Community exam 2

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? A. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement

A Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on the same criteria, but managed care integrates the financing and the delivery of health care. The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion.

A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? A. Evil eye b. Fallen fontanel c. Soul loss d. Indigestion

A A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye.

A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of the following actions should be taken by the nurse? A. Apply for a grant to fund a mobile clinic to take health care to the clients. b. Distribute flyers to the homeless that detail the location of various types of health care services. c. Refer homeless clients to areas that provide temporary housing. d. Solicit donations for food and clothing to be distributed to the homeless.

A Accessibility refers to the ability of clients to obtain needed health care services. Although all of these options lead to opportunities for improvement in health, either directly or indirectly, only applying for a grant for a mobile clinic can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places.

A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider when providing care? A. All teen pregnancies are considered high-risk. b. Limited self-care knowledge can lead to pregnancy complications. c. Pregnant teens are likely to receive prenatal care late in the pregnancy. d. Pregnant teens may have limited financial resources to pay for care.

A All of these statements are true; thus it is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy.

In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? A. Absence of culturally competent care b. Availability of specialists c. Distance of health care facilities from the place of residence d. High cost of health care

A Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers. For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers.

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? A. Be willing to enter into a long-term relationship with families. b. Direct and control the client's care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency.

A Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? A. Cancer b. Memory loss c. Skin rashes d. Headaches

A Chronic exposure to pesticides and chemicals may lead to cancer.

A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? A. Emergency department for immediate care b. Migrant Health Act clinics c. OSHA, because the man was injured by farm machinery d. Workers' Compensation, because injury was at work

A Farming and ranching do not often fall under OSHA guidelines, because they are considered small enterprises. Therefore, safety standards are not enforceable, nor is Workers' Compensation insurance usually available for the agricultural industry. Although there are migrant health clinics, they are not always geographically convenient. The only source the nurse can count on using is sending injured workers to emergency departments for immediate care.

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? A. At the city's homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner-city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs

A Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population the homeless shelter would be an appropriate location.

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? A. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement

A In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of time.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate? A. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b. Refer the man to a urologist to address the urinary bleeding. c. Suggest that the family take him to an urgent care center immediately. d. Treat the urinary infection and give the man medication to take to prevent the return of infection.

A It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent? A. Case management b. Client advocacy c. Holistic care d. Wrap-around services

A Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: A. endemic. b. epidemic. c. pandemic. d. sporadic

A Pertussis (whooping cough) is caused by the bacterium Bordetella pertussis. It is highly contagious and is considered endemic in the United States. Endemic means that the disease is constantly present within a geographic area or population. Vaccination against pertussis, delivered in combination with diphtheria and tetanus vaccination, is a part of the routine childhood immunization schedule. The increase in adolescent and adult pertussis is alarming not because of the increased morbidity—cases are mild or inapparent in these groups—but because these individuals serve as a reservoir of infection for infants, especially those younger than 6 months of age, who are the most vulnerable to pertussis and the most likely to suffer complications resulting in hospitalization and death.

The World Health Organization (WHO) developed the Five Keys to Safer Food campaign in 2001 to address the problem of foodborne and waterborne diarrheal diseases worldwide. This campaign emphasizes which of the following practices? A. Keep clean, separate raw and cooked, cook thoroughly b. Never use raw, always cook, buy better c. Wash, cut, cook, and throw away d. Wash, cover, and always refrigerate

A Protecting the nation's food supply from contamination by virulent microbes is a multifaceted issue that is and will continue to be incredibly costly, controversial, and time-consuming to address. The specter of terrorist threats to the food supply adds an additional layer of complexity. However, much foodborne illness, regardless of the causal agent, can be easily prevented through simple changes in food preparation, handling, and storage. WHO estimates that 2.2 million people, most of them children, die annually from foodborne and waterborne diarrheal diseases in less-developed countries. In 2001, WHO initiated a new campaign entitled Five Keys to Safer Food, a simplified version of an earlier campaign that includes the following elements: keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, and use safe water and raw materials.

A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. Which of the following actions by the nurse demonstrates the use of secondary prevention to limit caregiver stress? A. Asking caregivers how they are doing and suggesting coping strategies b. Encouraging caregivers to periodically leave the house for a couple of hours c. Establishing support groups for caregivers of older parents d. Referring some activities to neighbors and friends

A Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed. Also, encouraging caregivers to periodically leave the house for a couple of hours could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

A public health nurse is counseling a client who is trying to determine if a health maintenance organization (HMO) or preferred provider organization (PPO) will provide the better health care coverage. Which of the following best describes one main difference between these two types of coverage? A. HMOs provide comprehensive care to members for a fixed fee. b. PPOs designate providers that members can choose. c. PPOs provide one model of care delivery. d. HMOs provide financial incentives to encourage members to select HMO providers.

A The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed, "per member per month," fee. A PPO uses predetermined rates for services to be delivered to members. HMOs do not have one model of care delivery. PPOs provide financial incentives to encourage members to select PPO providers.

Which of the following demographic factors is expected to have the greatest influence on national health care spending? A. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

A The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the baby boom generation ages and retires, federal expenses for Social Security and health care will increase.

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: A. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. host resistance

A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of these factors may result in disease transmission. Many travelers are at risk for foodborne and waterborne diseases and should be careful to eat only thoroughly cooked foods prepared under reasonable hygienic conditions. Eating foods purchased from street vendors may not be wise. Fruits that can be peeled immediately before eating, such as bananas, are less likely to be a source of infection. Dairy products should be pasteurized and appropriately refrigerated. Only potable water (safe to drink) should be consumed, such as boiled water or bottled water. Other diarrheal diseases may not be related to viral or bacterial infective agents and may be the result of stress, fatigue, schedule changes, and consumption of unfamiliar foods.

When a situation exists in which there is potential contact with blood or body fluids, health care workers must always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying reason for requiring these practices, known as universal precautions, is that: A. blood and body fluids of all clients need to be handled as if they were infected. b. effective infection control surveillance programs are in place. c. health care settings are reservoirs of infection. d. health care workers do not effectively use hand hygiene.

A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other blood-borne pathogens.

A resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? A. Advanced nurse practitioner b. Allergist c. Pediatrician d. Pulmonologist

A The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). In contrast, urban adults are more likely to seek care from a medical specialist

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? A. "Don't drop out of school." b. "Sign up for childbirth classes." c. "Sign up for the WIC program." d. "Take your prenatal vitamins daily."

A The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child.

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? A. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

A Vulnerability can be reversed by obtaining resources to increase resilience. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status.

A nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) A. It is very difficult to obtain continuing education, except for online programs. B. Neighbors seem to expect the nurse to know everything about all health care and illness conditions. C. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d. People come to the health clinic before their situation becomes relatively serious.

A, B, C Rural people often develop independent and creative ways to cope because of the distance, isolation, and sparse resources they encounter. The boundaries between home and work blur because clients are also neighbors and friends of immediate family members. Nurses are highly regarded by the community and viewed as experts on health and illness. Residents may ask health-related questions and request recommendations whenever they see the nurse. Nurses in rural areas may also be expected to, in general, know something about everything, and this can be a demanding expectation. Some of the challenges are professional isolation, limited opportunities for continuing education, lack of other health personnel or professionals with whom the nurse can interact, heavy workloads, the need to function well in several clinical areas, lack of anonymity, and for some, a restricted social life.

Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.) A. Clients may have preexisting conditions not covered by insurance. B. Many physicians won't accept Medicaid clients. C. Medicaid won't pay for certain medical interventions. d. Medicaid recipients are noncompliant with their health care providers' recommendations.

A, B, C The primary reasons for delay, difficulty, or failure to access care include inability to afford health care and a variety of insurance-related reasons, including the insurer not approving, covering, or paying for care; the client having preexisting conditions; and physicians refusing to accept the insurance plan. Practical problems such as lack of childcare, transportation, long waiting periods, and communication issues also interfere.

Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) A. Environmental changes B. Host behavior c. Improved surveillance D. Microbial adaptation E. Public health infrastructure deterioration

A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel

Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) A. "I always address the problem that the client believes is the most important." b. "I avoid asking clients for income or financial information, because this is an invasion of privacy." C. "I try to observe the client's cultural traditions as I probe for signs of abuse." d. "I make sure to do a complete assessment, since we often don't know when the person will return to the clinic."

