smallpox is most prominent on the face and extremities with the same stage of legion development. Additionally, smallpox symptoms usually resemble influenza symptoms. The smallpox rash is distinctive from the varicella rash. Side effects from the vaccination mostly involve a low fever, soreness in the injection area, and enlarged glands under the armpit. The last case of smallpox was in 1977.

11. A nurse using the four-step public health approach to respond to violence. Which of the following actions would occur as the nurse identifies risk and protective factors? a. Planning a community-based educational program to respond to violence b. Reviewing police reports and population-based surveys c. Interviewing local community members about their experiences with violence d. Examining characteristics in the community where violence has not occurred

ANS: D A risk factor is defined as a characteristic that increases the likelihood of a person becoming a victim or perpetrator of violence, and a protective factor as a characteristic that decreases the likelihood of a person becoming a victim or perpetrator of violence. Knowing risk and protective factors can help responsible organizations and personnel to estimate violence magnitudes and devise appropriate prevention measures.

6. The school nurse has been asked to present a workshop on CA-MRSA for high school teachers. Which of the following information would the nurse most likely include? a. CA-MRSA is a common viral infection that responds well to antiviral meds. b. CA-MRSA is a serious bacterial infection that does not spread easily. c. CA-MRSA is a fungal infection common in school settings. d. CA-MRSA is a potentially fatal skin infection that is difficult to treat.

ANS: D CA-MRSA is a highly contagious bacterial infection that is difficult to treat and can result in pneumonia and death.

22. A nurse is advocating for improved disease prevention and health promotion within the local community. Which of the following interventions would the nurse most likely implement? a. Educate community members about the violence rates that exist within the community. b. Administer flu shots for elderly at a local senior citizens center. c. Participate in a disaster planning committee within the community. d. Talk with a state legislator about improved access to health care for the uninsured and underinsured.

ANS: D In order to be advocates for newly emerging priorities for disease prevention and health promotion, nurses in the twenty-first century need to participate in policy development for health promotion as the health care of individuals in acute settings shifts from hospitals to home and community settings, influence public expectations about health promotion, and promote equitable access to preventive health care. Talking with a state legislator about improving access to health care for the uninsured and underinsured is the only example that demonstrates the nurse in the role of an advocate working in one of these priority areas.

1. A nurse is encouraging members of the community to advocate for the prevention of premature deaths in children under the age of 5 at the international level. Which of the following interventions would most likely be discussed by the nurse? a. Using mosquito netting in sleeping areas b. Participating in international vaccination programs c. Implementing accident prevention programs d. Providing nutritional supplements

ANS: D Protein-energy malnutrition can be severely harmful to the mental and physical development of individuals, especially young children under the age of 5. Worldwide, one out of two deaths among children younger than 5 years old stems from protein-energy malnutrition.

20. A hurricane has just caused extensive damage within a local community. Which of the following are community members at risk to experience? a. Unequal access to health care b. Exposure to community-associated methicillin-resistant Staphylococcus aureus c. Increased incidence of suicide d. Outbreaks of acute respiratory infection

ANS: D Victims of natural disasters tend to have limited access to essential infrastructures for survival related to food, water, shelter, and sanitation. Infection outbreaks commonly diagnosed after natural disasters include diarrhea, acute respiratory infections, viral hepatitis, and snail and trematode infections.

3. A nurse is determining if children with severe acute malnutrition (SAM) should receive facility-based or community-based care. Which of the following children should receive care in the community? a. 3-year-old male who has a history of dehydration b. 9-month-old male whose family has adequate support and resources to obtain the recommended treatment c. 4-year-old female who has sensitivity to milk products d. 6-month-old female who has a good appetite and no underlying medical conditions

ANS: D When a child has a good appetite with no medical conditions (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, and/or infections), Ready-to-Use Therapeutic Foods (RUTF) under community-based care are appropriate. RUTF are special milk-based foods which are soft, crushable, and tasty nutrient- and energy-rich foods that can be consumed by children six months or older.