Public Health Final Questions

When assisting with community planning, nurses should encourage the development of which facilities to reduce the potential for crime and violence in the community?

1. Playgrounds 2. Movie Theaters 3. Swimming Pools

A nurse is providing care to a child who has been abused. Which characteristics are most likely present in this child's family?

1. Unemployed parents 2. No support network willing to offer assistance 3. Parents are not knowledgeable about child development 4. Mother seems frightened of her partner

2. A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor? a. Each sick nurse b. The communicable disease c. The hospital d. The patient

A

3. Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation? a. New workers employed less than 1 year b. Older workers with chronic illnesses c. Older workers with diminished hearing d. Women in their childbearing years

A

4. An employee in a laboratory drops a flask, resulting in a chemical splash into the employee's eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent? a. The chemical b. The employee c. The flask d. The laboratory

A

5. Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB? a. Housekeeping staff b. Medical staff c. Nursing staff d. Ward clerks

A

7. A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion? a. Anxiety, depression, and exhaustion b. Family turmoil c. Physical illnesses d. Sleeping disorders

A

Forensic nurses work collaboratively with professionals both within and outside of nursing. When working as content experts or clinician advisors to develop injury prevention programs, the forensic nurse is: a. addressing injury as a public health concern. b. differentiating intentional or unintentional injury. c. providing care to both victims and perpetrators. d. providing expert consultation for personal injury cases.

A

ANS: D Teens need to know that their concerns are heard. Health care providers may have their own opinions about what teenagers need and may fail to take the chief complaint offered in an interview seriously. A desire for pregnancy expressed by a teen should be discussed in depth even if the nurse feels uncomfortable providing information to a teen about how to conceive. During the interview, the nurse can provide preconception counseling and emphasize the need to achieve good health and to establish a health-promoting lifestyle before pregnancy. Health risks to the mother, as well as to fetal development, can be discussed. Not only does information presented in this way demonstrate that the nurse has heard what the teen is saying but it also allows the nurse to provide useful information that may encourage the teen to examine her plans carefully, seriously, and maturely. Cognitive Level: Application Associated Chapter Objective: 1 & 6 REF: p. 768

A high school teen tells the school nurse that she wants to become pregnant. The most appropriate nursing action is to: a. clarify the intent and inform the teen's parent(s) of the potential to influence her behaviors. b. discourage the teen's interest in pregnancy when she has a full life ahead of her. c. encourage the teen to use contraception if she intends to be sexually active. d. provide preconception counseling and emphasize the need to achieve good health.

ANS: B, C, E Pregnancy and birthrates increased steadily among teens of all ages from 1986 to 1991 and declined among teens of all ages and ethnicities from 1991 to 2005. Decreases in pregnancy among teens ages 15-17 have been attributed to reduced sexual activity (one-fourth of the reduction) and to improved contraceptive use (three-fourths of the reduction). For teens ages 18-19 the reduction is entirely attributed to increased contraceptive use with evidence showing that the use of long- acting reversible contraceptives tripled among this age group from 2007 to 2009. In 2008, 26% of pregnancies of teenagers were ended by elective abortion, a decrease from 46% of teen pregnancies in 1986. Cognitive Level: Synthesis Associated Chapter Objective: LO 2 REF: p. 769

A nurse planning a primary intervention program for adolescent pregnancy reviews trends in adolescent pregnancy, births, abortions, and adoption and notes that comparisons with other developed countries indicates which of the following? (Select all that apply.) a. Adolescent pregnancy rates continue to rise because of unreliable contraceptive methods. b. Use of contraceptives is improving among teens in the United States. c. Decreases in pregnancy among teens ages 15-17 have been attributed to reduced sexual activity. d. Female students are more likely to initiate sexual activity before the age of 13 years. e. Changes in parental notification or consent requirements for minors impacted rates of teen abortions.

Forensic nurses practice in a variety of arenas including: (Select all that apply.) a. courtrooms. b. correctional facilities. c. hospital risk-management departments. d. medical examiner offices. e. police departments.

A, B, C, D, E

Which is an example of a federal agency? Select all that apply. a. The U.S. Department of Health and Human Services b. The Centers for Disease Control and Prevention (CDC) c. The Health Resources and Services Administration d. The Pentagon

A,B,C

A public health nurse collaborates with agencies to address the problem of obesity in the community. Who would be the most appropriate people to include in this collaborative partnership? Select all that apply. a. Local health department staff members b. Restaurant owners c. Parks and recreation department staff members

A,B,C,D

1. Which of the following describes how occupational health nursing differs from other nursing specialties? (Select all that apply.) a. It is autonomous, because the occupational nurse works independently. b. The major focus is on the environment. c. Nurses focus on health promotion and disease prevention. d. Nursing care is given in the community.

AB

2. An occupational health nurse should be aware of which of the following trends in the marketplace? (Select all that apply.) a. A majority of new jobs will be in service-oriented employment. b. Employees will often have compressed work weeks, shift work, and reduced job security. c. A majority of positions will still be held by males. d. Many employees will be older and suffer chronic health problems.

ABD

4. A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

6. A recent movie release portrays a female drug user living with her abusive boyfriend, who has two children by different women, in a rundown inner city neighborhood with high levels of poverty and unemployment. This portrayal best describes the influence of which class of factors on societal responses to poverty and homelessness? a. Cultural b. Environmental c. Political d. Social

ANS: A Individual perceptions of poverty and poor persons are rooted in social, political, cultural, and environmental factors. Societal responses to poverty and homeless persons (what actions are taken to assist them) are deeply rooted in history, and that history has helped to shape cultural attitudes. Cultural attitudes affect, and are affected by, the discourses in various media. Portrayals of poor people as lazy and shiftless folk, desperate persons, criminals, and slackers living off of public assistance influence what we believe to be true about poor persons.

8. Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

ANS: A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because: a. community health is a shared responsibility. b. health objectives are defined nationally. c. population health is the responsibility of the government. d. public health trends focus on bioterrorism.

ANS: A PHNs partner with multidisciplinary teams of people within public health areas, in other human services and public safety agencies, and in community-based organizations. The health of communities is a shared responsibility that requires a variety of diverse and often nontraditional partnerships. Public health agency staffs include physicians, PHNs, nutritionists, environmental health professionals, health educators, various laboratory workers, epidemiologists, health planners, paraprofessionals who make home visits, and outreach workers. Community-based organizations include the American Red Cross (ARC), free clinics, advocacy groups, Head Start programs, daycare centers, community health centers, hospitals, senior centers, churches, academic institutions, and businesses. Other government agencies include fire/emergency services departments, law enforcement agencies, schools, parks/recreation departments, and elected officials. Cognitive Level: Analysis Associated Chapter Objective: 8 REF: p. 994

9. A cultural belief and an environmental factor that may increase the risk of potential pesticide exposure for some migrant workers are: a. hot-cold balance and housing. b. cuarentena and distance from health care services. c. need to achieve high productivity and transportation challenges. d. disease causality and proximity to the farm fields.

ANS: A Some migrant workers may not shower when they return from the fields as a result of cultural beliefs about being exposed to cooler water while feeling hot from working. Inadequate housing that lacks showers and/or adequate laundry machines also prevent farmworkers from washing pesticides off themselves and their clothing in a timely manner. This exposes the farmworker and the entire family to the risk of pesticide exposure.

The PHN applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health? a. Core Competency b. Core function c. Nursing role d. Standard of practice

ANS: A The core public health competencies are divided into eight domains: analytical assessment skills, basic public health science skills, cultural competency skills, communication skills, community dimensions of practice skills, financial planning and management skills, leadership and systems thinking skills, and policy development/program planning skills. This example demonstrates such competencies as analytical assessment, communication, leadership, and policy skills. Cognitive Level: Application Associated Chapter Objective: 7 REF: pp. 1002-1003

8. When working with the poor or homeless, to develop effective nursing interventions the nurse should evaluate clients and populations in the context of: a. environment. b. improvement in the quality of services. c. human dignity. d. nursing theories.

ANS: A The foundation of nursing theories is the assumption that human beings have inherent dignity and worth. Nursing is based on valuing individuals, promoting health, respecting and restoring dignity, and improving the quality of life of individuals, families, and aggregates. Conflicts in values, beliefs, and perceptions often arise when nurses work with persons from different social, cultural, and economic backgrounds. A lack of agreement between the professional's and the client's perceptions of need can lead to conflict. As a result of this conflict, clients may fail to follow the prescribed treatment protocol. The nurse may then inaccurately interpret the client's behavior as resistance, lack of cooperation, or noncompliance. Nurses should evaluate clients and populations in the context of the environment to develop effective nursing interventions. Care must be multidimensional and should include consideration of biological, psychological, social, political, cultural, environmental, economic, and spiritual factors.

6. A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

Public health nurses (PHNs) are challenged to respond to public health-related trends of the twenty-first century, which include: a. racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence. b. violence, availability of health care for all, and increasing life expectancy. c. health disparities, access issues, and adequate mental health program funding. d. rise of drug-resistant organisms, increased life expectancy, societal violence, and more effective disease surveillance.

ANS: A Twenty-first-century challenges include increasing rates of drug resistance in community-acquired pathogens and societal issues such as welfare reform, economic disparities, racial/ethnic disparities, behavioral influences on health, and unequal access to health care. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 1000

7. A nurse case manager identifies a potential health outcomes concern for a 1 year old with special needs living in an impoverished neighborhood, because this child is at increased risk for: a. developmental delays. b. ear infections. c. frequent colds and infections. d. irritability.

ANS: A Young children (0-5 years of age) are at highest risk for the most harmful effects of poverty. Good nutrition during the first years of life is crucial for normal cognitive development. Unfortunately, many children live in poverty during their early childhood years. The brain is directly affected by environmental stimulation during a critical time that extends from the prenatal period through early childhood. Among the risk factors that impede cognitive development in young children are inadequate nutrition, maternal substance abuse, maternal depression, environmental hazards, trauma, and abuse. Unfortunately, poor children often have greater exposure to risk factors such as these. Poverty increases the likelihood of chronic diseases, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron-deficiency anemia, and elevated blood lead levels.

A nurse working at a battered woman's shelter is counseling a pregnant woman who has just entered the shelter. When assessing the client's history, which information would the client most likely report? a. A history of abuse before pregnancy b. A history of child abuse c. A history of multiple pregnancies d. A history of substance abuse

ANS: A Abuse before pregnancy is the most important risk factor for physical battery during pregnancy.

A nurse plans to collect data about morbidity and mortality among migrant workers in a community. Which of the following barriers is the nurse most likely to encounter? a. Difficulty securing a stable population b. Lack of resources c. Unwilling participants d. Fear of deportation

ANS: A Accurate morbidity and mortality data are difficult to obtain due to farm workers leaving when no longer working, going back to their home to receive medical services, and decreases in infectious diseases that are easier to record. p 753

17. The nurse plans a home visit to a pregnant teen. The demonstrated outcome of this nursing intervention is a(n): a. Increase in birth weight and utilization of prenatal care and support services b. Increase in family coping skills to prevent crisis c. Coordinated and comprehensive teen pregnancy approach d. Family approach to health care

ANS: A An increase in birth weight and utilization of prenatal care and support services is a demonstrated outcome of a nurse planning a home visit to a pregnant teen.

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

ANS: A Chronic exposure to pesticides may lead to cancer. Acute exposure to pesticides may cause memory loss, skin rashes, and headaches. p756

Which of the following health problems ranks as one of the top five problems for farm workers aged 5 to -19 years? a. Dental problems b. Communicable diseases c. Gastrointestinal problems d. Stress

ANS: A Farm workers of all ages consistently have more dental disease than the general population. p 757

2. According to the 2007 Youth Risk Behavior Surveillance System, fewer teens reported engaging in which behavior? a. Current cigarette usage b. Current alcohol usage c. Trying marijuana d. Episodic heavy drinking

ANS: A Fewer teens reported currently smoking cigarettes or marijuana, riding in a car with a driver who had been drinking, trying methamphetamines, or attempting suicide. Current alcohol use, trying marijuana, and episodic heavy drinking still continue at high rates in teens.

A nurse is partnering with an organization to improve affordable housing in rural areas of the country. Which of the following best describes who the nurse is collaborating with? a. Housing Assistance Council (HAC) b. Local housing authority c. Temporary Assistance for Needy Families (TANF) d. Public Housing Development for Families

ANS: A HAC is a nonprofit organization whose mission is to improve affordable housing in rural areas. TANF is a program that assists families in need. The local housing authority provides public housing assistance. Public Housing Development for Families promotes the development of local strategies for affordable public housing. p 753

10. Which factor increases a young woman's risk for early sexual experiences and pregnancy? a. History of sexual abuse b. Parents who have high demands for their children to act maturely c. Parents who communicate openly with their teens about birth control and sexuality d. Male partner of the same age

ANS: A Having a history of sexual abuse increases a young woman's risk for early sexual experiences and pregnancy.

Homicide is the leading cause of death among which population? a. Children and youth between 1 and 19 years of age b. Native American women between 20 and 34 years of age c. White women between 25 and 34 years of age d. African American children between 15 and 19 years of age

ANS: A Homicide is the leading cause of death for children and youth between 1 and 19 years of age. It is the second leading cause of death among Native American women ages 20 to 34, and the fifth leading cause of death of white women ages 25 to 34.

14. A nurse is providing education to a parent-teacher organization about substance use and abuse among children. Which information would the nurse most likely include in this presentation? a. Inhalants are among the first drugs that young children use. b. Implementing the DARE program is the most effective way to prevent drug-use. c. Underage drinking is not a problem in most communities. d. Early experimentation with substances decreases the likelihood of future abuse.

ANS: A Inhalants are among the first drugs that young children use.

A nurse is assessing a client who has had an acute exposure to a pesticide. Which of the following symptoms is the client most likely to display? a. Memory loss b. Musculoskeletal problems c. Cancer d. Infertility

ANS: A Memory loss is a symptom that is displayed following an acute exposure to a pesticide. Musculoskeletal problems, cancer, and infertility are from chronic exposure. p 756 How to box

The nurse is caring for a migrant family. During the interview, the mother tells the nurse that the family follows an Eastern migratory stream originating in southern Florida. Which of the following statements is accurate? a. This is one of the migratory streams that migrant farm workers traditionally follow. b. This is a unique migratory pattern. c. This is a traditional family-generated migratory pattern. d. This is an unpredictable pattern that may lead the family through southern California.

ANS: A Migrant workers traditionally have followed one of three migratory streams: (1) Eastern, originating in Florida; (2) Midwestern, originating in Texas; and (3) Western, originating in California. pp751-752

A nurse is implementing a secondary prevention strategy. Which of the following activities would the nurse most likely implement? a. Monitoring for prenatal care b. Treatment for anemia c. HIV prevention d. Tetanus immunization

ANS: A Monitoring for prenatal care is an example of a secondary prevention strategy. Treatment for anemia is tertiary prevention, and HIV prevention and tetanus immunization are primary prevention strategies. p 761

Which action would be most appropriate for the nurse to take when working with a rape survivor? a. Provide continuous care once the victim enters the health care system. b. Examine evidence for its authenticity. c. Work with the criminal justice system to find the rapist. d. Provide long-term therapy for psychological trauma.

ANS: A Not only do nurses often provide continuous care, in some states nurses are trained as sexual assault examiners who gather forensic evidence.

. When making a home visit to a low income, frail, older person's home, a nurse would most likely suspect adult maltreatment if: a. The older person reports giving money to family members on a regular basis. b. The windows of the house are in need of repair. c. The older person spends a great deal of time watching television. d. There are dogs running loose in the yard of the home.

ANS: A Older adults are at risk for financial abuse through fraud, coercion to relinquish property rights, and money mismanagement. A low-income, frail, older person would most likely not be giving money to family members on a regular basis, because the client would need the money to meet basic needs.

20. Drug education programs in the school, such as Project DARE, are an example of which level of prevention? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Primary health care prevention

ANS: A Primary prevention includes education about drugs and guidelines for their use. DARE is a drug use prevention program.

Providing information about safe-sex practices is an example of which level of prevention? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

When the nurse helps the community to take a stand against violence and advocates for elected officials and local media to make non-violence a priority, the nurse is engaged in which level of prevention? a. Primary b. Secondary c. Tertiary d. Primary care

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

An example of secondary prevention is: a. Screening children for lead poisoning b. Working with communities on emergency preparedness plans c. Developing social networking interventions to modify community norms d. Educating patients with strokes at rehab centers to help optimize their functioning

ANS: A Screenings are secondary prevention activities.

A nurse is polite and non-confrontational when working with the family of a migrant worker. Which of the following concepts is the nurse demonstrating? a. Simpatía b. Respeto c. Dignidad d. Personalismo

ANS: A Simpatía means having polite, non-confrontational relationships with others. Respeto means respect, dignidad means dignity, and personalismo is relating to the individual. p760

23. A nurse caring for adolescents who have experienced substance abuse recognizes that they are most influenced by: a. Family-related factors b. Positive media messages c. Socioeconomic level d. Peer pressure

ANS: A Substance abuse among adolescents is influenced most by family-related factors, such as genetics, family stress, and parenting styles.

11. When working with teenagers, it is important for the nurse to recognize that some teens may get pregnant because they: a. Often feel invincible and do not recognize risks related to their behaviors b. Enjoy engaging in sexual activity and want children c. Influence each other and succumb to peer pressure d. Have realistic attitudes about school, work, parenting, and socializing

ANS: A Teens often feel invincible, and they do not think about the negative outcomes they are advised could come true.

Which event has the potential to weaken existing public health programs? a. The shift in funding to support bioterrorism response efforts b. The outbreaks of H1N1 influenza c. The number of citizens with human immunodeficiency virus d. The lack of public health nurses

ANS: A The events of the twenty-first century have shifted funding to bioterrorism programs. This shift of funding has the potential to weaken existing important public health programs.

24. When implementing the harm reduction model, the nurse focuses on using which approach? a. Education b. Law enforcement c. Scare tactics d. Rehabilitation

ANS: A The harm reduction model accepts the reality that psychoactive drug use is endemic, and it focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug abuse and get treatment for addicts.

A nurse is providing care for a Mexican client who has sustained a farm injury. If a major decision about the client's treatment needs to be made, who would most likely make that decision? a. The male head of the family b. The wife/mother c. The person needing services d. The crew leader

ANS: A The male is considered to be the major decision maker in the family, whereas the female is considered the caretaker. p 760

27. The nurse collects a urine specimen knowing that urinalysis for drug testing can be used to determine: a. Whether a certain drug has been used in the recent past b. The degree of intoxication c. The extent of performance impairment d. How much alcohol was consumed

ANS: A The nurse collects a urine specimen with the rationale that urinalysis for drug testing can be used to determine whether a certain drug has been used in the recent past.

A nurse is working from a client who is part of the Mexican culture and is experiencing a folk illness. Which of the following actions by the client should the nurse anticipate? a. Prefer to seek care with a folk healer b. Consult the female leader of the family c. Rely on Western medicine to cure the ailment d. Become isolated and not seek care

ANS: A There are four common folk illnesses that a nurse may encounter with the Mexican client: (1) mal de ojo (evil eye), (2) susto (fright), (3) empacho (indigestion), and (4) caida de mollera (fallen fontanel). When faced with one of these illnesses, the traditional Mexican individual would prefer to seek care with a folk healer. Healers known as curanderos, herbalistas, and espiritualistas are often sources of health care for folk illnesses. pp760-761

6. Which factor has been linked to the decrease in pregnancies among teens? a. Fewer are becoming sexually active. b. More are using complementary alternative methods of birth control. c. More have tighter parental control at home. d. Fewer are engaging in risky behaviors.

ANS: A These decreases are attributed to stabilization of the numbers of teens becoming sexually active, increased condom use, and increased use of more effective and long-acting hormonal methods of birth control.

Why is it important that the public health nurse be included in disaster planning? a. To be most effective as a disaster responder b. To anticipate the potential disasters that may occur c. To educate the public about their responsibilities if a disaster occurs d. To demonstrate the importance of community partnerships

ANS: A To be most effective as a disaster responder, the public health nurse needs to be part of the team before an emergency occurs.

32. A nurse lobbies with legislators for the passage of legislation to prohibit smoking of tobacco products in public places. Which level of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion

ANS: A When using primary prevention, the focus is on health promotion and disease prevention.

12. Which statement about a young man's reaction to the pregnancy of his partner is true? a. His reaction often depends on the nature of the relationship before the pregnancy. b. Most young men believe that fathering a child can make them feel manly. c. Most young men are not interested in their partner's pregnancy. d. His reaction often includes blaming the partner.

ANS: A Young men's reaction to their partner being pregnant often depends on the nature of the relationship before the pregnancy.

When assisting with community planning, nurses should encourage the development of which facilities to reduce the potential for crime and violence in the community? Select all that apply. a. Playgrounds b. Movie theaters c. Swimming pools d. Shopping malls

ANS: A, B, C Recreational facilities including playgrounds, movie theaters, and swimming pools all provide socially acceptable outlets for a variety of feelings, including aggression.

MULTIPLE RESPONSE 1. Which medical problems would a client with chronic alcohol abuse most likely experience? Select all that apply. a. Gastrointestinal disturbances b. Cardiac dysrhythmias c. Depression d. Organic brain syndrome

ANS: A, B, C, D Gastrointestinal disturbances, cardiac dysrhythmias, depression, and organic brain syndrome are some effects of chronic alcohol abuse.

Which factors are challenges of the migrant lifestyle? (Select all that apply.) a. Leaving one's home every year b. Traveling c. Experiencing uncertainty regarding work and housing d. Lack of resources e. Middle income wages

ANS: A, B, C, D Leaving one's home every year, traveling, experiencing uncertainty regarding work and housing, and lack of resources are some of the challenges of the migrant lifestyle. The specifics for payment differ depending on the location and type of work. Reports of average income for farmworkers have varied p752

A nurse is providing care to a child who has been abused. Which characteristics are most likely present in this child's family? Select all that apply. a. The parents are unemployed. b. There is no support network willing to offer assistance. c. The parents are not knowledgeable about child development. d. The mother seems frightened of her partner.

ANS: A, B, C, D Risk factors for child abuse include unemployed parents, no support network, parents not knowledgeable about child development, and a mother who is scared of her partner.

1. Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) a. Higher incidence of acute and chronic disease b. Higher risk of physical trauma c. Crisis-oriented health care, usually in emergency departments d. Reduced eligibility for entitlement/assistance programs e. Lack of awareness of care options

ANS: A, B, C, E Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.

The Quad Council of Public Health Nursing identified eight principles that distinguish the public health nursing specialty from other nursing specialties, including which of the following? (Select all that apply.) a. Collaboration with other professions, organizations, and entities b. Optimal use of available resources c. Population-based unit of care d. Primary obligation to work for the good of individuals and families e. Engagement with clients as an equal partner

ANS: A, B, C, E The tenets (principles) of public health nursing were developed by the Quad Council of Public Health Nursing and integrated into the Scope and Standards of Public Health Nursing Practice of the American Nurses Association (ANA, 2005). These principles distinguish public health nursing from other nursing specialties. The eight principles include population-based unit of care; primary obligation to achieve the "greatest good for the greatest number"; engagement with clients as an equal partner; priority emphasis on primary prevention; focus on strategies that create healthy environmental, social, and economic conditions in which populations may thrive; obligation to reach out to all who might benefit; optimal use of available resources; and collaboration with other professionals, organizations, and entities. Cognitive Level: Synthesis Associated Chapter Objective: 1 REF: p. 998

What are reasons that adolescents may not seek care for health problems? Select all that apply. a. Access to care may be hindered because there are not enough professionals with expertise in dealing with the teen population. b. Cost of care or availability of insurance may limit services. c. Teenagers do not care about their health. d. Health care professionals may not be able to discuss sensitive topics in a non-judgmental way.

ANS: A, B, D Adolescents may not seek care because their access to care is hindered by either lack of professionals or costs of the care; they may fear that health care professionals will not be able to discuss sensitive topics with them in a non-judgmental way. Although health may not be a top priority, it shouldn't be assumed that teenagers do not care about it.

Which are therapeutic approaches for the nurse to use in working with adolescent clients? Select all that apply. a. Creating a caring and understanding atmosphere b. Using neutral words in eliciting symptoms c. Insisting that teens use appropriate terminology when expressing their concerns d. Paying attention to what the teen verbalizes and fails to verbalize

ANS: A, B, D Creating a caring and understanding atmosphere, using neutral words to elicit symptoms, and paying attention to what the teen verbalizes and fails to verbalize. The nurse can offer more appropriate terms for the client to use once trust is established.

7. Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

ANS: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

1. The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

ANS: B A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

2. The nurse case manager in a migrant farmworker clinic assesses this vulnerable population from the perspective of occupational and environmental risks related to: a. contaminated water, applied chemicals, and unfamiliar farm equipment. b. naturally occurring plant substances, pesticides, and fear of injury reporting. c. traffic accidents, weather, lack of worker supervision, and inadequate sewage. d. weather, pesticides, and strict enforcement of occupational regulations.

ANS: B Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.

A PHN in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of: a. case finding. b. case management. c. collaboration. d. provision of direct services.

ANS: B Case management is a major tertiary prevention function for PHNs at the community level of practice. Case managers assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying services that will improve the overall community health status. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 1006-1007

The PHN ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The PHN is adhering to the principles of: a. collaboration. b. partnership. c. public health care. d. public health nursing.

ANS: B Changes can be accomplished more easily and effectively by partnerships and collaboration among groups than by the individual client and PHN working alone. The Community Campus Partnerships for Health involved its members and partners in developing nine principles of good practice for community partnerships in 1998. These include agreeing on a mission; values, goals, and measurable outcomes; establishing a relationship characterized by mutual trust, respect, genuineness, and commitment; building on identified strengths and assets but also determining areas for improvement; balancing power and enabling resources to be shared; ensuring clear, open, and accessible communication with ongoing listening and a common validated language; mutually establishing roles, norms, and processes; ensuring feedback to, among, and from all stakeholders; sharing the credit for accomplishments; and taking time for the partnership to develop and evolve. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 994

2. Which of the following best represents the concept of homelessness as crisis poverty? a. Man with chronic alcoholism and drug abuse living in a halfway house b. Recently unemployed man evicted from his apartment c. Teenager living on the streets and abusing drugs d. Woman with schizophrenia who is living in a shelter

ANS: B Crisis poverty is a conception of homelessness that views the homeless as people whose lives are generally marked by hardship and struggle. For this group, homelessness is often transient or episodic. Their homelessness may result from lack of employment opportunities, lack of education, obsolete job skills, and/or domestic violence.

5. A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are: a. natives of Guatemala. b. natives of Mexico. c. natives of Panama. d. newly arrived from Haiti.

ANS: B Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel). Symptoms and folk treatments may vary depending on the individual's or family's place of origin in Mexico. When experiencing a folk illness, the traditional Mexican individual would prefer to seek care from a folk healer. The more common healers are curanderos, herbalists, and espiritualistas. The most common herbs used by the folk healers are chamomile (manzanilla), peppermint (yerba buena), aloe vera, nopales (cactus), and epazote. The nurse needs to ask clients what herbs and other remedies they have tried to help with their symptoms. Use of some herbs with prescribed medication may be contraindicated, and the nurse needs to include that information in client counseling. Any client counseling should incorporate awareness of and sensitivity to the client's culture.

1. A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. The most effective strategy to consider when networking with homeless individuals, families, or populations is to: a. form a community partnership to establish a clinic for homeless persons. b. create a trusting environment and establish a therapeutic relationship. c. collaborate with the local United Way to obtain funding for primary care services. d. dialogue with local clergy to address the unmet primary care need for homeless persons.

ANS: B Nurses need to be able to work with poor and homeless clients to promote, maintain, and restore health. Nurses must be prepared to look at the whole picture: the person, the family, and the community interacting with the environment. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

9. An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

The PHN serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on public health programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

ANS: B Public health's shift from being the primary care provider of last resort to the developing partnerships to meet the health promotion and disease prevention needs of populations has raised concerns about available health care for the uninsured and underinsured. The role of the PHN given this ongoing shift in health care delivery is still being developed in many agencies. PHNs retain responsibility for ensuring that all populations have access to affordable, quality health care services. They accomplish this by advocating for legislation that promotes universal health care, such as increased funding for community health centers and expansion of Medicaid eligibility criteria, and by forming partnerships with hospitals, free clinics, and other organizations to ensure the availability of health care for all populations in the community. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 999

3. Which statement best illustrates that the main causes of teen mortality are high-risk behaviors? a. Teenagers generally leave home before they are mature enough. b. Teenagers often engage in activities that put them at risk for life-threatening diseases. c. Teenagers are prone to developing chronic diseases that lead to disability early in life. d. Teenagers want to get pregnant at an early age to be able to enjoy life later on.

ANS: B Teenagers are often engaged in activities that put them at risk for life-threatening diseases. For example, the human immunodeficiency virus (HIV) infection and newly identified sexually transmitted diseases are prevalent in teenagers.

5. A nurse working in a clinic in an inner city with high poverty and unemployment rates recognizes the need for programs for women because impoverished women are at higher risk for: a. decreased access to social services. b. poorer health status. c. exposure to environmental toxins. d. poorer academic success.

ANS: B The relationship between poverty and health is significant. Poverty presents a formidable obstacle to positive health across the life span. Those in lower income groups have poorer health status, and those with poor health have decreased ability to work and improve their socioeconomic status.

12. The nurse is interviewing a client who reports that he drinks alcohol when snorting cocaine. This client is experiencing: a. Drug addiction b. Polysubstance use c. Drug and alcohol abuse d. Indiscriminate drug use

ANS: B A client who drinks alcohol when snorting cocaine is suffering from polysubstance abuse

A nurse is working with a client whose principal employment is in agriculture on a seasonal basis and has established temporary housing in the area while employed. Which of the following terms best describes this laborer? a. Seasonal farm worker b. Migrant farm worker c. Transient worker d. Share cropper

ANS: B A migrant farm worker is a laborer whose principal employment is in agriculture on a seasonal basis and, for the purposes of such employment, establishes a temporary abode. A seasonal farmworker returns to his permanent residence, works in agriculture for at least 25 days or parts of days, and does not work year round only in agriculture. A transient worker moves from place to place to find work. A share cropper is a tenant farmer who uses part of the crop to pay for rent. p751

A nurse providing services for uninsured women is performing the function of: a. Role model b. Primary caregiver c. Outreach worker d. Case manager

ANS: B A nurse providing services for uninsured women is acting in the role of primary caregiver.

When a public health nurse discusses with a client which services are appropriate to meet her needs, the public health nurse is functioning as a(n): a. Case manager b. Advocate c. Counselor d. Role model

ANS: B A public health nurse discusses with a client which services are appropriate to meet her needs. In this case, the nurses the public health function is that of an advocate.

Which factor may limit access to care for migrant farm workers? a. Unwillingness to seek affordable health care b. Lack of knowledge regarding services c. Availability of 24-hour health care services d. Adequate transportation

ANS: B Because of isolation, migrant farm workers lack usual sources of information regarding available services. Migrant workers typically are unable to afford health care, have limited services available, and may not have adequate transportation to get to health care services. pp 754-755

A nurse is educating migrant women to serve as links between the existing health care agencies and the migrant farm worker family. Which of the following best describes the role of these women? a. Migrant head start workers b. Outreach care workers c. Physician assistants d. Nurse aides

ANS: B Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Physician assistants and nurse aides do not serve in this lay person role in the community. p761

Which statement is true about health care services for migrant workers? a. Clinics are usually found within walking distance from work. b. Undocumented workers fear deportation when using clinics. c. Health care records are kept by workers to allow for continuation of services. d. Clinics are most often open on weekends and keep evening hours.

ANS: B Clinics are usually a great distance from work and offer health services only during work hours. Health records do not typically follow the client. p 754

17. A nurse is providing care for a family in which a non-addict is experiencing a stress-induced preoccupation with an addicts life leading to extreme dependence on the addict. This describes: a. Obsession b. Codependency c. Enabling d. Addiction

ANS: B Codependency occurs when a person in a close relationship with an addict develops unhealthy coping mechanisms to continue the relationship.

4. Dependence is a term that refers to the: a. Presence and severity of withdrawal symptoms b. Necessary use of drugs to prevent withdrawal symptoms c. Level of intoxication associated with addiction d. Amount of substance needed to satisfy cravings

ANS: B Dependence refers to the necessary use of drugs to prevent withdrawal symptoms.

18. Which stage of change is a client experiencing when a commitment to take action has not yet been made? a. Precontemplation b. Contemplation c. Preparation d. Action

ANS: B During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem.

19. At the primary level of prevention related to teen pregnancy, what can the community health nurse do? a. Teach well-baby classes to new mothers. b. Teach young people about sexual practices that will prevent untimely pregnancy. c. Provide services for pregnancy detection. d. Counsel a young couple about abortion and adoption

ANS: B Education often occurs at the primary level of prevention. The primary level of prevention focuses on preventing a problem before it occurs.

What type of abuse is occurring when a child does not receive the basic nurturing and caring needed for healthy development? a. Sexual abuse b. Emotional neglect c. Physical neglect d. Child abuse

ANS: B Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child.

When assessing a community, the nurse identifies which factor as a community characteristic for violence? a. Lack of family cohesion b. High crime rate c. Social isolation d. Substance abuse

ANS: B High crime rate is the only "community characteristic." The others are individual or family factors.

14. A nurse counseling a pregnant adolescent about her nutritional needs during pregnancy includes information that nutritional needs are based primarily on: a. Chronologic age b. Gynecologic age c. Prepregnancy diet history d. Blood protein levels

ANS: B Nutritional needs are based upon gynecologic age, the number of years between chronologic age, and age at menarche.

5. What has happened in the United States as a result of prohibition? a. Substance abuse has declined. b. Violent crime and corruption has increased. c. The need for community health nurses has declined. d. Facilities to treat substance abuse have improved.

ANS: B Prohibition has led to increased crime and corruption among law officials related to the illicit market.

22. Which action would the nurse take when giving advice using the acronym FRAMES? a. Offer a menu of options or choices. b. Provide clear guidance to change risky behavior. c. Support the clients ability to change the behavior. d. Emphasize the clients responsibility for change.

ANS: B Providing clear guidance to change risky behavior is one of the elements of the FRAMES method of intervention.

A nurse is implementing a tertiary prevention strategy. Which of the following activities would the nurse most likely implement? a. Diabetes screening b. Rehabilitation for musculoskeletal injury c. Birth control d. Pregnancy testing

ANS: B Rehabilitation for musculoskeletal injury is an example of tertiary prevention. Diabetes screening and pregnancy testing are secondary prevention strategies, and birth control is a primary prevention. p761

Placing an injured victim in a safe location after being abused is _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

6. Which factor has contributed to the problem of substance abuse? a. Increased knowledge about the use of drugs b. Social acceptability of certain drugs c. Recognition of substance abuse as a health problem d. Control of the content and strength of illegal drugs

ANS: B Social acceptance of certain drugs contributes to the substance abuse problem.

3. The use of any substance that threatens a persons health or impairs his or her social or economic functioning is: a. Drug dependence b. Substance abuse c. Drug addiction d. Illegal

ANS: B Substance abuse is the use of any substance that threatens a persons health or impairs his or her social or economic functioning.

Which agency delegates the authority of the local health department? a. The federal government b. The state c. Local authorities d. Regional governing boards

ANS: B The authority of the local health department is delegated by the state.

16. The leading cause of birth defects in the United States is: a. Cigarette smoking b. Fetal alcohol syndrome c. Marijuana use d. HIV from sharing needles

ANS: B The leading preventable cause of birth defects in the United States is fetal alcohol syndrome, causing mental and behavioral impairment.

Which statement about migrant and seasonal farm workers is true? a. There are more than 10 million working in the United States. b. The majority are Mexican. c. Most are employed in the Northeastern states. d. Thirty-five percent are undocumented workers.

ANS: B The majority of migrant farm workers are foreign-born (72%) and predominantly Mexican (68%). Estimates suggest there are approximately 1.0 to 1.8 million hired farmworkers. Five states account for 65% of all farm workers: (1) California, (2) Florida, (3) Washington, (4) Oregon, and (5) North Carolina. Of the migrant and seasonal farmworkers, 52% have legal authorization to work in the United States. p751

16. Which nursing intervention is most appropriate when counseling an adolescent female about prevention of iron deficiency anemia? a. Provide information about appropriate weight gain during puberty. b. Educate about consuming foods containing vitamin C. c. Instruct on drinking at least 8 glasses of water each day. d. Emphasize the need to follow up with a dietician.

ANS: B The nurse should educate about iron-rich foods and foods that promote iron absorption, such as those containing vitamin C.

. Which is the first action a nurse should take when developing a community program to prevent violence? a. Talk to people who are victims of violence for their opinion. b. Identify factors that lead to violence. c. Develop a plan of action to combat violence. d. Evaluate current community programs.

ANS: B The starting point is the identification of factors that lead to violence, such as poverty, urban crowding, and racial inequality.

A nurse considering working as a public health nurse should recognize that the American Public Health Association Public Health Nursing Section has recommended which level of educational preparation? a. Associate degree b. Baccalaureate degree c. Masters degree d. Certification

ANS: B This is because all public health nurses should have a background in the social and behavioral sciences, epidemiology, environmental health, current treatment modalities, and health care delivery options in order to fully understand health policy, research, and treatment choices and to translate this knowledge into the promotion of healthy populations.

A public health nurse is working in a community where there have been multiple closures of large factories leaving many individuals without employment. Unemployment places this population at risk for: a. Becoming an abuser at home b. Committing violence in and outside the home c. Applying for unemployment benefits d. Neglecting the needs of their children

ANS: B Unemployment is associated with violence within and outside the home.

Which group has the highest rate of violence? a. Older, Caucasian men b. Young, minority men c. Young, Caucasian women d. Older, minority women

ANS: B Young, minority men have the highest rate of violence.

1. The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps

ANS: B, C, D Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policymakers at local, state, and national levels are necessary actions that nurses are prepared to undertake.

1. Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

3. The definition of a migrant farmworker includes which of the following? a. Farmer who helps his neighbors on their farms after his own crop fails b. High school student who works part time at his uncle's rose farm c. Teenager who moved with his family ten times in 2 years to work different crops d. Woman who works in the crop fields in the summer and at a grocery store in thewinter

ANS: C According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day. A seasonal farmworker returns to his permanent residence, worked in agriculture for at least 25 days or parts of days and did not work year round only in agriculture.

State public health agency responsibilities include: a. conducting community health assessments. b. enforcing public health codes. c. monitoring health status. d. providing expertise that facilitates evidence-based practice.

ANS: C Federal public health agencies develop regulations that implement policies formulated by Congress, provide funding to state and territorial health agencies for public health activities, survey the nation's health status and health needs, set practices and standards, provide expertise that facilitates evidence-based practice, coordinate public health activities across state lines, and support health service research. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. They receive funding from federal agencies to implement public health initiatives. Local public health agencies are responsible for implementing and enforcing local public health codes and ordinances and providing essential public health services to the community. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 995

Rapid changes in public health are providing a challenge to PHNs because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the PHN. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established: a. core public health functions as the competency framework. b. Minnesota Department of Health's Intervention Wheel as the practice competencies. c. standards for baccalaureate- and master's-prepared PHNs. d. Quad Council principles as the primary framework for practice.

ANS: C Historically, many of the core public health competencies were provided by PHNs who had learned these skills in the workplace while gaining knowledge through years of practice. Because of rapid changes in public health and limited resources, this approach to competency development can no longer be sustained. In 2007 and again in 2013, the ANA revised the 1999 Scope and Standards of Public Health Practice to reflect the increasing complexity and rapid changes faced by PHNs. The revised standards include standards that must be met by all nurses with baccalaureate degrees, the entry level into public health nursing, as well as standards that must be fulfilled by advanced practice PHNs prepared at the master's level. Cognitive Level: Analysis Associated Chapter Objective: 7 REF: pp. 1002-1003

4. Within the impoverished older adult population, the most vulnerable group may be: a. elderly couples living in poverty with serious chronic illnesses. b. elderly men with alcoholism and limited incomes. c. homeless older adults. d. newly widowed, low-income elderly women.

ANS: C Homeless older adults are the most vulnerable of the impoverished older adult population. They have long lived in poverty, have fewer supportive relationships, and are likely to have become homeless as a result of catastrophic events. Life expectancy for homeless older adults is significantly lower than that for older housed adults. Permanent physical deformities, often secondary to poor or absent medical care, are common among homeless older adults. Homeless older adults suffer from untreated chronic conditions, including tuberculosis, hypertension, arthritis, cardiovascular disease, injuries, malnutrition, poor oral health, and hypothermia. As with younger homeless persons, older adults who are homeless must focus their energy on survival, which leaves little time for health promotion activities.

6. An undocumented migrant farmworker has been diagnosed with TB. The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6-12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.

ANS: C Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.

7. The local hospital emergency department has recently noted an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of the rise in cases and schedules a case mapping of: a. bars frequented by migrant workers. b. farm fields employing migrant workers. c. housing for migrant workers. d. restaurants frequented by migrant workers.

ANS: C Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.

5. After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? a. The federal government is ultimately responsible for the health status of the nation b. The public demands that the government protect the people c. Public health departments do not have the resources to accomplish these goals independently d. State health agencies must take a universal approach to achieving objectives

ANS: C Partnerships and collaboration among groups are much more powerful in making change than the individual client and PHN working alone. Because public health departments do not have the resources to accomplish the Healthy People 2020 goals independently, collaboration is essential to quality public health nursing practice, and collaboration with existing groups at the local level is encouraged. New partnerships are formed related to specific goals. Communities develop coalitions to address selected objectives, based on community needs that include all of the local community stakeholders, such as social service; mental health; educational, recreational, and governmental agencies and institutions; as well as businesses. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 1003

3. Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

ANS: C Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

8. A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. An evidence-based strategy that would be effective for this mobile population is educating: a. advocacy groups for migrant farmworkers. b. local policymakers. c. migrant lay health workers. d. workers seeking care at the migrant health clinic.

ANS: C The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.

4. The migrant clinic's mobile van program provides health education through lay health workers; screening for pesticide illness, tuberculosis (TB), and diabetes; pregnancy testing; and treatment for some acute and chronic illnesses typically seen in this vulnerable population. In dealing with this population's beliefs about disease causality, this program demonstrates the application of the health promotion and disease prevention principle of: a. advocacy. b. cultural competency. c. outreach. d. primary prevention.

ANS: C The same principles of health promotion and prevention apply to migrant farmworkers as to the rest of the U.S. population. However, health promotion and disease prevention as presented by nurses may be difficult concepts for migrant workers to embrace because of their beliefs regarding disease causality, their irregular and episodic contact with the health system, and their lower educational level. Health promotion begins by informing the farmworker family about health topics and the resources available to improve health. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers.

1. In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle, especially their current: a. communicable diseases. b. educational level. c. housing arrangements. d. pesticide exposure.

ANS: C The way of life of migrant farmworkers and their families is stressful. They often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.

2. In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

ANS: C Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

9. To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses must first: a. apply epidemiologic principles for prevention. b. develop resource expertise in the community. c. examine their personal beliefs, values, and experiences. d. understand the federal criteria and guidelines for poverty.

ANS: C To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses need to understand poverty as a concept with historical, social, political, economic, biological, psychological, and spiritual dimensions. Understanding the concepts of poverty and homelessness begins with an examination of one's own beliefs, values, and personal experience.

What effect does alcohol consumption have on migrant farm workers? a. Provides relaxation and is important for migrant workers' well-being b. Adds additional risks to pesticide exposure c. Poses safety hazards for farm workers d. Allows migrant workers to sleep better, thus improving daytime productivity

ANS: C Alcohol can contribute to farm-related injuries. Drug and alcohol use has been identified as a significant source of stress. Alcohol can also contribute to health problems, greater risk for human immunodeficiency virus (HIV), violence in camps/home sites, domestic violence, and decreased funds for personal and family needs. p 758

7. A client who is experiencing a drug addiction is at risk for having a(n): a. Infant with a high birth weight b. Easily cured illness or disease c. Accident or committing suicide d. Problem finding employment

ANS: C Alcohol, tobacco, and other drug (ATOD) abuse and addiction is associated with many problems, including neonates with low birth weights and congenital anomalies; accidents, homicides, and suicides; chronic diseases such as cardiovascular disease, cancer, lung disease, hepatitis, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS); and mental illness.

A nurse is assessing an individual who has been the victim of domestic violence. Which part of the body should the nurse assess first? a. Front of the body b. Back of the body c. Proximal parts of the body d. Distal parts of the body

ANS: C Attacks are often inflicted on proximal parts of the body which can easily be disguised by clothing, so the nurse should assess this area first.

19. A nurse is working with a client during a smoking cessation program. The client has developed an action plan for smoking cessation, but has not yet implemented it. Which stage of change is the client experiencing? a. Precontemplation b. Contemplation c. Preparation d. Action

ANS: C During preparation, the individual is prepared for action and may reduce the problem behavior but has not taken effective action yet.

9. Which information about parental consent would be accurate for the nurse to provide to an adolescent client who is seeking an abortion? a. Parental consent must be given to the abortion provider. b. Parents must be notified by the abortion provider before the abortion is performed. c. The adolescent's right to privacy and ability to give consent varies by state. d. Federal protection of the adolescent's right to privacy makes consent unnecessary.

ANS: C For an adolescent female seeking abortion, her right to privacy and ability to give consent vary by state.

A nurse is counseling a client who has just ended an abusive relationship. Which emotion would the client most likely display? a. Anger b. Apathy c. Grief d. Guilt

ANS: C Grief is a response to the relationship when it is over.

21. When assessing for addiction, the nurse should be aware that a primary symptom of addiction is: a. Anger b. Apathy c. Denial d. Violence

ANS: C In assessing for addiction, the nurse should be aware that a primary symptom of addiction is denial.

A community health nurse visits a home and notices multiple bruises on a 4-year-old child. The mother reports that her husband is an alcoholic and is currently sleeping. What is the most appropriate action for the nurse to take? a. Question the mother about sexual abuse. b. Initiate interventions directed at family violence. c. Report the case of suspected child abuse to authorities. d. Refer the mother to a social worker or Al-Anon group.

ANS: C It is required by law that nurses report all cases of suspected child abuse.

11. Which statement about nicotine and smoking is accurate? a. Cigars contain higher doses of nicotine than cigarettes. b. Tolerance to nicotine takes days to develop. c. Sidestream smoke contains more toxic compounds than mainstream smoke. d. The harsher smoke of pipes and cigars is more hazardous than cigarette smoke.

ANS: C It is true that sidestream smoke contains greater concentrations of toxic and carcinogenic compounds than mainstream smoke.

When providing tertiary prevention, the nurse should include: a. Education b. Prevention c. Referral d. Detection

ANS: C Nurses should know about available community resources for abuse victims and perpetrators.

A nurse is assessing the occupational health risks of a migrant farm worker. Which health risk is the nurse most likely to find? a. Denial of care when going to the emergency room b. Difficulty obtaining affordable health insurance c. Increased exposure to chemicals and work-related injuries d. Episodic violence from farm owners and employers

ANS: C Occupational health risks for migrant farm workers include working conditions, exposure to chemicals, and using machinery. Denial of care and difficulty obtaining health insurance are not occupational health risks. Episodic violence from farm owners is not a known occupational health risk p755

Which is a principle of good practice for community partnerships? a. Partnerships are easily formed among those working in public health. b. Partnerships use their own roles to accomplish tasks. c. Partnerships are built on identified strengths and assets. d. Partnerships are loose associations among people.

ANS: C Partnerships are built up on identified strengths and assets including areas that need improvement. This is one of the principles of good practice.

A nurse is counseling a client who has been abusive towards a spouse. Which experience has the client most likely had in the past? a. Perceived or actual crisis b. History of social isolation c. Previous exposure to violence d. Long-term marital strain

ANS: C Perpetrators of intimate partner violence often believe that violence within an interpersonal relationship is a normal behavior pattern, based on their upbringing, living conditions, and increased stress.

A child who lives in extreme poverty is at greatest risk for which type of abuse? a. Sexual abuse b. Emotional neglect c. Physical neglect d. Child abuse

ANS: C Physical neglect is failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care.

A nurse is a political advocate for the migrant population. Which of the following best describes the action being taken by the nurse? a. Upholding immigration laws and deporting illegal aliens b. Passing laws to improve the living conditions of migrant farm workers c. Educating communities about the health problems of migrant farm workers d. Learning to speak Spanish for better communication with migrant farm workers

ANS: C Political advocacy can include educating communities about these individuals. This education helps to provide legislators and policy makers at local, state, and national levels with the information needed to make policy decisions. p762

Which activity demonstrates the use of a tertiary prevention strategy? a. Providing immunizations b. Conducting lead screening activities for children c. Providing case management services for clients with chronic illness d. Identifying and treating clients in a TB clinic

ANS: C Providing immunizations is a primary prevention, and conducting lead screening activities and identifying and treating clients in a TB clinic are at the secondary level of prevention. Tertiary prevention refers to activities aimed at rehabilitation of the disease process and return to the highest possible functioning.

A nurse working in public health focuses on: a. Home visiting and hospice care b. Care communicable diseases c. Health maintenance and health promotion d. Illness prevention

ANS: C Public health nurses employed in local, state, and federal agencies work together to identify, develop, and implement interventions that will improve and maintain the nations health.

Which action is the most appropriate for the public health nurse to take when working with uninsured individuals? a. Providing direct care for this population in times of acute illness b. Advocating for federal policy changes for this population c. Assisting this population to access necessary health care services d. Encouraging lifestyle changes for this population

ANS: C Public health nurses serve vulnerable populations by acting as a bridge between these populations and the resource needs for this at-risk group by approaching health care providers on behalf of individuals seeking medical/health services and keeping the needs of this population on the political agenda.

A nurse anticipates that a woman who has been battered for a number of years has most likely seen an increase in: a. Self-blame b. Remorse by the man c. Severity of the abuse d. Emotional strength

ANS: C Severity of abuse and its frequency is most likely to increase over time.

2. Which health problem causes more deaths, illnesses, and disabilities than any other in the United States? a. Tobacco addiction b. Alcohol abuse c. Substance abuse d. Caffeine addiction

ANS: C Substance abuse is the number one national health problem.

Which legislation changed the availability of federal services accessible to certain immigrants to the United States? a. Migrant Health Act of 1962 b. Supplemental Security Income (SSI) c. Welfare reform legislation of 1996 d. Food stamps

ANS: C The Welfare reform legislation of 1996 changed the availability of federal services accessible to certain immigrants in the United States. The Migrant Health Act provides funds for primary and supplemental health services to migrant workers and their families. Because of the welfare reform legislation of 1996, many legal immigrants and unauthorized immigrants are ineligible for services such as SSI and food stamps. p754

The greatest risk factor for suicide in adult women is: a. Divorce b. Unemployment c. Intimate partner violence d. Terminal illness

ANS: C The greatest risk factor for actual and attempted suicide in adult women is intimate partner violence.

25. A nurse recommends to a school board that other methods besides the just say no approach be considered when providing drug use prevention education to the elementary students. The rationale for this recommendation is: a. Children do not like to hear the word no, and the approach is too negative. b. Project DARE is more effective and has decreased drug use. c. Children are naturally curious and may experiment with drugs. d. Just say no to drugs does not include smoking and alcohol abuse.

ANS: C The just say no approach does not help young people because children are naturally curious and drug experimentation is often part of normal development, children from dysfunctional homes often use drugs to get attention and escape intolerable environments, and it does not address the powerful component of peer pressure.

A nurse working in a correctional facility recognizes that the majority of women who experience violence in prison: a. Are violent themselves b. Have committed homicides c. Have a history of experiencing multiple types of abuse d. Are in prison for child abuse

ANS: C The majority of women who experience abuse in prison have a history of experiencing multiple types of abuse as a child and as an adult.

8. The oldest and most widely used psychoactive drug in the world is: a. Marijuana b. Heroin c. Alcohol d. Cocaine

ANS: C The oldest and most widely used psychoactive drug in the world is alcohol.

The public health nurse who aims to change behaviors such as poor hand washing skills and unsafe sex practices is acting in the role of a(n): a. Case manager b. Advocate c. Educator d. Role model

ANS: C The public health nurse who aims to change behaviors, such as poor hand washing skills and unsafe sex practices, is acting in the role of educator.

15. Which would be the most appropriate nursing intervention for the nurse to implement when assessing a pregnant teen's weight gain? a. Advise the teen to play close attention to weight gain. b. Encourage the teen to gain as much weight as possible. c. Recommend weight gain based on prepregnancy weight. d. Instruct about the benefits to the fetus by gaining 2 pounds per week.

ANS: C The weight gain recommendations for the pregnant adolescent are based on the teen's prepregnancy weight. Teenagers who begin the pregnancy at a normal weight should be counseled to begin weight gain in the first trimester and to average gains of 1 pound per week for the second and third trimesters.

1. Why must nurses examine their attitudes about alcohol, tobacco, and other drug abuse and addiction before working with individuals with this health problem? a. Working with clients who have addiction problems often puts the nurse at risk for violence. b. The population of persons with drug and alcohol addiction is found in low-income neighborhoods. c. To be therapeutic, a nurse must develop a trusting non-judgmental relationship with clients. d. Nurses are the primary persons who treat addiction problems.

ANS: C To be therapeutic, the nurse must develop a trusting, non-judgmental relationship with clients. Therefore, nurses must examine their own attitudes ahead of time.

18. A nurse is teaching a pregnant teenager about the risks of contracting a sexually transmitted infection. Which statement would the nurse most likely make? a. Sexually transmitted infections can cause cognition issues in your infant. b. Contracting a sexually transmitted infection may cause you to need assistance to care for your infant. c. Sexually transmitted infections can cause premature labor. d. The father of the baby is at high risk to contract a sexually transmitted infection.

ANS: C When a young woman is pregnant, these infections can cause premature rupture of membranes, premature labor, and postpartum infection. Periodic screening during pregnancy should be done.

31. A nurse partners with multiple agencies in the community to create a support group for those suffering from addiction in the community. Which level of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion

ANS: C When using tertiary prevention, the nurse helps the addict and the addicts family.

3. Which objective related to adolescent health is discussed in Healthy People 2020? a. Increasing the age of legal consumption of alcohol to 25 b. Increasing the number of planned pregnancies c. Increasing the proportion of teens who receive formal instruction on reproductive health issues d. Increasing the proportion of teens who consistently use some form of birth control

ANS: C, D Healthy People 2020 goals are to increase the proportion of 15 to 19 year olds who use condoms and hormonal contraceptive and increasing the proportion of teens who receive reproductive health information through formal instruction as well as from their parents or guardians.

3. Deinstitutionalization of chronically ill individuals from publicly funded psychiatric hospitals had the unintended consequence of: a. moving clients to readily available community-based care. b. shortening hospital stays in mental health facilities. c. increasing the funding for community-based services. d. increasing the number of homeless persons.

ANS: D Deinstitutionalization of chronically mentally ill individuals from public psychiatric hospitals increased the number of homeless persons. The intent was to move clients from public psychiatric hospitals to community-based treatment centers. However, adequate community-based services were not funded. Few of the intended community mental health centers were ever built.

30. A nurse refers a client to Alcoholics Anonymous (AA). Who will play the most important role in the treatment of alcoholism at this support group? a. Self b. Spouses c. Children d. Peers

ANS: D Alcoholics Anonymous began a strong movement of peer support to treat a chronic illness. The fellowship, support, and encouragement among AA members provide a vital social network for the person recovering from an addiction.

15. Which individual would mostly likely have the lowest blood alcohol concentration? a. An individual who consumes a drink with a high concentration of alcohol b. An individual who drinks without consuming food c. An individual of the female gender d. An individual with a high body weight

ANS: D An individual with a high body weight would likely have the lowest blood alcohol concentration. Increased alcohol concentration, drinking without consuming food, and being a female are all factors which increase blood alcohol concentration.

Which of the following disorders has been identified as an occupational health risk for agricultural workers? a. Stroke b. Heart disease c. Diabetes d. Cancer

ANS: D Cancer is an identified but not well-documented health problem for migrant farm workers associated with their exposure to chemicals. Other identified health risks are musculoskeletal injuries, traumatic injuries, respiratory problems, dermatitis, infectious diseases, and eye problems. p 756

Why is violence a concern for community health nursing practice? a. Violence is a universal problem. b. Violence impacts everyone in the United States. c. Nurses must spend a great deal of time on the results of violence. d. Significant mortality and morbidity results from violence.

ANS: D Communities across the United States are concerned about crime and violence rates because of significant mortality and morbidity that often results.

29. When assessing drug use patterns of a client, which question is most appropriate for the nurse ask? a. Where was the drug acquired? b. Who gave the drug to you? c. What drug was taken? d. How often do you use the drug?

ANS: D During an assessment, all relevant drug-use history is collected and aids in the assessment of drug-use patterns. The nurse should note any changes in drug-use patterns over time. Thus, the most appropriate question is the nurse asking how often a client uses drugs.

ANS: D Communities across the United States are concerned about crime and violence rates because of significant mortality and morbidity that often results.

ANS: D For reported rapes, cities constitute higher risk areas than do rural areas, and the hours between 8 PM and 2 AM, weekends, and the summer months are the most critical times.

8. A teenage mother discusses with the school nurse the possibility of having a second child. Which risk factor would place this client at higher risk for having a second pregnancy? a. Remaining in school b. Reporting an unplanned first pregnancy c. Being from a small family d. Having a disadvantaged background

ANS: D Having a disadvantaged background is a risk factor for a second teen pregnancy.

After reviewing the objectives of Healthy People 2020, the public health nurse determines that programming for communicable diseases in the community should focus on: a. Encouraging community members to engage in healthy behaviors b. Identifying high-risk sexual behaviors among community members c. Monitoring the sexual activity of adolescents d. Providing information about the hazards of multiple sexual partners

ANS: D Healthy People 2020 lists communicable disease as an area of focus including levels of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the public health nurse providing information on the hazards of multiple sexual partners and street drug use.

Homicides are least likely to be perpetrated by a(n): a. Friend b. Acquaintance c. Family member d. Stranger

ANS: D Homicides are usually perpetrated by friends, acquaintances, or family members during an argument.

26. When providing comprehensive education about HIV transmission for an injection drug user (IDU), the most important information to include is: a. How and where to acquire needles b. Proper needle usage and possible injection sites c. Spreading of the virus via homosexual activities d. Using bleach between needle uses

ANS: D IDUs represent the most rapidly growing source of new cases of acquired immunodeficiency syndrome (AIDS), and they are the greatest risk for spread of the virus in the heterosexual community. Emphasis is being placed on reduction of the transmission of this disease through contaminated needles. Nurses should provide education on cleaning needles with bleach between uses and on needle exchange programs to decrease the spread of the virus.

7. A parent has requested access to his child's medical records at a school-based health clinic. Which statement about access and release of a minor's medical record is correct? a. Reproductive information is protected by the Health Insurance Portability and Accounting Act (HIPAA). b. A minor cannot get birth control without parental consent. c. Medical records are available to anyone who wishes to access them. d. Parents can legally access all medical records of a minor child.

ANS: D In many states, parents can legally access all medical records of their minor children, which limits the confidentiality assurances offered to a teen seeking reproductive health care.

A nurse is planning to provide culturally effective care to Mexican migrant farm workers. Which of the following strategies should be used by the nurse? a. Learn how to speak Spanish to improve communication b. Understand that traditional beliefs and practices are more common among the well-educated population c. Consult the female head of household about health care matters d. Recognize that cultural backgrounds of the workers will vary depending on their place of origin

ANS: D It would be incorrect to assume that all Mexicans have the same cultural beliefs. The nurse must remember that beliefs and practices differ between regions and localities of a country, and among individuals. Mexico is a multicultural country; therefore, the cultural backgrounds of Mexican immigrants vary depending on their place of origin. pp759-760

5. Many teenagers who give birth: a. Are from middle class families b. Are honor students c. Planned to get pregnant d. See few advantages in delaying pregnancy

ANS: D Many teenagers who give birth see few advantages in delaying pregnancy.

10. The most widely used illicit drug in the United States is: a. Alcohol b. Heroin c. Cocaine d. Marijuana

ANS: D Marijuana is the most widely used illicit drug in the United States.

13. An important concept for nurses to keep in mind when providing adoption counseling with pregnant teenagers is: a. Have the father present as well during the counseling session. b. When speaking of adoption, use the words "giving the child away." c. Describe the details of raising a child in order to influence adoption decisions. d. Do not impose opinions on the decision-making process of teen mothers.

ANS: D Nurses must keep in mind that they should avoid imposing opinions on the decision-making process of teen mothers.

. In which situation is child abuse most likely to occur? a. When the parents have realistic expectations for their children b. When the parents' sense of control is threatened c. When the parents are overly sensitive to their children's needs d. When the parents lack a social support network

ANS: D Parents with a lack of social support, history of abuse as a child, have minimum education, a tendency toward depression, or multiple stress factors may be at risk for abusing their children.

A nurse is implementing a primary prevention strategy. Which of the following activities would the nurse most likely implement? a. Urine screening for pesticide exposure b. Tuberculosis (TB) skin testing c. Treatment of lead poisoning d. Reduction of pesticide exposure

ANS: D Reduction of pesticide exposure is an example of primary prevention. Urine screening and TB skin testing are secondary prevention, and treatment of lead poisoning is tertiary prevention. p761

13. Which physical effect is the nurse most likely to be concerned about when caring for a client who has had long-term marijuana use? a. Constipation b. Cardiac dysrhythmia c. Abdominal pain d. Respiratory tract damage

ANS: D Respiratory tract damage occurs from smoking the drug and is the greatest physical concern among chronic users.

28. What would a nurse look for when investigating the setting of a particular drug experience? a. A back alley or abandoned building where people are using crack b. An area at the local high school where students are known to smoke cigarettes c. The individuals using the drug, including that individuals expectations d. The physical, social, and cultural environment within which the use occurs

ANS: D Setting is the influence of the physical, social, and cultural environmental within which the use occurs. The other answers are too specific; the last option covers the entire scope of the setting.

A nurse is implementing a primary prevention strategy for migrant workers. Which of the following activities would the nurse most likely implement? a. Caring for persons afflicted with pesticide exposure b. Setting up clinics for persons with HIV c. Doing research in the field related to heat stress d. Educating about prevention of such illnesses as HIV and infectious diseases

ANS: D The primary level of prevention often includes education for the prevention of diseases, measures to reduce pesticide exposure, and immunizations. Caring for persons afflicted with pesticide exposure, setting up clinics for persons with HIV, and doing research in the field related to heat stress are examples of tertiary prevention. p 761

Which role of the nurse is being used when a public health nurse assists a client in identifying the services needed the most at the least cost? a. Role model b. Primary caregiver c. Outreach worker d. Case manager

ANS: D The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager.

1. What is the cause of teen pregnancy? a. Changing moral attitudes b. Sexual code c. Economic circumstances d. No uniform reason

ANS: D There is no uniform cause of teen pregnancy.

4. A high school-aged teen tells the school nurse that she wants to become pregnant. The most appropriate nursing action is to: a. Ignore the comment. b. Tell the teen that she should not engage in sexual activity or get pregnant. c. Call the teen's parents. d. Provide preconceptual counseling and emphasize the need to achieve good health.

ANS: D This demonstrates that the nurse has heard what the teen is saying and has provided useful information that may encourage the teen to examine her plans carefully, seriously, and maturely.

9. How much alcohol can the liver metabolize in an hour? a. 1 ounce of whiskey b. 3 ounces of wine c. 5 ounces of wine d. 12 ounces of beer

ANS: D Whiskey is 3/4 oz and wine is 4 oz.

Which statement about migrant and seasonal farm workers is true? a. The economic status of migrant workers has improved over the last decade. b. This is a transient population that does not need nursing care. c. Most migrant workers are eager to accept health care services. d. Availability of food in the United States depends on these individuals.

ANS: D Availability and affordability of food in the United States depends on these individuals, yet their economic and social status has not changed significantly over the past decades. Most migrant workers do not seek out health care services. p751

A nurse working at a battered woman's shelter is counseling a pregnant woman who has just entered the shelter. When assessing the clients history, which information would the client most likely report?

Abuse before pregnancy

ANS: B Abusive parenting is more likely to occur when the parents have limited knowledge about normal child development. It may also be more likely to occur among parents who cannot adequately empathize with a child's needs. The frustration caused by this failure may be exhibited as abusive behavior toward a child. Teens who show greater psychological distress or lack social support should also be assessed for child abuse risk by the nurse. Limited verbal communication and eye contact with the child, displays of frustration, and ambivalence are indicators of limited knowledge regarding infant growth and development. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 776

Adolescents who feel competent as parents have enhanced self-esteem, which, in turn, positively influences their relationship with their child and response to the child's cues signaling basic needs or distress. It is important for the nurse to initiate parenting education for both parents as early as possible to increase the teens' understanding of their child's growth, development, and needs in order to reduce the risk for: a. academic behavior problems in the future. b. abusive parenting. c. limited verbal communication with the infant. d. negative parenting feedback.

11. The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented? a. Both secondary and tertiary prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

B

13. An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Tertiary care prevention

B

15. An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change? a. To prevent injury b. To limit disability c. To provide primary prevention d. To provide tertiary prevention

B

21. Which of the following best describes the mission of OSHA? a. To create an inspection system to avoid preventable loss of life b. To ensure safe and healthful working conditions c. To establish rules for employee safety d. To share factory illness and injury rates with the public

B

22. Which of the following statements best describes how workers' compensation legislation has changed employer behavior? a. Employers have improved safety of working conditions because safety data is now public information. b. Companies have improved safety of working conditions because worker's compensation insurance premiums are now based on previous claims. c. Employers were legally required to implement safety changes. d. Companies have become more involved in the legislative process.

B

A forensic nurse maintains an awareness of human behavior and environment which is then interpreted by knowledge and lived experience in making expert decisions. This concept of forensic nursing theory is known as: a. justice. b. perceptivity. c. presence. d. victimization.

B

The focus on the need for safety during periods of emergent trauma, collective violence, or chronic abuse is based on the theoretical framework contributions of: a. Haddon's Matrix. b. Maslow's hierarchy of needs and desires. c. the rights of citizens. d. concept of ways of knowing

B

Which of the following health risks results from incidents of crime and victimization? a. Diabetes mellitus b. Distress of the human spirit c. Incarceration d. Unwanted pregnancy

B

1. What is the goal of local public health departments? a. To monitor communicable diseases b. To improve the health status of communities c. To offer services for the uninsured d. To enforce environmental codes and laws

B The goal of local public health departments is to safeguard the publics health and improve the health status of communities.

Which principles are included in the Scope and Standards of Public Health Nursing Practice? Select all that apply. a. The client or unit of care is the population. b. Primary prevention is given priority. c. All processes must include partnering with representatives of the people. d. Government agencies mandate requirements for public health.

B,C

5. An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information? (Select all that apply.) a. To assess how others have rated the company in relation to employment there b. To compare the prospective employer's injury rate with similar employers' rates c. To learn more about the usual processes and products of the company as well as typical hazards d. To learn how employees feel about the employer

BC

4. Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers? (Select all that apply.) a. To fulfill their ethical and moral responsibility b. To avoid the cost of liability suits, workers' compensation, etc. c. To maintain good public relations d. To meet legislated standards and avoid significant penalties for noncompliance

BD

12. An occupational health nurse is removing a foreign body from a patient's eye. Which of the following levels of prevention is being implemented? a. Injury prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

C

18. A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic's clients. Which of the following best explains why the nurse is collecting this data? a. This data will be useful in a research study the nurse is conducting. b. This data will provide evidence of clinic resources being wasted on minor health problems. c. This data will help identify patterns in the risk factors associated with a particular subgroup. d. This data can be used to show trends that can be included in the next grant proposal for further funding.

C

20. Which of the following interventions regarding worker safety would be the least effective? a. Using job rotation and workplace monitoring b. Designing equipment so that employee exposure to hazards is minimized c. Having employees use safety measures and personal protective equipment d. Designing the environment to encourage employees to follow workplace procedures

C

23. Which of the following would most likely be one of the first steps taken in employer disaster planning? a. All employees are invited to attend sessions on disaster planning. b. Employers stress the importance of disaster drills and encourage active participation. c. Exhaustive inventory of chemicals and industrial hazards is completed. d. Written disaster plans are distributed to each employee and each worksite.

C

8. In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families? a. Acute care inpatient settings b. Community clinics and physicians' offices c. Emergency departments and psychiatric units d. In homes during home health visits

C

A forensic nurse who provides expert consultation regarding back injury disabilities and functional limitations on a workman's compensation case in a civil hearing but did not provide direct client care, is practicing as a: a. forensic nurse advocate. b. forensic nurse examiner. c. legal nurse consultant. d. nurse attorney.

C

The sexual assault nurse examiner (SANE) works in collaboration with the emergency department providers and ______________. a. clergy b. epidemiologists c. law enforcement d. psychiatric practitioner

C

When forensic nurses provide direct care to all victims injured following an alcohol-related auto accident, the forensic nurse is engaged in: a. injury prevention. b. primary prevention. c. secondary prevention. d. tertiary prevention.

C

3. Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace? (Select all that apply.) a. All chemicals are inherently dangerous to humans. b. Chemicals are often used when natural substances are equally effective. c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown.

CD

Homicide is the leading cause of death among which population?

Children and youth between 1 and 19

A public health nurse is working in a community where there have been multiple closures of large factories leaving many individuals without employment. Unemployment places this population at risk for:

Committing violence in and outside the home

1. An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace? a. Find employment in physical labor; at least your body will be in good condition. b. Professional positions are the safest choice for employment. c. White collar positions provide the least risk for injury. d. There is no "safe" occupation or profession.

D

10. Which of the following is the primary reason that large companies are becoming more involved in their employees' personal health and well-being? a. It is an ethical and moral responsibility. b. It improves public relations within the community. c. It allows managers to better understand their employees. d. It provides a cost savings to the company.

D

14. The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion? a. To provide an example to other employees to ensure future cooperation with safety measures b. To enforce an economic penalty for not obeying nurse's instructions regarding safety measures c. To ensure that all employees keep their positions during an economic downturn d. To continue employment and income with limited duty as a rehabilitation effort after an injury

D

16. A nurse is completing a health history on a client during a routine physical exam. Which of the following questions, which is often omitted, should be asked by the nurse? a. "How is your family doing?" b. "What problems have you been having?" c. "What health concerns do you have today?" d. "Where do you work and what do you do there?"

D

17. A nurse is interviewing a person who has stated on her entry health form that she is retired. Which of the following is the most crucial question for the nurse to ask? a. "Have you had any problems since leaving your employment?" b. "How do you spend your time now?" c. "What has retirement been like for you?" d. "Where were you previously employed and what did you do there?"

D

19. As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse? a. To document employee efficiency and effectiveness at their jobs b. To look for evidence of personal protective equipment being torn or destroyed c. To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day d. To observe effectiveness of safety education and equipment

D

6. Which of the following is the most common disabling condition when measured by days away from work? a. Bruises b. Cuts and lacerations c. Mental illnesses d. Sprains and strains

D

9. The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe? a. Comfort level of the PPE b. Effectiveness of the nurse's teaching c. Knowledge level of the employee d. Psychosocial norms of the setting

D

A unique competency of forensic nursing is the collection of trace evidence to be used in clinical investigations. This competency is related to which standard of practice for the specialty? a. Collaboration b. Ethics c. Leadership d. Scientific process

D

The rate of injury and crime is lower in communities that promote good health. This statistical fact speaks to the health determinants of injury, identified in Healthy People 2020. Because of this correlation, the measures that improve health, lower risk, and _________________ also reduce physical and emotional injury. a. incarcerate criminals b. marginalize populations c. promote population practice d. reduce disparities

D

What type of abuse is occurring when a child does not receive the basic nurturing and caring needed for healthy development?

Emotional neglect

ANS: B Family structure can influence adolescent sexual behavior and pregnancy. Adolescents raised in single-parent families are more likely to report sexual experiences and to have become sexually active at a young age than those raised in two-parent families. "Two-parent family" does not necessarily mean a "traditional" family structure. Other factors, such as parental higher education, family communication, and good family health practices, are also associated with decreased sexual risk behaviors. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 771

Factors that are associated with decreased sexual risk behaviors in teens include higher levels of parental education and: a. age-restricted discussion of sexual issues. b. good family health practices. c. strict parental rules on behaviors. d. membership in the white majority versus other racial groups.

ANS: C Teen lifestyles generally do not promote overall good nutrition. Teen diets tend to rely on processed snacks high in fat, calories, sugar, and sodium. The pregnancy may occur concurrently with the adolescent growth spurt, so that a significant increase in caloric nutrients is required. Nutritional needs are impacted by the teen's gynecological age. School meals cannot be assumed to be balanced and nutritionally appropriate for pregnant teens. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: pp. 774-776

For the pregnant adolescent, the factors that pose the greatest nutritional challenge are: a. chronological age and fetal growth. b. family support and teen attitude. c. lifestyle, growth, and development. d. need to limit weight gain and increase exercise.

A nurse is counseling a client who has just ended an abusive relationship. Which emotion would the client most likely display?

Grief

A nurse working in a correctional facility recognizes that the majority of women who experience violence in prison:

Have a history of experiencing multiple types of abuse

When assessing a community, the nurse identifies which factor as a community characteristic for violence?

High crime rate

Which is the first action a nurse should take when developing a community program to prevent violence?

Identify factors that lead to violence

The greatest risk factor for suicide in adult women is:

Intimate partner violence

A child who lives in extreme poverty is at greatest risk for what type of abuse?

Physical neglect

A nurse is counseling a client who has been abusive towards a spouse. Which experience has the client most likely had in the past?

Previous exposure to violence

When the nurse helps the community to take a stand against violence and advocates for elected officials and local media to make non-violence a priority, the nurse is engaged in which level of prevention?

Primary

Which action would be most appropriate for the nurse to take when working with a rape survivor?

Provide continuous care once the victim enters the health care system

A nurse is assessing an individual who has been the victim of domestic violence. Which part of the body should the nurse assess first?

Proximal parts of the body

Which statement about rape is true?

Rapes are most likely to occur on a weekend

When providing tertiary prevention, the nurse should include:

Referral

A community health nurse visits a home and notices multiple bruises on a 4-year old child. The mother reports that her husband is an alcoholic and is currently sleeping. What is the most appropriate action for the nurse to take?

Report the case of suspected abuse to authorities

Placing an injured victim in a safe location after being abused is:

Secondary Prevention

A nurse anticipates that a woman who has been battered for a number of years most likely has seen an increase in:

Severity of the abuse

Why is violence a concern for community health nursing practice?

Significant mortality and morbidity results from violence

Homicides are LEAST likely to be perpetrated by:

Stranger

ANS: A Many adults have difficulty understanding why young people would jeopardize their careers and personal potential by becoming pregnant during their teen years. Adolescents, however, do not view the world in the same way that adults do. Teens may feel invincible and therefore do not recognize any risk related to their behaviors or anticipate the consequences. They may not think that the negative outcomes of which they are warned could occur and believe that they are unique and different and that everything will work out fine. Pregnant teens often express the unrealistic attitude that they can do it all: school, work, parenting, and socializing. In addition, the earlier the age at which sexual activity begins (sexual debut), the less likely it is that a birth control method will be used. Inconsistent use of birth control can reflect a teen's willingness to take risks, dissatisfaction with available birth control methods, and ambivalence about becoming pregnant. Peer and partner pressure also places teens at greater risk when their friends are sexually active. Sexual victimization, family structure, and parenting styles have a significant impact. Adolescents raised in single-parent families are more likely to report sexual experiences. Parents who are extremely demanding and controlling or neglectful and who have low expectations are least successful in instilling parental values in their children. Cognitive Level: Synthesis Associated Chapter Objective: 3 REF: p. 769-770 & p. 770-772

Teens are at higher risk for becoming pregnant because of the presence of multidimensional factors that include such things as adolescent immaturity, low levels of contraceptive use, and: a. early age of initiation of sexual activity, sexual victimization, and peer pressure. b. parenting styles, family structure, and paternity issues. c. partner pressure, discouragement of abortion, and poor nutrition. d. poor nutrition, preterm delivery, and late-term prenatal care.

ANS: D Paternity, or fatherhood, is legally established at the time of the birth for a teen who is married. However, it is more difficult to establish paternity for unmarried couples. Some of the difficulty lies in the complexity of the specific state systems for young men to acknowledge paternity. In some states, a young man may have to work with the judicial system outside of the hospital after the birth, and if he is younger than age 18 years, he may need to involve his parents. Some young couples do not attempt to establish paternity and prefer a verbal promise of assistance for the teen mother and child. Although a verbal commitment may be acceptable when the child is born, the mother may become more inclined to pursue the establishment of paternity later when the relationship ends or when reasons arise related to the financial, social, or emotional needs of the child. Young women who receive state or federal assistance (e.g., Aid to Dependent Children, Medicaid) may be asked to name the child's father so that the judicial process can be used to establish paternity. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 772

The challenges faced by a pregnant teen when attempting to establish paternity may be impacted by: a. beliefs that impregnating a women proves masculinity. b. demands for involvement in the child's birth. c. denial of paternity because of associated financial obligations. d. involvement of the legal system to acknowledge paternity.

ANS: A Healthy People 2020 seeks to reduce pregnancies among teenagers, decrease the number of adolescents engaging in sexual intercourse before age 15 years, increase the number of adolescents who have never engaged in sexual intercourse, increase the use of barrier methods and other contraceptive methods among sexually active teens, and increase the number of young adults who have received formal instruction on reproductive issues before turning age 18 years. In addition, providing anticipatory guidance to the entire family can model open discussions about sexually related issues in a manner that increases parent-teen dialogue. All of the activities listed above are appropriate interventions by the nurse during a home visit. Anticipatory guidance regarding sexuality issues directly addresses the Healthy People 2020 objectives related to family planning. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 770

The community health nurse visits the home of a pregnant teen who lives with her parents, one older brother, and two preteen sisters. The best strategy for meeting the objectives of Healthy People 2020 would be for the nurse to offer which of the following for the entire family? a. Anticipatory guidance addressing sexuality issues b. Assessment for financial assistance c. Assessment of family dynamics d. Environmental assessment addressing suitability for child rearing

ANS: C Per federal regulations (1975), the schooling and educational needs of the pregnant teen must be met. The potential for a closely spaced second birth may be lessened by the teen's return to school. The nurse can coordinate with the school to tailor efforts to keep the student in school. The nurse should also discuss self-care activities with the student and make related needs known to the school's teachers and staff. Specific areas to be addressed include the need to use the bathroom frequently, the need to carry and drink more fluids or snacks to relieve nausea, the need to avoid climbing stairs and carrying heavy book bags, and problems fitting comfortably behind stationary desks. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 777

The nurse is following a pregnant teen who attends the local high school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy and assist in keeping the teen in school. The nurse's interventions will involve the teen and the staff and teachers at the local high school. These interventions should address specific needs related to: a. adequate hydration and screening for depression. b. desk space and desk location in the classroom. c. frequency of bathroom breaks and modifications to bookbag weight. d. use of the stairs and consumption of high-carbohydrate sodas for snacks.

When making a home visit to a low income, frail, older persons home, a nurse would most likely suspect adult maltreatment if:

The older person reports giving money to family members on a regular basis

ANS: A Many teenagers who become pregnant are caught in a cycle of poverty, school failure, and limited life options. A disproportionate number of teens who give birth are poor (more than 75%), have limited educational achievements, and see few advantages in delaying pregnancy because they do not expect that their circumstances will improve at a later time. Cognitive Level: Analysis Associated Chapter Objective: 2 & 6 REF: p. 767

When planning a program for pregnant adolescents, the nurse should be aware that pregnant adolescents who decide to have a child experience an increased risk for: a. reduced lifetime earning potential. b. eating disorders. c. genetic diseases in their infants. d. weight gain.

In which situation is child abuse most likely to occur?

When the parents lack a social support network

Which group has the highest rate of violence?

Young, minority men