A, C Because poverty is a primary cause of vulnerability, the nurse should include questions about the client's financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used. Focus on what data are needed to help the client that day with the problem the client believes is most important.

In which of the following situations would the federal government provide money through tax relief for private enterprise? (Select all that apply.) A. A business pays for part of health insurance premiums for its employees b. A business purchases gifts for its employees to award them for their service C. An employer provides health screenings and immunizations d. An employer requests reimbursement for employee transportation costs

A, C Businesses can pay for disease prevention and health promotion services for employees (and sometimes their families) in the form of immunizations, health screenings, and counseling. The business can then deduct these costs as a business expense, which reduces the amount the business owes the government in taxes on their profits. Similarly, when businesses subsidize health insurance for their employees—and families—this is also a business expense, which decreases the amount the business would otherwise pay in taxes. Thus, the government indirectly provides the money, but the business, a part of the private sector, decides how it is used.

A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of the following interventions should be implemented by the nurse? (Select all that apply.) A. Publicize data on success of health promotion efforts, including cost savings. b. Lobby for decreased reimbursement for secondary and tertiary care services. C. Establish standards for appropriate screenings at specific intervals. d. Encourage members of the military service to engage in appropriate healthy lifestyle behaviors.

A, C Reasons given for the lack of emphasis on prevention in clinical practice and lack of financial investment in prevention include provider uncertainty about which clients should receive services and at what intervals, lack of information about preventive services, negative attitudes about the importance of preventive care, lack of time for delivery of preventive services, delayed or absent feedback regarding success of preventive measures, less reimbursement for these services than for curative services, lack of organization to deliver preventive services, and lack of use of services by the poor and elderly. Although all of the above suggestions may have some merit, some would be illegal, such as requiring people to change their lifestyle.

Which of the following are some major differences in health care today, as compared with the first half of the twentieth century? (Select all that apply.) A. Consumers are influenced by advertising for specific health care agents or procedures. b. The emphasis is on the continued expansion of health care facilities, especially acute care hospitals. C. Education and specialization of personnel have increased. d. The need to create new ways to pay for health care is a central focus.

A, C Since the 1980s, the United States has been in a period of limited resources, with an emphasis on containing costs, restricting growth in the health care industry, and reorganizing care delivery. Results have included shorter hospital stays and substitution of one set of personnel (such as nurse practitioners) for another set (physicians). Such trends are made more challenging by increased direct marketing to consumers. Also with increased knowledge has come increased education and specialization.

A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) A. "Community members will probably hold you in higher regard and will look up to you." b. "Expect to have less autonomy in a small town than you have working as a nurse in a medical center." C. "You may feel like an isolated outsider, because the community may not immediately accept you." D. "You will have to be very sensitive about the differences in the rural lifestyle."

A, C, D Nurses working in rural areas usually have a prestigious status in the community and are viewed as role models. They have greater (not less) independence and autonomy, fewer (not more) resources, and need to have more generalist (not specialized) knowledge and skills.

Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) A. About 25% of all U.S. residents live in rural settings. b. People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c. Diagnoses in rural areas are usually for physical injuries, not mental health concerns. D. A high prevalence of poverty exists among rural families.

A, D About 25% of all U.S. residents live in rural settings. Rural residents are less likely to engage in preventive behavior and they tend to be poorer than their urban counterparts (more than 25% of rural Americans live in or near poverty, and nearly 40% of all rural children are impoverished). Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations. Often rural health professionals live and practice in a particular community for decades. Consequently, rural respondents tend to know their usual provider of health care.

According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a. $21,200 B. $23,050 c. $25,200 d. $27,050

B According to the Federal Register in January 2012, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $23,050.

The nurse is making a postpartum visit to a teenage mother and her month-old infant. Which of the following assessments would be most important? a. Assessing for mother's ability to fulfill her own growth and development tasks B. Assessing for mother's knowledge about normal infant growth and development c. Assessing how much the teenage mother's own mother is helping her cope with child care d. Assessing whether the baby's father is being helpful to the mother

B Although the nurse might assess for any and all of these options, the primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse.

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care? a. Clinic operating hours B. Ability to pay for services c. Availability of local provider services d. Transportation availability

B Because there are not enough health care services available to provide desired services to everyone, the focus has been on reducing costs by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing (either directly or indirectly). The primary determinant, however, is the ability to pay for services. Without this ability, services are denied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out of pocket are unable to obtain services.

In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. This best exemplifies communicable disease control through: a. health education. B. multisystem approach. c. improved public health infrastructure. d. reduction of environmental hazards

B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed.

Which of the following is the most rapidly growing group of homeless? a. Adolescents B. Families with children c. Persons in crisis d. Single men

B Families with children are the fastest-growing segment of the homeless population.

Which of the following groups pays the largest amount for health care in the United States today? a. Consumers B. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

B Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers.

The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the following would be the best action to take to improve client outcomes? a. Provide antibiotics to all homeless persons with chronic, nonhealing wounds B. Offer daily access to a room with soap, water, and bandages c. Hand out free bandaging supplies following each clinic visit d. Perform regular monitoring of the client's wound condition

B Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. B. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Re-administer the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest x-rays.

B Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working. Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results.

Which of the following racial groups experiences the highest incidence of poverty? a. Non-Hispanic Whites B. Blacks c. Hispanics d. Asians

B In terms of racial differences in the rate of poverty, non-Hispanic Whites had a rate of 9.9 %; Blacks had a rate of 27.4% and Hispanics had a rate of 26.6% (U.S. Bureau of the Census, 2012).

Which of the following accurately describes a challenge that will be faced by health care providers in the twenty-first century? a. Lack of available space to provide care for clients in hospitals B. Emergence of new and old communicable and infectious diseases c. New guidelines for chronic disease management d. Increased use of technology leading to a decreased need for health care workers

B In the twenty-first century the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease the care provided for these diseases and wouldn't be seen as a challenge. The use of technology will continue to increase, but the need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.

Which of the following groups is most at risk for suicide? a. Adolescents under age 20 B. Men over age 85 c. Females 25 to 45 years of age d. Women over age 65

B Men over age 85 are in the highest risk category for suicide.

Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures B. Poverty c. Prejudice d. Social isolation

B People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability.

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child? a. Concern that the child is being mistreated by other children B. Concern that the child has developmental delays c. Concern that the child is given adequate food during lunch d. Concern that the child may need to sit in the front in order to be able to see well

B Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Poverty-stricken children may be hungry and fatigued and have dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children also experience higher rates of school absenteeism, academic failure, and emotional and behavioral maladjustments. The stress of homelessness can be seen in withdrawal, depression, anxiety, aggression, regression, and self-mutilation. Homeless children may have delayed communication, more mental health problems, and histories of abuse.

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) B. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

B Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors.

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? a. Applying for a grant to establish a day care center to serve dependent older adult clients living with working families B. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare

B Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a bill offering health care financial aid to families at risk addresses initiating interventions beforean illness occurs.

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a. A bill that establishes policies requiring all persons to pay the same cost for services regardless of income B. A bill that promotes universal health insurance coverage c. A bill that requires all health care providers to give care to uninsured persons without charge d. A bill that requires health care workers to report undocumented immigrants who present for treatment

B Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care.

Which of the following conditions of the rural environment provides increased opportunities for teaching? a. Increased interaction among residents due to neighbors visiting neighbors on the family farms B. Involvement in rural community activities provides more contact with community residents than in urban areas c. Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention d. Increased illnesses and injuries of rural residents require that they see nurses more often

B Rural areas have fewer churches, stores, and schools. Thus, nurses may go to the same church, shop at the same stores, and/or have children in the same schools as their clients. There are also fewer organizations, so it is easier to become involved and meet everyone while participating. Visiting neighbors does not increase opportunities for teaching. The fact that nursing responsibilities include all levels of prevention is true of both urban and rural areas. The statement about increased illness and injuries in rural residents is wrong, because although illnesses and injuries are increased, rural residents often do not seek care for these conditions.

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? a. Primary prevention B. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

B Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease.

A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following actions would the nurse most likely take? a. Assist teen mothers to learn about their body changes during pregnancy. B. Develop programs that allow teen mothers to complete their education. c. Offer courses in proper care of babies and how to be a parent. d. Monitor pregnant teens to detect early problems with pregnancy.

B Single motherhood is increasing. A direct correlation exists between lack of education and poverty. Similarly, a direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth.

A 6-year-old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful when temperature is not elevated. B. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2-4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs).

A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, which of the following comments by a parent would cause concern? a. "I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." B. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c. "My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d. "I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

B Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy.

A nurse was shocked when late one night she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. Which of the following is the most likely explanation for a healthy young adult engaging in such behavior? a. He ate his meal but wanted more and had no more money. B. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c. A friend had thrown his meal away, and he thought he could find his friend's untouched food. d. He was doing this to fulfill an obligation of fraternity initiation at the college.

B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.

A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? a. Avoiding touching the client except when necessary as part of the physical examination B. Calling the client by name, socializing before addressing the problem, and being very respectful c. Keeping all interactions direct, to the point, and targeted on the reason for presentation d. Maintaining a non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

B The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual's dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior.

A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) a. Cholera B. Hepatitis C. High blood level of lead d. Malaria

B, C Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis, as well as exposure to high levels of lead. Tuberculosis (TB) is more prevalent in Mexico than in the United States, and some infected immigrants work as migrant farmworkers. Additionally, TB tends to spread in regions where housing is crowded. Migrant farmworkers have higher rates of TB than most population groups.

A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.) a. Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. B. Cuddle and hold the baby while smiling and gazing into the baby's eyes. c. Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face. D. Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes.

B, D Suggestions for promoting interaction between an adult and a baby include the following: maintaining a distance of 8 to 10 inches from the baby, smiling, and making eye contact. Talk to the baby, but avoid "baby talk." Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). Babies love to play and enjoy "taking walks" and looking at brightly colored objects or toys that make noises.

A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern? a. Elevated blood pressure b. First prenatal visit at 5 months' gestation C. Persistent homelessness d. Positive STD test

C All these assessment findings are of concern and need attention. However, pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus, being homeless is the most dangerous sign of those listed.

A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? a. Appendicitis b. Bacterial gastroenteritis C. Pesticide poisoning d. Viral illness

C Although all of these conditions can cause some or all of the symptoms listed, because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild psychological and behavioral deficits such as memory loss, difficulty with concentration, and mood changes, abdominal pain, nausea, vomiting, diarrhea, headache, malaise, skin rashes, and eye irritation.

Although infectious disease epidemics are still the major cause of death worldwide, they have subsided in the United States because of improvements in nutrition and sanitation, the discovery of antibiotics, and the development of vaccines. Infectious diseases have not vanished, however, and remain a continuing cause of concern. Healthy People 2020 has a number of objectives aimed at reducing these illnesses because of the morbidity, mortality, and costs associated with infectious diseases. One such costly disease trend related to an increase in the performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs is the rise of: a. Escherichia coli 0157:H7. b. multisyndrome effect. C. health care-associated infections. d. severe acute respiratory syndrome

C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Pennsylvania, the first state in the country to examine the costs of these infections, reported that health care-associated infections led to $2 billion in additional hospital charges and at least 1500 preventable deaths in 2004. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff.

Which of the following best describes a health professional shortage area (HPSA)? a. An area with inadequate health care facilities for residents b. An isolated area of underserved populations within an urban region C. A region with insufficient numbers of health care providers d. A rural region of the United States with a population density of less than 10,000

C An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties.

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education? a. "If a client who does not speak English comes in, you must obtain an interpreter right away." b. "We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns." C. "You will like working with Hispanic immigrants because they have close-knit family structures." d. "You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

C Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence.

A migrant farmworker brings his daughter into the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a. It was a rare occurrence, which probably won't be repeated. b. The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. C. Children may work on small farms because the family may need the additional income. d. The parents were busy working and didn't realize the child was outside so long.

C Children 12 to 13 years of age can work on a farm with the parents' consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family's economic survival.

A community mental health nurse is working within the community to help prevent youth violence. Which of the following interventions would most likely be implemented by the nurse? a. Distributing literature that associates violence with a lack of intelligence b. Explaining to youth why youth violence is detrimental to society C. Partnering with associations to provide alternative activities that improve social skills d. Recommending increased funding to prosecute and jail teens associated with violent activity

C Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act.

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? a. Insurance resources b. Health care rationing C. Health economics d. Medical technology

C Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the health care industry. The other options are important components of health economics but by themselves do not provide the broad understanding called for in this question.

A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2012 = 2/100,000; 2013 = 3/100,000; 2014 = 1/100,000 b. 2012 = 4/100,000; 2013 = 8/100,000; 2014 = 6/100,000 C. 2012 = 12/100,000; 2013 = 8/100,000; 2014 = 31/100,000 d. 2012 = 16/100,000; 2013 = 24/100,000; 2014 = 9/100,000

C In this community's report, the incidence of hepatitis A in 2014 was more than double the incidence in 2012. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated.

Which of the following is the leading cause of disability for Americans 15 to 44 years of age? a. Accidents b. Arthritis C. Major depressive disorder d. Workplace injuries

C Major depressive disorder is the leading cause of disability for Americans between the ages of 15 and 44 years.

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department C. Medicaid d. Medicare

C Medicaid provides coverage for adults with low income and their children.

Which of the following services would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit C. Stay in skilled nursing facility d. Transportation by an ambulance

C Medicare Part A covers hospital care, home care, and skilled nursing care.

Which of the following best explains how the government inadvertently encourages low-income persons to use emergency departments as their primary care provider? a. A huge amount of paperwork is required when Medicaid clients go to a physician's office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. C. Legally, emergency departments must see clients even if clients can't pay. d. Physicians' limited office hours make them unavailable during evenings and weekends.

C People on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians can choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of ability to pay. Emergency department copayments are modest and are frequently waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary care services.

A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a. The child is accident-prone and clumsy. b. The child is being bullied and pushed around by other children. C. The child is more likely to have school absences. D. The child is in need of a vision screening.

C Poverty also increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. These children may also be hungry and fatigued and experience dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism (Emerson, 2004).

An example of secondary prevention of infectious disease is: a. malaria chemoprophylaxis. b. Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS. C. quarantine. d. restaurant inspections.

C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza

A nurse is working to improve her self-awareness in order to provide better client-centered care to clients living in poverty. Which of the following questions should the nurse ask herself? a. What would I do if I lived in poverty? b. What can be done to get poor people motivated to work? C. How have the media images of poor persons shaped my image of poverty? d. How can community resources assist those living in poverty?

C Self-awareness is a key component of providing authentic, genuine client-centered care. To clarify their own values and perspectives about poverty, nurses should ask themselves questions about poverty and persons living in poverty. These questions should cause the nurse to reflect on how his or her ideas of poverty have been developed. The only question that relates to the nurse reflecting on how personal values and perspectives have been developed is, "How have the media images of poor persons shaped my image of poverty?" The other questions address how to address the issue of poverty or concerns of the nurse but do not address increasing the nurse's self-awareness.

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? a. Administration of skin tests to identify persons who have been infected with tubercle bacilli b. Assessing for signs and symptoms of active tuberculosis C. Directly observing clients with active tuberculosis as they take their antitubercular medications d. Interpretation of tuberculosis skin test findings

C Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB.

Which of the following is the most accurate description of a migrant farmworker? a. A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends b. A person who immigrates to the United States to "follow the crops" in performing seasonal farm work C. A person who moves from place to place to earn money performing seasonal agricultural work d. A person who specializes in the development of rural land for the purpose of farming

C The Office of Migrant Health of the U.S. Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode." The emphasis is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

A nurse is trying to decrease the risk for depression among older adults. Which of the following interventions should the nurse implement? a. Encourage moving to a nursing home where others of the same age reside. b. Monitor for signs and symptoms of depression. C. Organize an exercise and health promotion program at the local senior citizen center. d. Teach older clients to focus on their strengths rather than their weaknesses.

C The depression rate among older adults is half that of younger people, but the presence of a physical or chronic illness increases rates of depression. Depression rates for older adults in nursing homes range from 15% to 25%; thus, encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underuse the mental health system and are more likely to be seen in primary care or to be recipients of care in institutions. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describe why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a. Her friends were suggesting ways to make the problem go away. b. She knew she could not be pregnant because her boyfriend said he used a condom. C. She was afraid her parents would pressure her to terminate the pregnancy. D. She kept hoping the pregnancy would just go away.

C, D Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, because they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Being told that a condom was used doesn't make it so. The girl should know whether a condom was used or not without relying on verbal statements.

An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a. Their personal belongings may be stolen while they are at the clinic. b. Immigration officials will send them back to their home country. c. The clinic personnel will look down on them and be biased against them. D. They weren't getting paid for that day, and continued employment is never certain.

D Any of the answers might be true; however, most migrant farmworkers are legal residents or U.S. citizens, not illegal immigrants. Many do not have their own transportation and must rely on friends. Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain.

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? a. A proportion of actual cost arbitrarily decided by the Medicare panel b. The federal budget constraints for the current fiscal year c. Hospital and health care provider feedback and political persuasion D. Prospective payment scale based on the medical diagnosis

D As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs).

Which of the following individuals would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English b. A 25-year-old female with health insurance c. A 50-year-old male with hypertension D. A 30-year-old male who is unemployed

D Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, child care needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income.

Which of the following factors predisposes many migrant farmworkers to disenfranchisement? a. Being a minority group member b. Inability to attend religious services because of work requirements c. Previous experiences of physical abuse D. Short length of time in the community

D Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds.

A nurse is trying to maximize the quality of life of her clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition D. Teaching a high school boy about sexually transmitted infections and proper condom application

D Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs.

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? a. Education of health care providers moved into universities. b. People finally had enough money to pay for medical care. c. The improved outcomes of hospital care were recognized. D. Advances were made in safe water, sewage disposal, and pasteurization of milk.

D Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes.

Which of the following statements best describes why health care of the homeless is so expensive to the community? a. Health conditions of the homeless require increased preventive services. b. Homeless clients typically make more clinic visits for multiple health problems. c. Homeless people spread contagious diseases to those they pass on the street. D. Most care to homeless people takes place in hospital emergency departments.

D Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore, health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics.

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment D. Neglecting to order certain tests or treatment to minimize cost to the provider

D In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the amount of money received to provide care to members of this group.

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. D. Strongly consider not applying, because this population will be expensive to treat.

D Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care).

A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mother asks, "Do you think my son is crazy?" Which of the following is the most appropriate response by the nurse? a. "Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b. "Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c. "Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." D. "Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

D Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. With more time the nurse can help the mother deal with feelings of having a "crazy" family member and the effects of such behavior on the whole family.

Of the four main factors that affect health, which is the least important? a. Environment b. Human biology c. Lifestyle choices D. Health care system

D Of the four major factors that affect health—personal behavior (or lifestyle), environmental factors (including physical, social, and economic environments), human biology, and the health care system—medical services are said to have the least effect. Behavior (lifestyle) has been shown to have the greatest effect, but environment and biology account for 70% of all illnesses.

A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? a. Observe farmworkers for evidence of unsafe handling of pesticides. b. Provide teaching on how to handle pesticides to avoid or decrease exposure. c. Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. D. Treat a client who has pesticide exposure to prevent complications.

D Tertiary prevention involves actions taken when a person already has a condition so that complications and worsening of the condition are avoided.

Which of the following statements best describes an outcome of the Balanced Budget Act of 1997? a. Additional funding was provided to the State Children's Health Insurance Program (SCHIP). b. Individuals were able to keep their health insurance when moving from one place to another. c. Patient privacy and security of health information was enhanced. D. A prospective payment system for home health services was created.

D The Balanced Budget Act of 1997 had some shifts in payment with the stipulations related to home health. In an attempt to curb the rapid growth in spending on home health and financial fraud in that industry, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective payment for home health services. The Health Insurance Portability and Accountability Act of 1996 was intended to help people keep their health insurance when moving from one place to another as well as provide privacy and security of personal health information. The State Children's Health Insurance Program (SCHIP) was created by Title XXI of the Social Security Act in 1998.

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business man who works for a large corporation D. A 32-year-old man who works part-time at a small business

D The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it.

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a. Disadvantaged families b. Multi-problem families c. Resilient populations D. Vulnerable populations

D Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations.