Community Health Final

Improving the Health of Adolescents and Young Adults

A Guide for States and Communities helps guide people and organizations through public health processes that address the 21 Critical Health Objectives identified in Healthy People 2020 for adolescents and young adults.

The school nurse is evaluating a health program for possible updates in the school district. Which component should the nurse address to ensure safe and supportive learning environment for students?

A social and emotional school climate promotes health, growth, and development by providing a safe and supportive learning environment.

Hospice care includes services that are reasonable and necessary for the comfort and management of a terminal illness. Which services might be included? (Select all that apply.) A) Physician services B) Nursing care C) Long-term inclient pain control D) Hospice aide services E) Social worker services

ANs: A, B, D, E Feedback: Hospice care services may include physician services, nursing care, hospice aide services, social worker services, and short-term, not long-term, inclient care (for pain and symptom management).

The occupational health nurse works in facility located in a region that is highly prone to tornadoes. Which intervention should the nurse make sure is included in the facility's emergency plan to address this potential threat? A) A shelter-in-place policy and procedure B) Personal protective equipment C) Evacuation drills D) Decontamination procedures

Ans: A Feedback: A shelter-in-place policy and procedure must be established for emergencies such as hurricanes, tornadoes, high winds, or chemical releases in buildings such as healthcare and correctional facilities. Personal protective equipment and decontamination procedures are needed for those who work with and around hazardous materials and chemicals but would not be needed for a tornado. During a tornado, workers should shelter in place, not evacuate the building.

The leading cause of death in 2014 was: A) Cerebrovascular disease B) Chronic lower respiratory disease C) Diabetes mellitus D) Heart disease

Ans: D Feedback: In 2014, the 10 leading causes of death accounting for 80% of all deaths in the United States include, in descending order, heart disease, malignant neoplasms, chronic lower respiratory disease, accidents, strokes, Alzheimer disease, diabetes mellitus, influenza and pneumonia, renal disease, and suicide.

Which industry has the highest number of fatal injuries? A) Agriculture B) Construction C) Mining D) Transportation

Ans: D Feedback: The number of fatal injuries related to transportation is the highest.

Advertising the _____ number and developing a _____ program may help some, but these interventions are not noted to be the most affective.

Hotline number, family-based program

The nurse cares for a client whose husband of 50 years died last week. The nurse arrives at her home to find her staring out of a window in a stupor, her face devoid of any emotion. When the nurse speaks with her, the client seems withdrawn and distant. Which phase of grief should the nurse most suspect this client to be in? A. Numb shock B. Emotional turmoil C. Reorganization D. Resolution

ANS: A Feedback: In the Numb Shock phase of grief = the widow or widower cannot believe the spouse's death occurred & is marked by shock, emotional dullness, & restless behavior that may include stupor & withdrawal; one wants to protect oneself from the feeling of loss- In the Emotional Turmoil or Depression phase of grief = alarm or panic-type reactions occur & emotional expression may include crying, low mood, sleep disturbance, & anorexia; anger, guilt, or longing for the deceased may take place- The widow or widower may also become preoccupied with the meaning of the loss- In the Reorganization or Resolution phase of grief = coping strategies & positive outlooks emerge- A Final Resolution phase leads to acceptance of the loss & the widow or widower may return to prior levels of functioning

The occupational health nurse for a hydroelectric plant uses root cause analysis to investigate a recent accidental electrocution of a plant worker. The nurse currently is defining the characteristics of the case. In which step of the root cause analysis is the nurse? A) Define the problem B) Collect data C) Identify possible causal factors D) Identify the root cause

Ans: A Feedback: Defining the problem includes defining the characteristics of the case and determining the circumstances under which it occurred. Collecting data includes determining whether similar illnesses or injuries occurred in the past, comparing similarities and differences, creating a time line related to the problem, and determining the impact of the problem. Identifying possible causal factors includes convening people involved in the situation to discuss the cause, determining the sequence of events that led to the illness or injury, identifying the conditions that allowed the problem to occur, identifying related problems, creating a chart of possible causal factors, and identifying causal factors and possible interrelationships. Identifying the root cause includes identifying the true causes of the illness or injury, determining why the causal factor or factors exist, and determining the real reason the problem occurred.

The nurse cares for a client whose husband of 50 years died a year ago. A behavior that indicates the client has reached the reorganization phase of grief is when she: A) Joins a book club to get out of the house and meet new people B) Expresses no emotions regarding the loss of her husband C) Begins crying on a daily basis D) Experiences panic attacks regularly

Ans: A Feedback: In the reorganization or resolution phase of grief, coping strategies and positive outlooks emerge, such as joining a book club. A final resolution phase leads to acceptance of the loss. The widow or widower may return to prior levels of functioning. In the numb shock phase of grief, the widow or widower cannot believe the spouse's death occurred. This phase is marked by shock, emotional dullness, and restless behavior that may include stupor and withdrawal. One wants to protect oneself from the feeling of loss. In the emotional turmoil or depression phase of grief, alarm or panic-type reactions occur. Emotional expression may include crying, low mood, sleep disturbance, and anorexia. Anger, guilt, or longing for the deceased may take place. The widow or widower may also become preoccupied with the meaning of the loss.

A living will is a document that: A) Describes the client's wishes regarding treatment intended to sustain life B) Designates someone to make medical decisions for the client if he or she is unable to do so C) Permits someone access to the client's finances D) Ensures appropriate end-of-life care

Ans: A Feedback: Living wills are documents in which clients describe their wishes regarding treatment intended to sustain life. A healthcare proxy or durable power of attorney for healthcare is a person designated to make decisions for the client if he or she is unable to do so. The healthcare proxy is responsible for medical decisions only if the client is unable to do this and does not have legitimate input into any other areas of the client's affairs. Decision making around the time of death raises many legal and ethical questions. Advance directives such as a living will can help with these question, though may not necessarily represent a guarantee that the client's wishes will be carried out.

The nurse cares for a client who has a laceration on her arm and reports moderate aching, throbbing pain from the injury. Which medication should the nurse expect to be ordered first for this client? A) Acetaminophen B) Ibuprofen C) Opioids D) Anticonvulsants

Ans: A Feedback: Nociceptive pain usually resolves when the injury heals, and initial treatment involves nonopioid pain relievers. Acetaminophen is usually the first choice, followed by nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; then physicians choose opioids. Difficult to relieve with routine pain medications, neuropathic pain may be deep and severe. At times, anticonvulsants, antidepressants, and opioids are used for pain relief.

The nurse examines a client who is taking haloperidol for schizophrenia and notices that she habitually twists her tongue and arms. This side effect of her medication is known as: A)Tardive dyskinesia B)Akathisia C)Dystonia D)Neuroleptic malignant syndrome

Ans: A Feedback: Of particular concern with the first-generation antipsychotics is the risk of developing tardive dyskinesia. This condition, which is irreversible, is characterized by twisting movements of the tongue, limbs, and torso. Some of the other debilitating side effects of the first-generation antipsychotics include akathisia (extreme restlessness in the limbs), dystonia (severe stiffness in muscles, most prominently the neck), blurred vision, urinary retention, and neuroleptic malignant syndrome.

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exemplifies a primary prevention strategy for mental health problems? A)Educate families and community groups about mental health issues, symptoms of stress, and barriers to seeking help B)Screen for mental health disorders C)Promote support groups for people with mental health disorders D)Initiate health-promotion activities as a part of rehabilitation services

Ans: A Feedback: Primary prevention strategies include educating families and community groups about mental health issues, symptoms of stress, and barriers to seeking help. Secondary strategies include screening for mental health disorders. Tertiary strategies include promoting support groups for people with mental health disorders and initiating health-promotion activities as a part of rehabilitation services.

A line operator in a manufacturing facility comes in to the on-site clinic reporting numbness in his hands after excessive exposure to the toxin benzene. Applying the epidemiologic triad to this scenario, which is the host? A) Line operator B) Manufacturing facility C) Benzene D) Hands

Ans: A Feedback: The epidemiologic triad is very helpful in occupational health nursing practice as a means to understand the complex relationships among the workers, hazards in the workplace, and hazards in the environment. In the epidemiologic triad, each worker is a host within the work population. The agents in the epidemiologic triad are workplace hazards classified as biological, chemical, physical, or psychosocial agents. The workplace exists within an external environment with specific geological and atmospheric characteristics, air and water quality, and presence or absence of environmental pollution.

Which injury has the highest incidence rate among occupational injuries and illnesses that result in days away from work? A) Sprains B) Broken bones C) Cuts D) Carpal tunnel syndrome

Ans: A Feedback: The highest incidence rate resulting in days away from work occurred from sprains, strains, and tears. Cuts were in second place, fractures in fourth place, and carpal tunnel syndrome in seventh place.

The community health nurse addresses cyber bullying in the local middle schools. Currently, there are no policies in place for this issue. The most appropriate first step isto: A) Explore current programs to prevent bullying and youth violence B) Develop rules for acceptable and safe use of all electronic media for all students C) Ban use of the Internet at all schools D) Actively monitor students' social media postings

Ans: A Feedback: The most appropriate first step to take would be to explore current programs to prevent bullying and youth violence. Many of the programs developed to prevent face-to-face aggression address topics such as school climate and peer influences that are likely to be important for prevention of electronic aggression. By researching and perhaps adopting an existing program, the nurse will not have to develop a program from scratch. Developing rules for acceptable and safe use of all electronic media for all students is not likely to be effective because there would be no way to enforce them. This would be a more appropriate action for parents and caregivers. Banning all use of the Internet at all schools would be impractical, as the Internet is increasingly being incorporated into learning, and impossible to enforce. Actively monitoring students' social media postings would be impractical, as no one would have time for this, and cyber bullying can occur on many different sites and devices.

A parish nurse helps an older woman in the congregation who is taking multiple medications develop a system whereby the woman can more easily remember to take the right medications at the right time. Which is the primary ethical principle observed by the nurse in this situation? A)Autonomy B)Confidentiality C)Beneficence D)Nonmaleficence

Ans: A Feedback: The parish nurse works to empower members of the congregation to take charge of their health, such as by helping an older woman develop a system to help her remember to take the right medications at the right time. This can enhance their autonomy. One area in which parish nurses can commit an ethical breach comes up often in the family context of a congregation; this area is the need to protect confidentiality. The faith community nurse is also to be guided by beneficence, the act of doing good. This is an even more stringent requirement than nonmaleficence, the need to do no harm.

The nurse assesses a 7-year-old girl who has had problems at school lately with her behavior and mood. On the basis of the description provided by the child's mother, the nurse suspects either attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder may be involved. Which behaviors—when occurring in all spheres of the child's life—would most strongly suggest ADHD rather than bipolar disorder in this client? A)Hyperactivity and impulsivity B)Mood and anxiety symptoms C)Irritability and impulsivity D)Anxiety and hyperactivity

Ans: A Feedback:In children with ADHD, hyperactivity and impulsivity are evident in all spheres of the child's life. Unlike bipolar disorder, mood and anxiety symptoms are not predominant in ADHD; generally, teachers and parents do not characterize the child with ADHD as angry, irritable, and moody.

In an institution-based model of nursing, the nurse: (Select all that apply.) A)Serves a health system with assignment to particular congregational settings B)Serves as a liaison between a health system and a congregation C)Is part of the ministry staff of the congregation D)Serves a particular faith community by virtue of a contract or job description E)Provides care of the human spirit

Ans: A, B Feedback: In the institution-based model, the nurse serves a health system with assignment to particular congregational settings, acting as a liaison between the health system and the congregation and helping plan and coordinate care, particularly at times of transition. In the parish nursing model, the nurse contributes to the health and wholeness of people in the context of a faith community, is part of the ministry staff of the congregation, and serves the illness needs of individual people, families, and the entire faith community. In the congregation-based model, the nurse serves a particular faith community by virtue of a contract or job description; this model supports the concept of a faith community nurse who can be paid or serve as a volunteer. Spiritual care is care of the human spirit that may include dealing with the meaning of health, illness or loss, and relationships with God and others, and that which has the goal of peace.

The occupational health nurse is a member of the emergency planning committee in the workplace. The nurse is helping to formulate an emergency plan for the facility. Which key components should the nurse include in the emergency plan? (Select all that apply.) A) Alarms B) Phones C) Reporting D) Communication E) Evacuation

Ans: A,C,D,E Feedback: Key components of the emergency plan involve alarms, reporting, communication, evacuation, a system for counting the occupants, procedures for staff who do not immediately evacuate, and rescue and medical services. Phones would not be a component of the plan.

The occupational health nurse is a member of the emergency planning committee in the workplace. The nurse is helping to formulate an emergency plan for the facility. Which goals should the nurse keep in mind while developing the plan? (Select all that apply.) A) Establish clear reporting instructions for employees. B) Provide instructions on safe lifting techniques. C) Identify hazardous substances that workers are exposed to in their daily work. D) Name key personnel who will assume necessary tasks. E) Establish emergency escape routes.

Ans: A,D,E Feedback: The goals of an emergency plan are to anticipate emergencies and to establish clear reporting instructions for employees. The plan names key personnel who will assume necessary tasks. It establishes emergency escape routes and procedures to identify workers and visitors with and without disabilities. The plan ensures that predesignated areas have been arranged and employees have participated in actual drills. An emergency plan would not include providing instructions on safe lifting techniques or identifying hazardous substances, as these are normal work concerns, not emergencies.

The occupational health nurse for a computer manufacturer is required to conduct a physical examination of each new hire. The rationale for this action is to: A) Screen for cardiac defects the worker may be unaware of. B) Ensure the worker's fitness for the job. C) Determine possible causes of the worker's chief complaint. D) Provide a baseline for future comparison. E) Determine the worker's eligibility for the company health insurance plan.

Ans: B Feedback: A health record can be kept on the employees as part of their other employment records. This process often starts with an initial physical examination appropriate to the type of work that is going to be done. The physical examination helps ensure fitness for the job and provides a baseline for future comparison. The physical examination is not performed to screen for cardiac defects, determine possible causes of a chief complaint, or determine a worker's eligibility for the company health insurance plan.

A client has just been pronounced dead. The first action the nurse should take is to: A) Remove all tubes B) Don gloves C) Grasp the eyelashes and gently pull the lids down D) Insert the dentures into the mouth

Ans: B Feedback: After the pronouncement of death, the nurse should glove, remove all tubes, replace soiled dressings, pad the anal area in case of drainage, and gently wash the body to remove any discharges. The body should lie on its back, with head and shoulders elevated on a pillow. The nurse should grasp the eyelashes and gently pull the lids down. Insertion of dentures is necessary.

The occupational health nurse at a company has seen three different employees in one week who have all reported similar upper respiratory symptoms. Which rate should the nurse consider calculating to understand the severity of this problem and to determine whether a cluster or cohort is forming? A) Productivity rate B) Incidence rate C) Prevalence rate D) Ratio of affected to unaffected

Ans: B Feedback: If there happens to be more than one worker from the same department with consistent symptoms and objective findings, the OHN may immediately begin to suspect that a cluster or cohort is forming and should determine the number of new cases of the condition, or the incidence rate. Clusters are aggregations of disease diagnoses collected from a specific population within a distinct period of time or space. The calculation of incidence rates is a helpful tool in understanding the severity of a workplace problem. Prevalence reflects the total burden of the injury or illness that exists in the population—in this case, the workplace. It includes both new cases and existing cases, as opposed to the incidence rate, which only includes new cases. Ratios can compare and involve groups of workers in settings. This approach adds clarity when comparing the number of affected workers in an organization that employs workers located in various geographic locations.

Which is an advantage, from the perspective of a faith community nurse, of working in an unpaid congregation-based model? A)Is recognized as a member of the ministry team B)Can limit how much time he or she offers to the congregation C)Receives much assistance from other nurses D)Can serve as an ambassador and referral agent to a health system

Ans: B Feedback: One advantage is that the faith community nurse can limit how much time he or she offers and can maintain other employment. In a paid, institution-based model, a faith community nurse is employed by a health system, hospital, or community agency. The benefit to the agency is that the faith-based nurse can serve as an ambassador and referral agent for the institution. Both paid and unpaid congregation-based models share a disadvantage. The nurse usually operates independently, with little assistance from other nurses, and there is little support for developing new approaches to care. One disadvantage to having an unpaid faith community nurse is that this person may not be recognized as a member of the ministry team and will probably have fewer hours to offer in service.

Supportive relationships with the spiritual head of the congregation are important for the success of a faith community nursing program. Unless the pastor has worked with a faith community nurse before, repeated explanations will most likely be necessary. The spiritual head of the congregation may need further education to clear up the common misconception that the nurse will: A)Provide confidential professional nursing care B)Be a private visiting nurse for the congregation C)Make referrals for appropriate healthcare in the faith community D)Work under the ANA's Faith Community Nursing Scope of Practice

Ans: B Feedback: One common misconception is that the faith community nurse is a private visiting nurse for the congregation. The faith community nurse provides confidential professional nursing and refers to the American Nurses Association (ANA)'s Faith Community Nursing: Scope and Standards of Practice (2005) for guidance. If a member of the congregation is in need of visiting nurse services, then the faith community nurse provides an appropriate referral.

The occupational health nurse with a construction company is responsible for filling out a record of accidents and illnesses that occur on the company's work sites. Which source should the nurse consult to acquire the proper record-keeping form and guidelines? A) FMLA B) OSHA C) HIPAA D) NORA

Ans: B Feedback: The Occupational Safety and Health Administration (OSHA) designs and distributes record-keeping forms called the OSHA log. The Occupational health nurse is usually responsible for filling out the OSHA log. This injury log is a record of accidents and illnesses that occur within a given year at every workplace facility employing 10 or more people. According to the Family and Medical Leave Act (FMLA), in the case of serious illness affecting themselves or family members, when all conditions are met under this act, employees can leave work for up to 12 weeks and return to work without penalty. The Health Insurance Portability and Accountability Act (HIPAA) mandates that all medical information be held in confidence. One way to ensure privacy is to keep all health-related information in a separate, secured file and storage area other than the business or human resource files. The National Occupational Research Agenda (NORA) is a partnership program to stimulate innovative research and improved practices for safer, healthier workplaces.

Which is one of the most important strategies recommended by the Centers for Disease Control and Prevention (CDC) for reducing the spread of HIV? A) Excluding students from school who have symptoms of sexually transmitted infections B) Routinely screening all adolescents and adults aged 13 to 64 C) Requiring parents to take their adolescent children who have sexually transmitted infections for treatment D) Keeping detailed records of all new cases of sexually transmitted infections in people aged 15 to 24 years

Ans: B Making HIV testing a routine part of healthcare for adolescents and adults 13 to 64 years of age is one of the most important strategies recommended by the CDC for reducing the spread of HIV. Accurate measures of sexually transmitted infections (STIs) in the 15- to 24-year-old population are difficult to obtain because many affected people have few, if any, identifiable symptoms. Symptomatic adolescents who are suspected of having an STI cannot be excluded from school. Federal law stipulates that adolescents can go directly to a health department-operated STI clinic for diagnosis and treatment of their disease without parental consent.

Being a school nurse requires which combination of practice type and decision making? A) Collaborative practice and interdependent decision making B) Autonomous practice and independent decision making C) Collaborative practice and dependent decision making D) Autonomous practice and interdependent decision making

Ans: B School nursing requires autonomous practice and independent decision making, not collaborative practice or dependent or interdependent decision making.

The occupational and environmental health nurse faces many different practice issuesevery day and can function comfortably in roles as a clinician, coordinator, and case manager following company procedures, using assessment checklists and clinical protocols to provide treatment. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

Ans: B Feedback: Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals. The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client. The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

Screening for cholesterol is an example of which prevention level? A)Primary B)Secondary C)Tertiary D)Quaternary

Ans: B Feedback: Primary prevention activities include programs on exercising to maintain health, smoking cessation programs, and heart-healthy eating programs. Secondary prevention includes screening for hypertension and setting up screenings such as mammogram vans or other tests to diagnose problems early. Tertiary prevention involves minimizing the effect of health problems and maximizing function for people with such conditions such as diabetes, stroke, or injury. There is no quaternary level of prevention.

The occupational and environmental health nurse quickly obtains the information needed for accurate assessment and zoom in on the critical aspects of a problem in response to a client situation. The nurse uses highly developed clinical and managerial skills in the work environment. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

Ans: C Feedback: Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals. The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client. The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

The chart of a client with brain cancer notes "CMO." Which intervention should the nurse most expect this client to receive? A) Chemotherapy for killing the cancer cells B) Radiotherapy for reducing the size of the tumor C) Morphine for pain management D) Antibiotic to fight off an infection

Ans: C Feedback: Comfort measures only (CMO) indicates a plan of care that specifies nursing interventions designed not to treat disease but to improve pain, function, or quality of life. Morphine for pain management best fits this description. Chemotherapy and radiotherapy are treatments for cancer and an antibiotic is a treatment for infection.

Which exemplifies a physical hazard? A) Infectious agents B) Hazardous drug and toxin exposures C) Electric and magnetic fields D) Sexual harassment

Ans: C Feedback: Electric and magnetic fields are an example of a physical hazard. Infectious agents are an example of a biological hazard. Hazardous drug and toxin exposures are an example of a chemical exposure. Sexual harassment is an example of a psychosocial factor.

Which is an example of a family assessment? A)Blood pressure screening B)Home assessment for safety C)Stress assessment for the family with a new baby D)Assessment for normal grieving for the recently widowed

Ans: C Feedback: Family assessments might include stress assessment for the family with a new baby. Individual assessments may include blood pressure, home assessment for safety, and assessing for normal grieving for the recently widowed.

In a parish nursing model, the nurse: A)Serves a health system with assignment to particular congregational settings B)Serves as a liaison between a health system and a congregation C)Is part of the ministry staff of the congregation D)Serves a particular faith community by virtue of a contract or job description

Ans: C Feedback: In the parish nursing model, the nurse contributes to the health and wholeness of people in the context of a faith community, is part of the ministry staff of the congregation, and serves the illness needs of individual people, families, and the entire faith community. In the institution-based model, the nurse serves a health system with assignment to particular congregational settings, acting as a liaison between the health system and the congregation and helping plan and coordinate care, particularly at times of transition. In the congregation-based model, the nurse serves a particular faith community by virtue of a contract or job description; this model supports the concept of a faith community nurse who can be paid or serve as a volunteer.

The nurse assesses a client who recently immigrated to the United States from Haiti. The client reports upset stomach and diarrhea. He explains that a witch doctor put a curse on him and that he sometimes sees evil spirits around him. The most accurate way to describe this type of illness would be as a: A)Mental illness B)Gastrointestinal disorder C)Culture-bound syndrome D)Hypochondria

Ans: C Feedback: Mental health and, conversely, mental illness are concepts bound by culture. Understanding of what connotes mental health is shaped by social norms that evolve from generation to generation. In Western cultures, medical science interprets any deviation from normative function of the five senses as indicative of a psychotic disorder. Hearing a voice, claiming to see an object, or having certain tactile sensations is viewed as a pathological state to be treated by psychiatric professionals. In some parts of the world, spiritual possession and belief in healers with special powers are culture-bound syndromes. Although gastrointestinal symptoms are involved in this client's condition, he suffers from more than just a gastrointestinal disorder. Hypochondria, or a condition in which one imagines that he or she has an illness but really does not, would not be applicable because the client has real symptoms and comes from a culture in which his illness is acknowledged as such.

The nurse cares for a client who is near death. For which change, indicating that death is imminent, should the nurse observe? A) Deep breaths with periods of apnea B) Mottling of upper extremities C) Skin cool and dusky D) Signs of respiratory alkalosis

Ans: C Feedback: Physiological changes that occur when death is imminent include gradual hypoxia, respiratory acidosis (not alkalosis), and renal failure. Changes in respiratory patterns (shallow [not deep] breaths with periods of apnea) may indicate significant neurological declines, with Cheyne-Stokes respirations often heralding the impending death. Skin may appear dusky or gray and feel cold or clammy. Mottling of the lower (not upper) extremities may take place days or hours before the actual death.

Which is an example of a tertiary prevention strategy that a nurse might implement or facilitate for members of a faith community? A)A program on radon detection in the home B)A class on cooking nutritious foods C)An occupational therapy program for patients recovering from strokes D)A water aerobics class for seniors

Ans: C Feedback: Primary prevention activities include programs on exercising to maintain health, smoking cessation programs, and heart-healthy eating programs. Tertiary prevention involves minimizing the effect of health problems and maximizing function for people with such conditions as diabetes, stroke, or injury.

Pain at the end of life is complex and multifactorial, and prevalence varies according to diagnosis and other factors. A client has somatic pain. How is this type of pain typically described? A) Burning, electrical, or tingling B) Gnawing, cramping, or aching C) Aching, throbbing, or stabbing D) Electrical, cramping, throbbing

Ans: C Feedback: Somatic pain is characterized by aching, throbbing, or stabbing. Neuropathic pain is often described as burning, electrical, or tingling. Visceral pain is characterized by gnawing, cramping, or aching.

The faith community nurse recently visited with a member of the congregation, Sandy, who is recovering from a hysterectomy. Following a church service one Sunday, another member of the congregation, Patricia, approaches you and says, "How is Sandy recovering from her surgery?" Which is the most appropriate response? A)"She still has some bleeding, but overall she's doing well." B)"You mean her hysterectomy? She's doing really well." C)"I'm afraid I can't share any details, but I'm sure she'd love a call or text from you." D)"I'm sorry, Patricia, but that's none of your business."

Ans: C Feedback: The parish nurse is bound by professional confidentiality not to reveal information about the health of patients, even if they are known to members of the congregation. Refusing to share information in a way that does not seem cold is a delicate art. One way to avoid this conflict is to explain to congregants early in the program, and often thereafter, that confidentiality for each member will be maintained. Often, the nurse can simply say, "I am sure that she would appreciate a call or a card"; this relieves pressure to share much information.

The nurse is setting up a faith community nursing program at a local synagogue and would like a better understanding of how the overall congregation is structured and organized. Who would be best to ask about the structure of the congregation? (Select all that apply.) A)Lay members B)Physician in the congregation C)Rabbi D)Health system administrator

Ans: C Feedback: The pastor, rabbi, or other congregational leader can be a great source of information about structure. If no suitable group exists, then the faith community nurse needs to assemble an advisory board. Lay members, including any physician in the congregation, may or may not be able to provide information about the structure of the congregation. A health system administrator would likely have no idea about the structure of the congregation.

In which phase of a school-based substance abuse program is information most likely to have meaning and applicability to students? A) Inoculation. B) Primary C) Early relevance D) Tertiary

Ans: C Feedback: The three phases during which introducing interventions is most likely to produce results are as follows: (1) the primary prevention or inoculation phase, which is designed to introduce knowledge; (2) the secondary prevention or early relevance phase, when information is likely to have meaning and applicability to students; and (3) the tertiary prevention or later relevance phase, when young people are actually being exposed to new situations involving experimentation.

A newly hired health and safety officer works for a large manufacturing facility. One of the officer's first jobs is to conduct a complete survey of the workplace to determine what hazards are present, the location of entries and exits, the availability of emergency equipment, and potential trouble spots. Which interventions should the officer implement to accomplish this goal? A) Ergonomics B) Occupational health history C) Root cause analysis D) Workplace walk-through

Ans: D Feedback: A workplace walk-through is a complete survey of the workplace, inside and outside, compiling information as to the presence of hazards, the location of entries and exits, the availability of emergency equipment, and potential trouble spots. Ergonomics is the study of the relationship between people and their working environment. Occupational health history is an assessment of the characteristics of the workers' present jobs, a chronological record of all past work and potential exposures, an occupational exposure inventory, and a list of other exposures in the home or community. Root cause analysis is a process for understanding and solving a problem, with the goal of determining what happened, why it happened, and what can be done to prevent its reoccurrence.

A Muslim client is receiving end-of-life care. As death approaches, what special considerations should the nurse take in the care of this client? A) Speak with the family about arrangements for cremation B) Schedule a visit from the chaplain for special rites C) Arrange for grief counseling for the client D) Place the client in a special position

Ans: D Feedback: As death approaches, a Muslim client is positioned supine facing Mecca. If the family is unavailable to do this, the nurse may do it, wearing gloves. Discussion of death and grief counseling are discouraged and cremation is not acceptable in the Muslim faith. A client of the Roman Catholic faith may wish to receive the sacrament of the anointing of the sick to give spiritual strength and prepare for death.

The occupational and environmental health nurse provides leadership in developingoccupational safety and health policy within the organization and function in an upper management role. The nurse has served as a consultant to both business and government and has designed and conducted significant research. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

Ans: D Feedback: Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals. The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client. The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

In a congregation-based model of nursing, the nurse: A)Serves a health system with assignment to particular congregational settings B)Serves as a liaison between a health system and a congregation C)Contributes to the health and wholeness of people in the context of a faith community D)Serves a particular faith community by virtue of a contract or job description

Ans: D Feedback: In the congregation-based model, the nurse serves a particular faith community by virtue of a contract or job description; this model supports the concept of a faith community nurse who can be paid or serve as a volunteer. In the institution-based model, the nurse serves a health system with assignment to particular congregational settings, acting as a liaison between the health system and the congregation and helping plan and coordinate care, particularly at times of transition. In the parish nursing model, the nurse contributes to the health and wholeness of people in the context of a faith community, is part of the ministry staff of the congregation, and serves the illness needs of individual people, families, and the entire faith community.

Which level of assessment occurs when assessing whether healthcare is accessible to members of the congregation? A)Individual B)Family C)Congregation D)Community

Ans: D Feedback: Individual assessments may include blood pressure, home assessment for safety, and assessing for normal grieving for the recently widowed. Family assessments might include stress assessment for the family with a new baby. Community assessments can include assessing whether healthcare is accessible to members of the congregation. There is no such thing as a congregation assessment.

Which is the most appropriate intervention to use in a school-based substance abuse program? A) Integrating students' goals with those of a prevention program B) Assessing the needs and interests of the group carefully after selecting a program C) Designing a program that is knowledge based D) Designing an interactive, behavior-focused program

Ans: D Feedback: Integrating the goals of the school (not those of the students) with those of the prevention program, assessing the needs and interests of the group carefully before (not after) the selection of any program, and designing programs that are behavior focused rather than knowledge based are important principles to use in education programs.

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exemplifies a tertiary prevention strategy for mental health problems? A)Screen for mental health disorders B)Refer high-risk people for diagnostic services C)Provide mental health services following stressful community events D)Promote support groups for people with mental health disorders

Ans: D Feedback: Tertiary prevention strategies include promoting support groups for people with mental health disorders and initiating health-promotion activities as a part of rehabilitation services. Secondary strategies include screening for mental health disorders, referring high-risk people for diagnostic services, and providing mental health services following stressful community events.

The nurse cares for a hospice client who reports pain from nerve damage related to diabetic neuropathy. She rates the pain at 9 out of 10. Which medication should she expect the physician to order for this client? A) Antidepressant B) Muscle relaxant C) Low doses of opioid D) High doses of opioid

Ans: D Feedback: The client has neuropathic pain; mild pain (1-3 on the 0-10 scale) requires the use of adjuvant drugs (nonopioid medications such as antidepressants and muscle relaxants). Moderate pain (4-6 on the pain scale) necessitates the use of low doses of opioids; the use of nonopioids and adjuvants may continue. Severe pain (7-10) requires the use of higher opioid doses.

Which mental illness is most likely to go untreated? A)Anxiety B)Bipolar disorder C)Depression D)Alcoholism

Ans: D Feedback: Those suffering from alcoholism and addictive disorders are most likely to go untreated (78%), followed by anxiety disorders (57%), depression (56%), and bipolar disorder (50%).

The school nurse works with a 12-year-old girl who is obese and has type 2 diabetes. As client advocate, which would be most appropriate nursing action? A)Scold the client when she buys a soda from a vending machine at school. B)Schedule a conference with the client's parents to discuss how to collaboratively manage her blood glucose level and encourage her to select appropriate foods in the cafeteria for lunch. C)Perform a finger stick and check the client's blood glucose level when she reports feeling weak and dizzy one day. D)Weigh the client each week in the office to help track her weight and hold her accountable to her weight loss goals.

Ans:B Feedback:Because advocacy involves teaching, empowering, and networking, scheduling a conference with the client's parents to discuss blood glucose management and nutrition would be the most appropriate action to take as her advocate. Performing a finger stick and checking her blood glucose level and weighing her weekly are not good examples of advocacy because they do not involve teaching, empowering, or networking. Scolding the client for buying a soda would not empower her but would likely shame her and would not be an effective intervention

The school nurse is concerned about the lack of nutritional choices available in the food vending machines at the school. Which is the best tool to address this situation?A) Food-Safe Schools Action Guide B) Health Education Curriculum Analysis Tool C) Improving the Health of Adolescents and Young Adults: A Guide for States and Communities D) Making It Happen!

D) Making It Happen! Making It Happen! is a health tool that provides examples and success stories of 32 schools and school districts that have implemented innovative approaches to improve the nutritional quality of foods and beverages sold outside the school meals program. Food-Safe Schools Action Guide (FSSAG) helps schools work with Cooperative Extension, health departments, and families in efforts to make schools food-safe. Health Education Curriculum Analysis Tool helps schools, school districts, and other school personnel responsible for curricular redesign to analyze health education curricula on the basis of alignment with national health education standards and characteristics of effective health education curricula. Improving the Health of Adolescents and Young Adults: A Guide for States and Communities helps guide people and organizations through public health processes that address the 21 Critical Health Objectives identified in Healthy People 2010 for adolescents and young adults.

Past ______ behavior is the strongest predictor of risk for suicide, but 60% of individuals who commit suicide did not have a previous attempt.

Past self-harm behavior

A _______ holds the greatest promise for lowering the rate of suicide because predicting who will commit suicide is challenging.

Population approach

The nurse assesses a homeless adolescent who recently attempted suicide by drug overdose. The risk factor the nurse points out is that ______ most likely to influence the attempted suicide.

Social isolation A significant social risk factor is social isolation, especially among immigrant or indigenous populations, homeless youth, or those in foster care. Other risk factors can include trauma, mood or substance use disorder. The use of nicotine and chronic pain may contribute to risk for some individuals, but they are not the most recognized.

School Health index

focuses on how schools can promote physical activity, healthy eating, and adoption of a tobacco-free lifestyle, and a wide range of safety-related behaviors in an attempt to counter common risk behaviors. The importance of the School Health Index is its ability to help schools identify the strengths and weaknesses of a particular school's policies and programs for promoting health and safety. On the basis of this assessment, school personnel can develop an action plan.

Health Education Curriculum Analysis Tool

helps schools, school districts, and other school personnel responsible for curricular redesign to analyze health education curricula on the basis of alignment with national health education standards and characteristics of effective health education curricula.