Community exam 3

6. Which group would most need adult daycare services? a. Caregivers who work all day b. Elderly who are bored staying home alone c. Elderly in whom Alzheimer's has been diagnosed d. Older men who want an opportunity to meet older women e. Older women who want to engage in arts and crafts activities

ANS: A Adult daycare provides a safe and supportive environment during the day for adults who cannot or choose not to stay alone. This service is often needed by caregivers who work during regular hours or need respite.

8. "I don't understand," a woman said. "I know I'm eligible for Medicare part A and it's free. Part B isn't free. When will I ever use it?" Which would be the most appropriate response by the nurse? a. "Part A is only for hospital bills. Most care is given on an outpatient basis. Part B pays a large portion of those costs." b. "Part A is a benefit because you paid into Social Security for more than 10 years. In comparison, part B is optional if you want that additional insurance." c. "Part B is easy to pay for; they take the cost out of your Social Security check each month." d. "Researchers have found that people don't waste health care resources if they have to pay a bit for them."

ANS: A All the responses are true, although the woman may not care about research findings. Further, she may well prefer the money from her Social Security benefit to be paid to her rather than go for additional insurance. However, the reason the woman needs to know why she should pay for part B is that so much care today is given on an outpatient basis, including diagnostic procedures, physicals, speech and occupational therapy, ambulances, durable medical equipment, and some home health care services.

13. Which is the most common reason for visual impairment in older adults? a. Cataracts b. Glaucoma c. Macular degeneration d. Presbyopia

ANS: A Among older adults, the three most common pathological eye conditions are cataracts, macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally clear lens of the eye. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with near vision, generally occurs in the 40s.

17. A nurse explained that the elderly are twice as likely to die in a home fire as younger persons and therefore suggested some safety measures. Which strategy would most likely have been suggested by the nurse? a. Have smoke detectors installed in the house b. Invite a family member to sleep in the house at night c. Practice escaping quickly from the house in case of an emergency d. Program your phone so the fire department can be reached by pushing only one button

ANS: A Community health nurses making home visits can assess their elderly client's home for fire risk and teach fire safety, including the importance of home smoke detectors and fire extinguishers. Inviting family members to spend the night, practicing a quick escape, and programming one's phone for the fire department are irrelevant if a smoke detector is not installed to alert the elderly client that there is a fire in the home.

10. "My health problems are too much to handle," said an elderly woman at her annual clinical checkup. "What's most important for me to do?" Which would be the most appropriate response by the nurse? a. "Focus on eating properly and staying active." b. "Get the shingles immunization along with your flu shot this year." c. "Keep active mentally—do you do crossword puzzles or Sudoku puzzles?" d. "Stay involved with others. Do you ever go to the senior citizens center?"

ANS: A Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. As the woman was already getting an annual checkup, the nurse should stress nutrition and exercise.

5. In the supermarket checkout, a young woman complained to her friend, "Old people think we taxpayers should pay for them to be in a nursing home. Seems like a waste of money." Which would be the most appropriate response by the nurse? a. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" b. "Those old people built our society; we owe it to them to support them now." c. "Would it be better to put each person to sleep when they reach a certain age such as 80 years?" d. "You know, you'll get old someday too. Won't you want someone to take care of you when you can't anymore?"

ANS: A In 2013, 93% of the Medicare population aged 65 years and older resided in traditional community settings. Three percent resided in community housing with at least one service available, and approximately 4% resided in long-term-care facilities. The other responses do not support a therapeutic response by the nurse in this situation.

18. An elderly gentleman was shoveling his snow when you arrived for a home visit. You notice that when he comes inside he is very pale, is shivering, and seems a bit confused. His skin is very cold when you touch it. Which action would be most appropriate for the nurse to take first? a. Apply warm moist towels to his head, neck, chest, and groin b. Give him hot coffee with sugar to drink c. Have him get in a tub of very hot water immediately d. Call 911

ANS: A Initial management is to prevent further loss of heat. Rewarming of the core temperature at a safe, slow rate is important to avoid lethal side effects. The reason for rewarming the core first is to prevent vasodilation that would place the individual in ventricular fibrillation. Measures that can be taken are: (1) remove the individual from the cold area as soon as possible; (2) add more clothing, especially to the head (e.g., use a hat or scarf); (3) provide a warm sweetened drink (no coffee or tea); and (4) apply mild heat to the head, neck, chest, and groin areas using hot water bottles or warm moist towels. Medical help is imperative, and hospitalization may be needed depending on the stage of hypothermia.

16. A nurse overheard an adult woman, shaking her head in exasperation as she said, "Dad, you're being unreasonable. It's not safe!" Which is the most likely reason for this argument? a. The dad wants to keep driving. b. The dad wants to keep cooking his own meals. c. The dad wants to keep taking care of himself each day without assistance. d. The dad wants to marry some young woman who may just want his money.

ANS: A One of the quality-of-life factors that is important to seniors is the ability to drive. Many older adults depend on driving in order to maintain independence and personal mobility. Age-related declines in vision, hearing, and other abilities as well as certain medical conditions and medications can affect driving skills. Thus, safety is a concern for any elderly driver. This safety concern outweighs the other concerns of cooking one's own meals, providing self-care, and marrying a younger woman.

14. Who should create a disaster plan including emergency supplies and where to meet in case of an emergency? a. All families b. All government officials c. All public health employees d. Members of Congress and the Supreme Court

ANS: A The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are: (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

5. Which do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives? a. Create fear to intimidate and coerce to accomplish a political goal b. Encourage others with similar beliefs to join them and their cause c. Obtain publicity for themselves and their goals d. Obtain increased negotiating power and respect

ANS: A The U.S. Code of Federal Regulations defines terrorism as "violent acts or acts dangerous to human life that appear to be intended to intimidate or coerce the civilian population or to influence the policy or conduct of a government."

11. Which underlying factor most likely contributes to homelessness? a. Substance abuse b. Unemployment c. Posttraumatic stress syndrome (PTSD) d. Depression

ANS: A The text states that persons as active agents do make decisions that result in homelessness. These choices result in a shortage of affordable housing, insufficient income, and scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. However, these decisions are made in highly contextualized conditions, frequently in the midst of mental illness or addiction to alcohol and/or other substances. Substance abuse may in turn lead to unemployment which causes insufficient income. Additionally, PTSD and severe mental illness can cause substance abuse to occur.

7. When does disaster management begin? a. Before a disaster occurs b. Immediately after the disaster c. Throughout the disaster period d. When the disaster begins

ANS: A When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.

2. A spouse of a veteran inquires as to if he will qualify for the Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA). Which describes what criteria will need to be met? (Select all that apply.) a. The veteran has been rated permanently and totally disabled for a service-connected disability by a VA regional office b. The spouse is a survivor of a veteran who died from a VA-rated service-connected disability c. The veteran has been diagnosed with PTSD by a VA regional office d. The spouse is a survivor of a veteran who died in the line of duty e. The spouse has been diagnosed with a terminal illness f. The veteran has been diagnosed with a terminal illness

ANS: A, B, D The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA. According to Benefits.gov (2017), to be eligible for CHAMPVA benefits and services, individuals must be in one of these categories: the spouse or child of a veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office; the surviving spouse or child of a veteran who died from a VA-rated service-connected disability; the surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled from a service-connected disability; the surviving spouse or child of a military member who died in the line of duty, not because of misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).

6. Which type of maps is crucial to be included in any disaster plan? a. Communication map showing telephone wires and cell phone towers b. Geographic map showing, for example, roads, highways, and train routes c. Resource map showing potential resources in persons and supplies d. Response maps showing sites of first responders, such as fire stations and police stations

ANS: C A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed).

1. Which disasters are considered natech (natural-technological) disasters? (Select all that apply.) a. Constant rain led to mud slides, and whole neighborhoods were buried. b. An earthquake caused structural collapse of bridges and highways in the area. c. People stampeded out of the overcrowded arena, trampling people who had fallen. d. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. e. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. f. Volcanic eruption covered the town with ash, making it difficult to breathe.

ANS: A, B, D, E Disasters are identified as natural, man-made, or a combination of both. A natech disaster is a natural disaster that creates or results in a widespread technological problem. Examples of natech disasters would include whole neighborhoods being buried by mudslides, earthquakes causing structural collapse of roadways or bridges, river flooding resulting in an overflow of the sewage plant and contaminated drinking water, and a tsunami washing out all of the power and telephone lines. People stampeding out of a crowded arena do not involve a disaster that results in a widespread technological problem, nor does a volcanic eruption that makes it hard to breathe.

1. Which best describes the term "literally homeless"? (Select all that apply.) a. Lacking a fixed, regular, and adequate nighttime residence b. Lacking a family residence c. Living in a place not typically used for human sleeping d. Living in a temporary living accommodation such as a hotel e. Living full-time in a recreational vehicle f. Sleeping in an extended-care facility or hospital

ANS: A, C Literally homeless is described as individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided. The term "literally homeless" is not used to describe those lacking a family residence, living in a temporary living accommodation such as a hotel or recreational vehicle, or sleeping in an extended care facility or hospital.

5. A woman admitted, "I did fall once, but it was an accident that I'm sure won't happen again." Which responses would be most appropriate for the nurse? (Select all that apply.) a. "Are you getting lots of calcium and vitamin D? Are you drinking milk or taking calcium pills?" b. "Do you have a couple glasses of wine each evening to relax you before you go to bed?" c. "Do you live in a one-story house and are your floors even without rugs to trip you up?" d. "Let me give you some balance and leg muscle exercises to practice at home each day." e. "Remember that if you start to fall, fall sideways if you can to minimize injury." f. "Review what medications you are taking."

ANS: A, C, D, F Simple exercises that strengthen leg muscles and exercises that can improve balance are recommended to be done daily. Adequate amounts of calcium and vitamin D, obtaining a bone density test, and taking medications that are available for slowing bone loss are activities that can help prevent falls. Seniors can also improve their environment to reduce their risk of falling by checking floor surfaces and curb heights; identifying weather-related problems before venturing outside; wearing supportive, low-heeled shoes; making sure that rooms are well lit; and ensuring that safety equipment is installed in bathrooms and stairwells. In the event of a fall, if the senior remembers to fall forward or backward or to land on their hands to break a fall, it will lessen the risk of hip fracture. Uneven surfaces such as sidewalks, curbs, or floor elevations; wet or slippery ground; and climbing up on household items not intended for climbing can result in loss of footing or loss of traction. Drinking alcoholic beverages increases the risk of falling because alcohol slows reflexes and response time; causes dizziness, sleepiness, or light-headedness; and alters balance. Medications such as blood pressure pills, heart medicines, diuretics, and tranquilizers may increase the risk of falling.

2. A nurse always reviewed the medications taken by elderly clients on each home visit. Which best explains the rationale for the nurse's action? (Select all that apply.) a. Age-related changes and polypharmacy make elderly clients vulnerable to drug interactions and dangerous adverse reactions. b. Elderly clients are known to sue if medications taken do not make them feel better, and lawsuits are to be avoided, if possible. c. Folk or herbal medicines are often the same as the generic medications prescribed by health care providers, so elderly often have overdoses. d. Older adults are known to consume many over-the-counter medications, as well as folk or herbal remedies. e. The elderly are known to be particularly noncompliant with pharmaceutical prescriptions. f. With the high prevalence of chronic diseases, elderly clients are taking a large number of medications.

ANS: A, D, F The high prevalence of chronic diseases in the elderly population causes this group to use a large number of medications. Older adults in the United States are responsible for more than one third of total outpatient spending on prescription drugs. Older adults also consume many over-the-counter medications, as well as "folk" or herbal remedies which are not typically prescribed by health care providers. The elderly population is vulnerable to the effects of drugs because of normal aging changes and age-related differences in pharmacokinetics and pharmacodynamics. Polypharmacy may also make older adults vulnerable to drug interactions and dangerous adverse reactions. It is unlikely that elderly clients will seek legal action if a medication does not make them feel better. The elderly are not known to be any more noncompliant with taking medications than the other segments of the population.

2. Which statement best describes how a disaster is the same as or different from an emergency? a. A disaster is personal, whereas an emergency is communitywide. b. An emergency is personal, whereas a disaster is communitywide. c. Both emergencies and disasters are devastating. d. Both emergencies and disasters are failures resulting in extensive insurance claims.

ANS: B A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Emergencies differ from disasters in that the agency, community, family, or individual can manage an emergency using their own resources. However, a disaster event may be beyond the ability of the community to respond to and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community. The type of emergency or disaster will determine the level of devastation or need for extensive insurance claims to be filed.

14. A veteran has been diagnosed with chronic multisymptom illness. Which would most likely be part of the client's health history? a. History of active duty service during the Vietnam War b. Unexplained cognitive dysfunction c. History of severe hypertension d. Frequent episodes of dysuria

ANS: B Approximately 250,000 veterans of the 1991 Gulf War (about 25% to 32%) returned home with multiple varied, unexplained symptoms, including fatigue, dizziness, headaches, cognitive dysfunction, musculoskeletal pain, respiratory problems, rashes, and diarrhea. Popular media of the time referred to the disorder as Gulf War Syndrome or Gulf War Illness, although today the VHA refers to this cluster of symptoms as chronic multisymptom illness (CMI).

22. As a nurse and a citizen, what is the nurse's additional responsibility in relation to disasters? a. Assume the nurse will be asked to volunteer to assist the American Red Cross with helping care for disaster victims b. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms c. Expect and plan for the possibility of being called to report to work for additional work efforts in caring for the sick and injured d. Expect to be a role model in preparing for and reacting to a disaster

ANS: B As a nurse, one is expected to be informed regarding the Guidelines for Early Detection for Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular disease, an unusual number of persons seeking care with similar complaints, clusters of patients from a single location, or a person presenting with an uncommon disease.

16. A nurse is assessing a female veteran for military sexual trauma (MST). Which would be the most appropriate question for the nurse to ask? a. During your military service, were you ever raped? b. Did anyone ever use force or threat of force to have sexual contact with you against your will? c. Can you describe any incidents of sexual harassment that you have been involved in? d. How long did you serve in the military?

ANS: B Because of stigma and shame, many veterans will not volunteer information regarding sexual trauma exposure. When screening for history of MST, it is best to avoid words that are emotionally or politically loaded (e.g., "rape") or words that are poorly defined (e.g., "sexual harassment"). Nonjudgmental, descriptive general questions are recommended, such as: Did anyone ever use force or threat of force to have sexual contact with you against your will?

14. A nurse completed the health assessment but needed to use the elderly woman's bathroom. The nurse noticed perineal pads under the sink. Which question would the nurse most likely ask the woman? a. "Can you tell me why you need to have perineal pads?" b. "Do you know how to do Kegel exercises to help control your urine?" c. "Does another woman live with you or visit often?" d. "Why do you have perineal pads? Are you bleeding down there?"

ANS: B Because the woman did not mention incontinence, it may be assumed to be very embarrassing. Therefore, the nurse should matter-of-factly address urine control problems by suggesting a self-help intervention of Kegel exercises. It may be assumed that the nurse, having completed a health assessment, would know about bleeding, as well as frequent visitors or family nearby.

12. Which action should be taken during a biological attack? a. Close doors and windows and turn off all ventilation b. Seek medical attention if you become sick c. Develop a family emergency plan d. Keep a written record of everything that you have eaten

ANS: B During a biological attack one should: move away quickly, wash with soap and water, contact authorities, listen to the media for official instructions, and seek medical attention if you become sick. If a chemical attack were occurring, the first action would be to close doors and windows. In the case of a biological attack, one should move quickly away from the area. A family emergency plan should be developed well in advance of a biological attack. Unless directed by the authorities, it should not be necessary in any type of an attack to keep a written record of everything that is eaten.

15. Which best describes how a community will know whether its disaster plan is adequate? a. After a disaster occurs and reports of deaths and injuries are fairly accurate b. By following practice drills involving various feasible scenarios as an initial step of planning c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the plan

ANS: B For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

17. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. Which action should be taken next? a. Put a green tag on his shirt and he can get in line to wait his turn for medical treatment b. Put a yellow tag on his shirt and then await transport to a medical facility c. Put a black tag on his shirt and give him a chair to rest in until something can be done d. Put a green tag on his shirt and ask him to use his good arm to help others make it to the staging area

ANS: B Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); and black is for the deceased or for those whose injuries are so extensive that nothing can be done to save them (e.g., multiple severe injuries).

9. A veteran has recently been diagnosed with posttraumatic stress disorder (PTSD). Which information obtained from the client during a health history would align with this diagnosis? a. The client reports that he has a history of hypertension and hyperlipidemia. b. The client states that he served as a sniper during the Gulf War. c. The client states that he was stationed in Japan. d. The client reports that his wife has a substance abuse problem.

ANS: B PTSD is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. Factors that contribute to an individual developing PTSD include getting injured or seeing another person injured, viewing a dead body, feeling helpless, having little or no social support after a traumatic event, dealing with extra stress after the event (e.g., loss of a loved one, pain and injury), or having a history of mental illness or substance abuse.

19. Which disaster would most likely cause the most long-lasting mental health concerns for its victims? a. For the fourth year in a row a flood hit an area, demolishing several houses, but families heard the warning siren and evacuated in time. b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. c. A tsunami hit the beach with unbelievable force, water sweeping over the entire harbor, although most boats had been moved to deep water. d. A volcano erupted and lava destroyed the main road to the village where several houses burned, but no one died in the eruption.

ANS: B Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are: (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged.

25. "Do you have any advice?" a young woman asked. "I'm eating lunch with my dad but he can't hear and he won't wear his hearing aid." Which suggestion should be made by the nurse? a. Encourage your dad to wear his hearing aid—if only for you b. Find a very quiet place with good lighting and very little background noise for lunch c. Repeat yourself several times using exactly the same words and gestures d. Talk very loudly while facing him directly

ANS: B Suggestions include to find a quiet place to talk to help reduce background noise, especially in restaurants and social gatherings; stand in good lighting and use facial expressions or gestures to give clues; face the person and talk clearly; speak a little more loudly than normal, but do not shout; and repeat yourself if necessary, using different words.

4. A veteran is receiving veteran's health care benefits. Which department directly coordinates these benefits? a. Veterans Benefits Administration (VBA) b. Veterans Health Administration (VHA) c. U.S. Department of Veterans Affairs (VA) d. Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA)

ANS: B The Department of Veterans Affairs has three subdivisions: the VHA, the Veterans Benefits Administration (VBA), and the National Cemetery Administration. The VHA provides all types of health care in every setting, including inpatient, outpatient, and long-term care. The VBA is an administrative arm responsible for unemployment and pension payments, home loans, vocational training, and educational benefits. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA.

9. Which agency should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response? a. Federal Emergency Management Agency (FEMA) b. Office of Emergency Management c. State Disaster Office d. The National Disaster Relief Agency

ANS: B The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.

6. Which best describes what happens when persons who work full-time and receive the typical minimum wage seek an apartment? a. Few clean and decent low-rent apartments exist. b. People do not like to rent to low-income persons. c. To afford housing, they need a job that pays at least three times minimum wage. d. There are not many trailer parks near their employment.

ANS: C An increasing number of low income people end up paying much more than they can afford for rent. Since 2007, the number of renters who pay more than half of their income for rent has increased dramatically.

3. Which best describes how the Continuum of Care (CoC) concept determines the number of homeless? (Select all that apply.) a. By asking local police departments to visit areas where the homeless hide and report the number of people found there each March b. By conducting a point-in-time (PIT) homeless persons count every other January c. By making an educated guess based on anecdotal data d. By completing a statistical analysis of the Census Bureau data e. By reporting the number of homeless persons who use emergency shelters or transitional housing during the year f. By sending CoC personnel into the community to try to find hidden homeless

ANS: B, E CoCs are local systems responsible for providing a range of housing and related services that meet the U.S. Department of Housing and Urban Development guidelines for persons experiencing homelessness. CoCs conduct PIT counts of homeless persons on one night in January of every other year. In addition, CoCs are required to report the number of homeless persons who use emergency shelters or transitional housing throughout each federal fiscal year.

24. Which best explains why all family members should want their aged relatives to have a living will? a. To confirm that the attorney is serving as guardian and family members do not have to be responsible b. To fulfill the federal Patient Self-Determination Act requirements c. To help family members know what their loved one does or does not want if he or she becomes incapacitated d. To keep physicians from writing a do-not-resuscitate order

ANS: C A living will is a legal document that allows individuals to specify what type of medical treatment they would or would not want if they became incapacitated or had an irreversible terminal illness. Living wills can direct physicians to withhold life-sustaining procedures and can assist family members in making decisions when they are unable to consult a comatose or medically incompetent relative. The purpose of a living will is not to appoint an attorney as a guardian. The Patient Self-Determination Act requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess an advance directive; it does not require that patients complete one.

3. A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. Which action should the hospital take immediately? a. Ask the governor of the state to declare the area a disaster area so state help can be obtained b. Call surrounding hospitals to set up burn units, because there will be too many patients for one hospital to manage c. Call in physicians and nursing staff who are experts in burn care d. Get in touch with the American Red Cross to assist families of the victims

ANS: C A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

4. Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. Which best describes how these patients are different from the first patients to arrive? a. Burn patients probably have skin damage, whereas the firefighters have lung damage. b. Burn patients will need extensive care over time, whereas the firefighters can probably stay the night with oxygen treatment and then be discharged. c. The burn patients were direct victims, whereas the firefighters are indirect victims. d. The second set of victims may have scarring, shortness of breath, and persistent hoarseness for the next few days.

ANS: C Both sets of victims would have inhaled smoke and have lung damage. The treatment and length of stay would be determined by the amount of damage, which may vary from victim to victim. Both sets of victims, depending on the severity of the burns, may have scarring, shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an individual who is immediately affected by the event; the indirect victim may be a family member or friend of the victim or a first responder

16. A school nurse was asked to see Lisa, a student in the fourth grade who was rumored to be living in a car with her mother. Which would most likely have caused the teacher to become concerned? a. Lisa is not always respectful of the teacher. b. Lisa has not been doing her homework. c. Lisa is developmentally delayed. d. Lisa has behaved in a sexually inappropriate manner.

ANS: C Homeless children experience STDs, physical and sexual abuse, skin disorders, anemia, drug and alcohol abuse, and unintentional injuries at higher rates than children in the general population. All children are not always respectful and do not always have their homework done and may act out behaviors seen on television.

17. The male home health nurse parked his marked car in preparation for visiting the next client when a young female walked over to the car and asked him if he would like to have some fun. Which provides the best explanation for this behavior? a. The girl was skipping school and wanted money for entertainment. b. The male nurse was extremely young and attractive and looked like he had money. c. The girl may have hoped a nurse would give her enough money to eat. d. Young girls often engage in thrilling, if high-risk, behaviors.

ANS: C Homeless youth experience sexually transmitted diseases, physical and sexual abuse, skin disorders, anemia, drug and alcohol abuse, and unintentional injuries at higher rates than in the general population. Depression, suicidal ideation, and disorders of behavior, personality, or thought also occur at higher rates among homeless. Family disruption, school failures, prostitution or "survival sex," and involvement with the legal system indicate that homeless social health is severely compromised. Thus, it is most likely that the girl is hoping that the nurse would provide her enough money to eat.

21. Which statement best reflects the model of justice U.S. health care is based on? a. All people are entitled to minimum standards of care. b. All people are responsible to help their neighbors. c. All people have a right to whatever their own efforts allow them to purchase. d. Like firefighting, police protection, libraries, and roads and highways, health care must be supported by tax money for the good of all who need such services.

ANS: C Market justice has been the dominant model and purports that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover, this model stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. In contrast, under a social justice model, all people are equally entitled to key ends (i.e., access to health care and minimum standards of income). Consequently, all members of society must accept collective burdens to provide a fair distribution of these ends.

14. Which best describes a major difference between women who have always had shelter and women who have been homeless? a. Educational opportunities and attainment b. History of gender relationships (marriages, divorces) c. Level of involvement with physical and/or sexual abuse d. Skills necessary for paid employment

ANS: C Research has revealed the extraordinary histories involving substance abuse, criminal activity, serious mental health concerns, marital dissolution, escape from intimate partner violence, housing accidents, limited employment options or job loss, and poor physical health that prevented gainful employment, among women experiencing homelessness. High numbers of homeless women report histories of foster placement as children and exposure to violence as both children and adults. This research has not documented the differences in educational opportunities, gender relationships, and skills necessary for paid employment.

12. A nurse is making the first home visit to a recently discharged elderly client. Which should the nurse most likely expect to find? a. A client who is unhappy with the disorganization of the house b. A client who will expect the nurse to do everything now that the nurse is at his or her house c. A client who may have hearing or vision problems or both d. A client who is upset with being discharged while still so ill and having to take on problems at home

ANS: C Sensory disabilities increase with age and may seriously affect an older person's quality of life and ability to carry out routine daily activities. The NHI Survey found that 7.3 million noninstitutionalized American adults 65 years and older reported significant vision loss. One in three adults 65 to 74 years of age and nearly half of adults 75 years old or older have difficulty hearing. Thus, the nurse should be anticipating the needs of the client rather than being concerned about the potential factors that the client may be upset about.

8. Which group of people is most likely to experience homelessness? a. Those who have a supportive family b. Those who have recently become unemployed c. Those who have substance abuse problems d. Those who frequently change jobs

ANS: C Some people experiencing homelessness have individual characteristics that, in interaction with the structural conditions of a shortage of affordable housing and insufficient income, perpetuate their homeless conditions. Supportive services for these people are deficient in quality and quantity. Some people need services to work and earn money. They are able to function in the workforce, whereas others need services to maintain their housing status. Included in this latter group are people whose serious chronic mental health and/or substance abuse problems preclude their functioning in the workforce and whose behaviors interfere frequently with their ability to obtain housing stability. People in this group need income assistance and comprehensive and accessible behavioral and physical health care.

1. A family will most likely lose their primary nighttime residence within the next week. Which term best describes their situation in relation to homelessness? a. Homeless under other federal statutes b. Literally homeless c. Imminent risk of homelessness d. Fleeing/attempting to flee intimate partner violence

ANS: C The U.S. Department of Housing and Urban Development has issued regulations that summarized the statutory definitions in four descriptive categories. These four categories with their respective definitions include: Literally homeless: Individuals and families who lack a fixed, regular, and adequate nighttime residence, including a subset for individuals who resided in an emergency shelter or a place not meant for human habitation and who are exiting an institution where he or she temporarily resided; Imminent risk of homeless: Individuals and families who will imminently lose their primary nighttime residence; Homeless under other federal statutes: Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; and Fleeing/attempting to flee DV: Individuals and families who are fleeing or are attempting to flee, DV, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.

20. Which type of behaviors would a nurse expect to see when a disaster first strikes a community? a. A sense of all being okay and that one can rebuild and go on b. Anger and despair that help being offered is insufficient, slow, and inadequate c. Everyone trying to help strangers, as well as their neighbors, survive d. People involved sharing their stories and reliving what occurred

ANS: C The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

8. Who is responsible for ensuring the safety and welfare of communities? a. Federal government b. Federal Emergency Management Agency c. Local government d. State government

ANS: C The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

1. A nurse is caring for a veteran who has suffered a polytraumatic injury. Which would be the primary consideration for the nurse when working with this client? a. Use of an assistive device for ambulation may be necessary. b. Diagnosis of posttraumatic stress disorder will be likely. c. Physical and cognitive abilities to complete ADLs independently may be lacking. d. A psychiatric referral will be needed.

ANS: C The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event, and frequently includes TBI. For example, a soldier who has lost a limb, suffered a TBI, and lost his eyesight from a rocket-propelled grenade attack is said to have a polytraumatic injury. Care for veterans with these injuries is especially complicated because of the presence of several overlapping physical and cognitive impairments affecting their ability to perform ADLs. The primary consideration would relate to the client's impairments in completing ADLs.

10. Which factors are most likely to contribute to homelessness? a. Intimate partner violence and substance abuse b. Scarcity of support systems and recent job loss c. Shortage of affordable housing and insufficient income d. Substance abuse and serious mental illness

ANS: C The text addresses three broad factors: (1) shortage of affordable housing, (2) insufficient income, and (3) scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. Intimate partner violence, substance abuse, and serious mental illness are not identified as the broad factor contributing to homelessness.

7. Which factor would prevent a homeless person from accepting employment adequate to pay for housing? a. Could not complete an employment application because of lack of mailing address b. Hope for a better position than the service positions available c. Lack of adequate resources to pay for other necessities d. Prefer to receive a handout than to have to work

ANS: C There are homeless people who are able to function in the workforce. The lack of affordable housing in combination with insufficient income results in people having to spend much of their income on rent and leaves them without adequate resources for other necessities, such as food, clothing, and health care. This situation substantially increases their risk for homelessness.

17. A veteran is receiving treatment for posttraumatic stress disorder (PTSD). As part of the therapy, the veteran identifies negative thoughts and emotions while focusing on specific sounds and movements. Which trauma-focused therapy is the client receiving? a. Cognitive processing therapy b. Prolonged exposure therapy c. Eye movement desensitization and reprocessing d. Cognitive behavioral therapy

ANS: C There are variations of trauma-focused therapies. These include (1) prolonged exposure therapy (where the individual is repeatedly questioned by the therapist about the trauma to encourage control of the thoughts and feelings to reduce fear of the memories); (2) cognitive processing therapy, which involves talking with the therapist about the negative thoughts and beliefs and development of strategies to manage the recollection of the trauma in a way that is less upsetting; and (3) eye movement desensitization and reprocessing, which involves identification of the negative thoughts, emotions, and feelings while focusing on specific sounds or movements, helping the brain work through the traumatic memories. Friedman noted that the most successful interventions include cognitive-behavioral therapy and medication (e.g., selective serotonin reuptake inhibitors such as sertraline [Zoloft] and paroxetine [Paxil]).

18. Which step should the nurse take first when triaging a victim of a disaster? a. Assess mental status b. Assess perfusion c. Assess respirations d. Assess blood pressure

ANS: C To assess an individual within the 1-minute guideline, the START system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual a question. Assessing blood pressure is not part of the 1-minute guideline.

2. Which strategies have been used to improve the collection of prevalence data for the homeless population? (Select all that apply.) a. Urban Institute study b. Homeless Assistance Report c. Continuum of Care (CoC) concept d. Homeless Information Management System (HMIS) e. Census Bureau f. Education for Homeless Children and Youth program

ANS: C, D Two strategies used by the U.S. Department of Housing and Urban Development in the efforts to strengthen the nation's efforts to reduce homelessness, including improvement in collecting prevalence data, are the CoC concept and the HMIS. The Census Bureau and Urban Institute study were historically used to collect data on the homeless population. Data collection improvements have been made since these studies were completed. The Department of Education uses the Education for Homeless Children and Youth program to collect data on homeless youth.

5. Which statements about veteran suicide are accurate? (Select all that apply.) a. Veteran suicides most likely occur from prescription drug overdose. b. An average of 50 veterans each day die by suicide. c. The suicide rate of veterans is higher than that of the general population. d. The majority of veterans who die from suicide are age 50 or older. e. The age group that has the highest suicide rate among female veterans is age 18 to 29 years old. f. The age group that has the highest suicide rate among male veterans is age over age 50.

ANS: C, D, E Among male veterans, suicide rates were highest in the 18 to 29 and 75 and older age groups, whereas suicide rates for females were highest in the 18 to 29 age group. An average of 20 veterans died by suicide each day. Veterans accounted for 18% of all deaths by suicide among U.S. adults although veterans only account for 8.5% of the U.S. population. Risk for suicide was 21% higher among veterans compared with U.S. civilian adults after adjusting for differences in age and gender. Approximately 67% of all veteran suicides resulted from firearm injuries. Approximately 65% of all veterans who died by suicide were age 50 or older.

2. Which best describes why earthquakes would be more frightening than floods to many people, even though both can cause extensive damage? (Select all that apply.) a. Death rate and scope are higher in earthquakes. b. There is a higher frequency of earthquakes. c. Imminence of earthquakes is unknown. d. It is not possible to prevent an earthquake. e. The intensity of earthquakes is higher. f. The predictability of earthquakes is lower.

ANS: C, D, F Death rate, intensity, and frequency depend on location and other factors. Hawaii, for example, has frequent earthquakes with little damage resulting. However, earthquakes cannot be predicted or prevented, whereas flooding can usually be predicted and most communities have taken steps to avoid or at least lessen the damage from floods. The frequency or intensity of earthquakes is not higher than that of flooding.

4. Which disorders are experienced at a higher rate by homeless adults when compared with the general population? (Select all that apply.) a. Hepatitis b. Diabetes c. Asthma d. HIV/AIDS e. Hypertension f. Alcoholism

ANS: C, E, F Chronic disorders experienced at higher rates than in the general population include hypertension; musculoskeletal disorder; gastrointestinal problems; respiratory problems (asthma, chronic bronchitis, emphysema); neurological disorders, including seizures; and poor dentition. Like physical health problems, serious mental illnesses and minor emotional problems occur more frequently among the homeless population than in the general population. High rates of alcohol and drug use exacerbate the existing acute and chronic physical and mental health problems. The rates of hepatitis, diabetes, and HIV/AIDS are not seen at a higher rate among the homeless adult population.

6. A client reports hearing loss and tinnitus following military duty in the Gulf War. Which term would best describe this client's injury? a. Posttraumatic stress disorder b. Polytrauma c. Traumatic brain injury d. Service-connected disability

ANS: D A service-connected disability is a disease or injury that was incurred as a result of or during the veteran's active duty, or one that was aggravated by military service. Posttraumatic stress disorder is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. A traumatic brain injury is a disruption of brain function caused by an external mechanical force, including blunt force trauma, penetration by a foreign object, acceleration or deceleration movements, and pressure waves from explosive blasts. The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event and frequently includes TBI.

2. Which is an example of a nonstochastic theory of aging? a. Cross-link theory b. Error theory c. Free radical theory d. Immunologic theory e. Somatic mutation theory f. Wear and tear theory

ANS: D All the theories except one are stochastic theories, that is, theories that are based on the assumption that events occur randomly and accumulate over time, which results in aging. The only nonstochastic theory, which views aging as predetermined, is the immunologic theory.

24. A nurse is using an upstream intervention when working with the homeless population. Which public health intervention will the nurse most likely use? a. Case management b. Outreach c. Surveillance d. Community organizing

ANS: D Although nurses may use all interventions at all three levels, community/public health nurses working more upstream, at the system level, employ collaboration, coalition building, community organizing, advocacy, social marketing, and policy development and enforcement. In contrast, community/public health nurses—working downstream with individuals, families, or groups—use surveillance, disease and other health event investigation, outreach, screening, case finding referral and follow-up, case management, delegated functions, health teaching, counseling, and consultation.

5. Which best describes the problem with the Section 8 housing program? a. Direct access to an apartment in a public housing facility is faster and easier. b. Most renters prefer the program to make direct payment to apartment owners willing to rent to them. c. Section 8 housing is essentially slum housing, and no one wants to live there. d. Supply is vastly less than the demand.

ANS: D Although these programs are intended to alleviate housing problems for low-income renters, the demand for these assisted housing programs has far exceeded the supply. Section 8 housing does not provide direct access to an apartment in a public housing facility or provide payment directly from the program to apartment owners. Section 8 housing provides affordable housing through the U.S. Department of Housing and Urban Development and is not slum housing.

4. Which represents the largest group of homeless adults? a. Minorities b. Disabled c. Females d. Males

ANS: D Among all sheltered homeless adults in 2015, approximately 62.1% were men; 37.9% were women. The sheltered homeless population is younger than the general population. Most homeless adults were between 31 and 50 years of age; 22.3% were less than 18 years of age; and 4% were older than 62. In the general population, 18% were over age of 62. Minorities comprised 61.9% of the total sheltered population. Adults with disabilities were over three times more likely to be experiencing sheltered homelessness than adults without disabilities.

12. Which individual would be described as being "doubled up"? a. An individual who has two chronic conditions b. An individual who has recently been released from prison c. An individual who maintains two jobs to avoid being homeless d. An individual who is forced to live with friends

ANS: D An individual may be considered to be homeless if that person is "doubled up," a term that refers to a situation where individuals are unable to maintain their housing situation and are forced to stay with a series of friends and/or extended family members. The other responses do not accurately describe being "doubled up."

1. Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster? a. American Red Cross (ARC) b. The Department of Homeland Security (DHS) c. Federal Emergency Management Agency (FEMA) d. The National Incident Management System (NIMS)

ANS: D Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President George W. Bush established the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2017a).

16. An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. Which action should the community take first? a. Send in ambulances to transport injured persons to medical facilities b. Send in media personnel to share the event and begin efforts to obtain donations for the injured c. Send in medical personnel to administer first aid and triage the injured d. Send in law officials to secure the area and ensure the safety of the victims

ANS: D Before search and rescue should begin, safety must be considered. In some instances, if a criminal action is suspected, law officials will be among the first to respond to secure the area and possibly gather evidence. While the area is being checked and then cleared of potential threats, a staging area can be set up at or near the site of the incident to direct onsite activities. Search and rescue of victims can begin once clearance is given, a disaster triage area is established, and an emergency treatment area is set up to provide first aid until transportation for victims to hospitals or health care facilities for treatment can be coordinated.

23. Which best describes a downstream intervention to solve the problem of homelessness? a. Improved use of community resources b. Increased employment opportunities c. Increased affordable housing d. Improved treatment of mental illness

ANS: D Building on McKinlay's "river" metaphor, McKinlay and Marceau (2000) purport that government and private efforts to address homeless health care problems largely focus on "pulling the bodies out of the river of homelessness." Such downstream interventions aimed at treating or alleviating health care problems, such as physical disease and mental illnesses, are worthy and needed. However, these interventions when used alone are far less adequate in alleviating homeless people's social health problems. To improve the social health of the homeless, it is necessary to go upstream and focus on the primary contributors to homelessness itself (i.e., lack of affordable housing, inadequate income, and insufficient services).

23. A wife explained to the nurse that her husband was becoming awfully forgetful, and now he's started getting lost on the way home from the golf club. She's scared he may be getting Alzheimer's disease. Which would be most appropriate action for the nurse to take? a. Ask the husband to explain why he thinks he got lost coming home b. Explain that all elderly persons get a little forgetful and not to worry c. Ask the husband to count backwards by 7 from 100 d. Hand the husband pencil and paper and ask him to draw a clock

ANS: D Clients with Alzheimer's disease are unable to draw a normal clock. The clock drawing test has become one of the most widely used screening instruments in clinical and research settings. It has been found to be an effective and easy-to-administer tool to screen for dementia. This should be the first action taken by the nurse to screen the client for Alzheimer's disease and take appropriate action as necessary.

9. Which best describes how health care professionals are involved in the problem of homelessness? a. Homeless persons make everyone uncomfortable when they beg for handouts. b. Homeless persons often live in emergency departments and clinics. c. Poverty leads to crimes, and health care professionals can be attacked and robbed outside health care facilities. d. Serious illnesses or disability creates high medical bills, which may lead to homelessness.

ANS: D In 2013, of households with an annual income less than $25,000, 21.6% had no health insurance. Lack of health insurance is a significant factor in creating homelessness. A serious illness or disability can lead to a downward spiral as a result of job loss, use of savings to pay for care, and inability to pay rent.

3. On the basis of all the work done by social scientists, approximately how many homeless persons should be expected and tolerated in our society? a. No more than 5% b. No more than 10% c. No more than 15% d. There should not be homeless persons in America.

ANS: D Kozol (1988) argued: "We would be wise to avoid the numbers game. Any search for the 'right number' carries the assumption that we may at last arrived at an acceptable number. There is no acceptable number. Whether the number is 1 million or 4 million, there are too many homeless people in America."

10. Which statement about military sexual trauma (MST) is accurate? a. MST is more common among male veterans. b. The majority of women who report MST state the perpetrator was an intimate partner. c. An Army veteran is at greatest risk to report MST. d. Insomnia is more severe among veterans who report a history of MST.

ANS: D MST is more common among women veterans, with 32.4% reporting MST compared with 4.6% of their male counterparts (Klingensmith et al, 2014). It is estimated that in one of seven women who report MST, the trauma was perpetrated by an intimate partner (Mercado et al, 2015). Insomnia is more common and more severe among veterans who report a history of MST (Jenkins et al, 2015). One of the risk factors/characteristics of veterans experiencing MST is being a Navy veteran, not Army.

19. A veteran has received special training to provide recovery-oriented support to other veterans within the VHA health system. Which role will the veteran most likely fulfill? a. Peer counselor b. Suicide hotline responder c. Suicide prevention coordinator d. Peer support specialist

ANS: D Peer support specialists are veterans who have been trained to provide recovery-oriented support and outreach that encourages other veterans to utilize VHA health services, particularly mental health, to assist with their recovery. The suicide prevention coordinator's primary role is to help veterans access timely mental health care, particularly in times of crises, and to assist health care treatment teams with managing the care of suicidal veterans. Hotline responders are trained in suicide prevention and crisis intervention and assist callers by initiating dispatch of emergency services to callers in imminent suicidal crisis and refer veterans to VA suicide prevention coordinators to ensure that veterans are connected to local mental health care.

2. Which best describes the recent trends in homelessness? a. The number of homeless individuals in school is decreasing. b. The number of homeless individuals is increasing. c. The number of homeless families is increasing. d. The number of homeless families is decreasing.

ANS: D The U.S. Department of Housing and Urban Development reported the following numbers of people in the total population and subpopulations who used shelters or transitional housing between October 1, 2015 and September 30, 2016: 355,212 individuals, a decrease of less than 1% between 2015 and 2016; 194,716 people in families with children, a decrease of 5% between 2015 and 2016.

8. A veteran has been diagnosed with an immersion foot injury. Which finding should the nurse anticipate when completing an assessment on the client? a. A foot that is deformed b. A foot that is unable to tolerate immersion in water c. A foot that the client is unable to bear weight on d. A foot that has occasional numbness

ANS: D The major cold injuries veterans suffer include frostbite, nonfreezing cold tissue damage, immersion foot (formerly called trench foot), and hypothermia. Cold injuries may result in long-term health problems, including the following signs and symptoms (at the site of exposure): changes in muscle, skin, nails, ligaments, and bones; skin cancer in frostbite scars; neurological injury with symptoms such as bouts of pain in the extremities, hot or cold tingling sensations, and numbness; vascular injury with Raynaud phenomenon with symptoms such as extremities becoming painful and white or discolored when cold.

15. Which veteran is most likely to experience homelessness? a. A 40-year-old single female b. A recently divorced 25-year-old male c. A recently divorced 30-year-old female d. A 35-year-old single male

ANS: D The majority of homeless veterans are single males between the ages of 31 and 50. Only 9% of homeless veterans are females. Marital status is not reported as one of the risk factors that relate to incidence of homelessness.

11. Which best describes the mission of the U.S. Department of Homeland Security (DHS)? a. To consolidate all existing agencies, groups, and organizations into a single department b. To distribute federal financial aid to disaster-stricken areas c. To enable appropriate response to assist a state having a disaster d. To prevent terrorism and ensure resilience to disasters

ANS: D There are five homeland security missions: prevent terrorism and enhance security, secure and manage U.S. borders, enforce and administer immigration laws, safeguard and secure cyberspace, and ensure resilience to disasters. This agency was created to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland, but this is not the mission of the agency. The Federal Emergency Management Agency distributes federal financial aid to disaster-stricken areas and is responsible to enable the appropriate response to assist a state having a disaster.

15. Which factor is the primary motivator for young (homeless) women engaging in survival sex? a. Peer influence b. Pursuit of drugs c. Coercion by perpetrators d. Desperation to meet basic needs

ANS: D Young (homeless) women involved in survival sex (participating in sexual acts in exchange for money, food, lodging, clothing, or drugs) are motivated primarily by desperation to meet basic needs, including a place to stay, food, and money, and one third mentioned that peers commonly were influential in decisions to engage in survival sex. Others were influenced by coercion (10%) or pursuit of drugs (10%) (Warf et al., 2013).

3. Which are the responsibilities of the Centers for Disease Control and Prevention (CDC) in relation to disasters? (Select all that apply.) a. Contacting family members with up-to-date information regarding victims and their condition b. Coordinating local services to prevent duplication and fragmentation c. Delivering first aid and arranging for prescription medications that were lost to be replaced d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims f. Setting up safe and comfortable disaster shelters (emergency housing) for families

ANS: D, E After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), the CDC—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross.