Chapter 27: HIV Infection, Hepatitis, Tuberculosis, and Sexually Transmitted Diseases, Chapter 30 - The Nurse in Home Health and Hospice, Ch. 29: The Faith Community Nurse, Ch. 31: The Nurse in the Schools, Ch. 32: The Nurse in Occupational Health

a

A nurse orienting to the home health role states, "I don't understand why we have to collaborate with so many other disciplines; this conflicts with the concept of nurses providing all direct care to the client in the home" Which of the following would be the best response? a. "The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care." b. "Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible." c. "Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base." d. "Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration."

A client diagnosed with human papillomavirus (HPV) states to the nurse, "I'm not concerned; I know the lesions disappear after a while." The nurse should counsel the client on which of the following? (Select all that apply.) A. The link between HPV and cervical cancer B. The fact that HPV is a reportable disease C. The need to surgically remove tumors, if present D. The serious complications for men E. The lack of a cure

A. The link between HPV and cervical cancer C. The need to surgically remove tumors, if present E. The lack of a cure

Nurses in community health conducting health education classes for populations vulnerable to HIV/AIDS should explain the natural history of the progression of human immunodeficiency virus (HIV). Of particular importance is the fact that the disease may go undetected during the primary infection phase because: A. antibody tests are typically negative. B. the immune system increases antibody production. C. the incubation period is prolonged. D. symptoms include myalgias, sore throat, and rash.

A. antibody tests are typically negative.

A strategy that may improve compliance with tuberculosis (TB) treatment is the: A. expansion of directly observed therapy. B. increased tuberculosis testing protocols. C. increased confirmatory testing protocols. D. treatment compliance education.

A. expansion of directly observed therapy.

6. A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. I wouldnt sit next to someone with HIV. b. Having unprotected sex with someone who is infected spreads HIV. c. Sharing needles when shooting up drugs spreads HIV. d. Transfusions of blood products that are contaminated can spread HIV.

ANS: A HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. Worldwide, the largest number of HIV infections result from heterosexual transmission.

10. A male client visits the clinic office complaining of a yellow, green discharge from his penis. Which of the following STDs has the client most likely contracted? a. Gonorrhea b. Syphilis c. Herpes simplex virus 2 d. Human papillomavirus

ANS: A The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility.

13. Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

ANS: A Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

12. A school nurse is administering medications at the school. Which of the following guidelines should be followed? A. A current drug reference should be available in case information is needed B. The nurse should administer medications brought in from home by the child C. Medications cannot be administered without a physician order D. Narcotics and controlled substances should be kept in a locked cabinet

ANS: A A current drug reference should be available in case information is needed A current drug reference should always be available so that it can be consulted for information. DIF: Cognitive Level: Apply (Application) REF: pp. 575-576

15. A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program. Which of the following is the school nurse most likely trying to prevent? A. Adolescent suicides B. Bullying C. Obesity D. Teenagers engaging in violence

ANS: A Adolescent suicides Suicide is the third leading cause of death in teenagers. To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses. DIF: Cognitive Level: Apply (Application) REF: p. 577

1. Which of the following best describes the primary difference between parish nursing and all other nursing positions? A. Affiliation with a church or congregation B. Incorporation of spiritual aspects into nursing care C. Provision of holistic nursing care D. Residence within the community of service

ANS: A Affiliation with a church or congregation In 1998 the American Nurses Association accepted parish nursing as the most recognized term for the practice of nurses working with congregations or faith communities. All nurses may choose to incorporate spiritual aspects into holistic nursing care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 536

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

ANS: A Anxiety, depression, and exhaustion An estimated 10% of Americans do some form of shift work that has the potential to lead to a variety of psychological and physical problems, including exhaustion, depression, anxiety, and gastrointestinal disturbance. Strategies to minimize the adverse effects of shift work, such as rotating shifts clockwise, are beneficial. DIF: Cognitive Level: Apply (Application) REF: p. 593

c

A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurse's current focus? a. Outcome identification b. Planning c. Implementation d. Evaluation

c

A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the best approach for the nurse to take? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

d

A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital. Which of the following is the best explanation for this? a. Home care assessment includes not only the client but the supplies and equipment the family may have available for use. b. The home environment is less organized and equipped for the nurse's use. c. Family members must also be assessed for possible problems that could interfere with the primary client's recovery. d. To be effective, the home health nurse must earn the family's trust and work in partnership with them.

d

A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident. Which of the following types of care will he most likely receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

b

A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. Which of the following best describes this type of nursing? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing

6. Which of the following statements best describes how clients and parish nurses typically perceive spiritual health? A. It exists at the point that cure is attained. B. It has a tangential relation to well-being. C. It is part of an ongoing dynamic process. D. It is usually unchanging across the life span.

ANS: C It is part of an ongoing dynamic process. Health, spiritual health, and healing are considered parts of an ongoing, dynamic process. Because spiritual health is central to well-being, influences are evident in the total individual and noted in a healthy congregation. Well-being and illness may occur simultaneously; spiritual healing or well-being can exist in the absence of cure. DIF: Cognitive Level: Understand (Comprehension) REF: p. 540

5. The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis

ANS: D HIV-infected persons who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB.

11. A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching

ANS: D Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

16. A client who is very upset says to the nurse, But we always used a condom! How could I have genital warts? Which of the following would be the best response by the nurse? a. Are you positive you always used a condom? b. Condoms dont always work. c. The condom might have had a tear in the latex. d. Skin to skin contact to a wart may have occurred outside the area that the condom covers.

ANS: D The challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur.

b

Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two boards of experts. b. Continuity of care is enhanced. c. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation. d. They are eligible for tax exemptions through affiliated agencies.

c

Which of the following is the primary focus of hospice care? a. Curing or controlling the client's chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves

b

Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associate's degree in nursing and RN licensure d. Eligibility for certification as a home health nurse

b

Which of the following statements best describes the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client's environment. c. Reimbursement for home health care varies from that of care provided in institutions. d. The focus of acute client care is on community health.

c

Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies

1. Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Herpes

ANS: C At the time of this writing, HBV infection can be prevented by immunization; vaccines for the remaining options are not yet available.

9. A nurse is considering accepting the parish nursing position within his congregation. Which of the following educational preparation is crucial for the nurse to have received? A. Baccalaureate education including community health nursing experience B. Graduate education in community health nursing C. Passing the national certifying exam for parish health nursing D. Worship experiences for the process of ministry

ANS: A Baccalaureate education including community health nursing experience Current educational preparation for the parish nurse includes the successful completion of extensive continuing education contact hours or designated coursework in parish nurse preparation at the baccalaureate or graduate level, as well as a thorough grasp of the scope and standards of the practice. These basic programs provide an orientation to the role and functions of the parish nurse, as well as worship experiences for the process of ministry. The parish nurse must be a member of the faith community and be comfortable with worship practices and traditions to function. DIF: Cognitive Level: Apply (Application) REF: p. 542

3. Which of the following best describes why it is helpful to be a member of a faith community? A. Belief and traditions help with coping. B. Members can ask others in the group for help. C. It is a social outlet. D. Members are able to get others to contribute to the causes they support.

ANS: A Belief and traditions help with coping. Although there is some truth in all the options, persons who encounter assaults with physical and emotional illness and brokenness and who are able to call upon their faith beliefs and religious traditions are able to increase coping skills and realize spiritual growth even during adversity. DIF: Cognitive Level: Understand (Comprehension) REF: p. 538

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

ANS: A Each sick nurse Each worker represents a host within the worker population group. DIF: Cognitive Level: Apply (Application) REF: p. 590

9. A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? A. Educate students about injury prevention measures B. Provide free condoms to sexually active students C. Screen for signs and symptoms of cancer D. Invite a guest speaker to talk about living with HIV

ANS: A Educate students about injury prevention measures Injuries are the leading cause of death in children and teenagers; therefore, prevention measures should focus on injury prevention. Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety. DIF: Cognitive Level: Apply (Application) REF: p. 573

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

ANS: A Housekeeping staff Transmission of tuberculosis (TB) within health care settings has reemerged as a major public health problem. Outbreaks of this type of TB have been reported in hospitals, and some workers have developed active drug-resistant TB. Many workers in these settings are employed as maintenance workers, security guards, aides, or cleaning people, who tend not to be well protected from inadvertent exposures, which include contaminated bed linen in the laundry, soiled equipment, and trash containing contaminated dressings or specimens. DIF: Cognitive Level: Understand (Comprehension) REF: p. 591

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

ANS: A New workers employed less than 1 year The population group at greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job.. Because of the inherent risks, the nurse should spend extra time with this group to decrease risk. DIF: Cognitive Level: Understand (Comprehension) REF: p. 590

7. The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? A. Primary B. Secondary C. Tertiary D. Both primary and secondary

ANS: A Primary Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol. DIF: Cognitive Level: Apply (Application) REF: p. 572

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

ANS: A The chemical Agents represent potential dangers or risk to the health and safety of workers. If the flask had broken and glass got into the employee's eye, then the flask would be an agent. However, in the case given, the chemical itself caused the damage. DIF: Cognitive Level: Apply (Application) REF: p. 591

24. 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.

ANS: A, B A. It is autonomous, because the occupational nurse works independently. B. The major focus is on the environment. Occupational health specialty practice focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment. It involves the prevention of adverse health effects from occupational and environmental hazards. It provides for and delivers occupational and environmental health and safety services to workers, worker populations, and community groups. It is an autonomous specialty, and nurses make independent nursing judgments in providing health care. All nurses should engage in health promotion and disease prevention, and many specialties provide care in the community. Several specialties (such as advanced practice nurses) are required to be nationally certified to be employed. DIF: Cognitive Level: Understand (Comprehension) REF: p. 586

25. 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.

ANS: A, B, D 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. D. Many employees will be older and suffer chronic health problems. Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. The workforce will become older, including many employees with chronic health problems. By the year 2020, minorities are projected to constitute 20.6% of the workforce and women approximately 47% of the workforce (Toossi, 2012). The U.S. economy was once based on agriculture, then primarily on manufacturing, and now on highly technological positions. Currently, service-providing positions account for virtually all job growth; soon almost one of every two worker jobs will be in service positions. DIF: Cognitive Level: Understand (Comprehension) REF: p. 588

8. Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the clients name, address, or contact information? a. Client doesnt actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test and collection agencies will not be able to harass them. d. Client wants to be sure care providers dont share results with their family.

ANS: B An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination.

15. Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a cauliflower appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

ANS: B HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter.

12. Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs b. It can cause problems in infants born to infected mothers c. It is not frequently seen in the United States d. It is so difficult and expensive to treat

ANS: B Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers, although it is rather easily treated with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

14. When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs. b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. c. The presence of an STD in women with cervical cancer may lead to congenital defects in offspring. d. The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.

ANS: B The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information.

8. A group of parish nurses affiliated with a number of faith-based communities located in different regions across the state are attending a quarterly meeting. Which of the following statements made by one of them indicates a lack of understanding of parish nursing? A. "I always make sure to have new clients sign a release of information form to obtain their health record from their previous parish nurse." B. "Because I work for and within the church, I am immune from civil laws." C. "The pastor and I work together for the spiritual health of the community." D. "Yes, I am happy to pray with my clients and help them worship."

ANS: B "Because I work for and within the church, I am immune from civil laws." The nurse must personally and professionally abide by the parameters of the nurse practice act of the jurisdiction and maintain an active license of that state. DIF: Cognitive Level: Apply (Application) REF: p. 541

13. An upset mother calls the school nurse and says, "How dare you say my child has lice? My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? A. "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." B. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." C. "You may have been traveling. Lice are often found in motels." D. "I'm sure you're correct; one of my volunteers probably made an error. I'll recheck."

ANS: B "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life-threatening, and the necessary shampoo and other items to treat lice are widely available over the counter. DIF: Cognitive Level: Apply (Application) REF: p. 576

12. A faith community nurse is partnering with a local public health department to develop programs for primary, secondary, and tertiary prevention activities. Which of the following should be used as the primary guide for development? A. Contemporary articles in nursing journals B. Evidence-based practice guidelines for treatment of disease C. Healthy People 2020 goals and objectives D. Preferences of partners who are funding the programs

ANS: C Healthy People 2020 goals and objectives Healthy People 2020 guidelines are basic to the planning of health care. Evidence-based practice is for treatment, not for program development. DIF: Cognitive Level: Apply (Application) REF: p. 544

14. Which of the following statements by a parish nurse exhibits a lack of understanding of the concept of pastoral care? A. "By working with my clients to help them identify their spiritual strengths, I am drawing on pastoral care aspects of practice." B. "To incorporate pastoral care, I should involve the pastor in ministering to the members of the congregation." C. "I use pastoral care when I emphasize the spiritual dimension of nursing when providing care." D. "When I lend support to my clients during times of joy, as well as during their times of sorrow, this illustrates an important aspect of pastoral care."

ANS: B "To incorporate pastoral care, I should involve the pastor in ministering to the members of the congregation." The nurse fulfills the role of pastoral care through stressing the spiritual dimension of nursing, lending support during times of joy and sorrow, guiding the person through health and illness throughout life, and helping identify the spiritual strengths that assist in coping with particular events. Pastoral care is a service ministry formalized by a church or faith community, not necessarily involving the pastor. DIF: Cognitive Level: Apply (Application) REF: pp. 545-546

8. Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car, and wearing a helmet when biking or skateboarding? A. Because children won't know if someone doesn't tell them B. Because injuries are the leading cause of death in children and most injuries are preventable C. Because it is a dangerous world and someone has to warn children about the dangers D. Because teaching is easy and more fun than passing out bandages and documenting care

ANS: B Because injuries are the leading cause of death in children and most injuries are preventable The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 573

6. Which of the following best describes services that are offered at a school-based health center? A. Employee care at a discounted cost at the school B. Care to others in the community C. Sex education, birth control, family planning, and care throughout pregnancy D. Referral and networking with other health care services in the community

ANS: B Care to others in the community School-based health centers give care not only to students but also to other persons in the community. They may provide social services, daycare, job training, and educational counseling in addition to the medical and nursing care, mental health counseling, and dental care seen in smaller school-based centers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

4. At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? A. Consultant B. Community outreach C. Counselor D. Researcher

ANS: B Community outreach When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools. DIF: Cognitive Level: Apply (Application) REF: p. 570

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.

ANS: B Companies have improved safety of working conditions because worker's compensation insurance premiums are now based on previous claims. Workers' compensation acts are important state laws that govern financial compensation of employees who suffer work-related health problems. Each state sets rules for the reimbursement of employees with occupational health problems for medical expenses and lost work time associated with the illness or injury. Workers' compensation claims and the experience-based insurance premiums paid by industry have been important motivators for increasing the health and safety of the workplace. DIF: Cognitive Level: Understand (Comprehension) REF: p. 600

3. A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? A. Case manager B. Consultant C. Counselor D. Health educator

ANS: B Consultant The school nurse is the person best able to provide health information to school administrators, teachers, and parent-teacher groups. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The nurse also can recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places. DIF: Cognitive Level: Apply (Application) REF: p. 570

13. A parish nurse is evaluating health programs that provide holistic care across the life span. Which of the following methods would be the most appropriate approach? A. Bringing families together to plan programs to meet the needs of individuals B. Establishing a wellness committee to assist in the evaluation process C. Matching financial resources with program objectives and goals D. Revisiting assessment data to be certain that planning reflects actual problems observed

ANS: B Establishing a wellness committee to assist in the evaluation process The nurse and members of the congregation assess, plan, implement, and evaluate programs. The process of providing holistic care is enhanced by an active wellness committee or health cabinet. The other options deal with factors other than program evaluation. DIF: Cognitive Level: Apply (Application) REF: p. 544

2. To help congregation members better meet their nutritional needs, the parish nurse organized members to participate in activities that focused on fellowship while providing healthy meals to homebound members and serving "healthy heart" church suppers. Which of the following activities is being completed? A. Entitlement programs B. Health ministries C. Partnerships D. Pastoral care practices

ANS: B Health ministries Health ministries are those activities and programs in faith communities organized around health and healing to promote wholeness in health across the life span. These services include activities such as visiting the homebound, providing meals for families in crisis or when returning home after hospitalization, organizing prayer circles, serving "healthy heart" church suppers, and holding regular grief support groups. DIF: Cognitive Level: Apply (Application) REF: p. 536

15. A parish nurse is using the institution-based model to plan care for a client with a chronic illness. Which of the following activities would the nurse most likely implement? A. Bringing in family members to work with the client and nurse in decision making B. Partnering with outlying health care centers for coordinating optimal care C. Pulling from the collective strengths of faith-based community members for social support for the client D. Relying on congregational prayer as a component of healing

ANS: B Partnering with outlying health care centers for coordinating optimal care The institution-based model includes greater collaboration and partnerships. The nurse may be in a contractual relationship with hospitals, medical centers, long-term care establishments, or educational institutions. Therefore, although the nurse may do all of these things, the item that is related to the institution-based model is partnering with outlying health care centers. DIF: Cognitive Level: Apply (Application) REF: p. 536

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

ANS: B Primary prevention Delivery of primary prevention services to employees is directed toward promoting health and averting a problem. Primary prevention is attempting to avoid harm through protecting measures, in this case reducing ear damage due to high noise levels and eye damage from flying particles or fluids. DIF: Cognitive Level: Apply (Application) REF: p. 595

10. The school nurse has arranged for volunteers to help check each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? A. Primary B. Secondary C. Tertiary D. Both primary and secondary

ANS: B Secondary Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers. DIF: Cognitive Level: Apply (Application) REF: p. 574

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

ANS: B Secondary prevention Secondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible moment in its course and elimination or modification of the hazard-producing situation. DIF: Cognitive Level: Apply (Application) REF: p. 595

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

ANS: B To ensure safe and healthful working conditions The Occupational Safety and Health Act of 1970 had as its purpose to ensure "safe and healthful working conditions for working men and women." DIF: Cognitive Level: Remember (Knowledge) REF: pp. 599-600

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

ANS: B To limit disability Interventions aimed at disability limitation are intended to prevent further harm or deterioration, and they include referral for counseling and treatment of an employee with an emotional or mental health problem whose work performance has deteriorated and removal of workers from heavy metal exposure who manifest neurological symptoms. DIF: Cognitive Level: Apply (Application) REF: p. 595

28. 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

ANS: B, C 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 All business organizations are classified within the North American Industry Classification System (NAICS) with a numerical code. This code, usually a digit to digit number, indicates a company's product and, therefore, the possible types of occupational health hazards that may be associated with the processes and materials used by its employees. NAICS codes are used to collect and report data on businesses. For example, illness and injury rates of one company are compared with the rates of other companies of similar size with the same NAICS code to determine whether the company is having an excess of illness or injury. By knowing the NAICS code of a company, a health care professional can access reference books that describe the usual processes, materials, and by-products of that kind of company. DIF: Cognitive Level: Apply (Application) REF: pp. 596-599

27. 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

ANS: B, D B. To avoid the cost of liability suits, workers' compensation, etc. D. To meet legislated standards and avoid significant penalties for noncompliance Legislation at the federal and state levels has had a significant effect on efforts to provide a healthy and safe environment for all workers. OSHA employees have distributed citations to companies that do not meet minimal occupational health and safety standards. Criminal charges have been filed against business owners when preventable work-related deaths have occurred. Another important stimulus for health and safety programs is the desire to avoid the cost of liability and workers' compensation claims and other expenses when employees are injured or killed. DIF: Cognitive Level: Understand (Comprehension) REF: p. 594

9. A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a. Side effects of PrEP include extreme lethargy and joint pain. b. PrEP has been shown to be effective in preventing transmission of the disease from sharing needles. c. The effectiveness of PrEP will depend on your adherence to the medication regimen. d. PrEP will prevent you from contracting HIV and Hepatitis B.

ANS: C Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b).

7. In the United States, which demographic group has the highest risk for HIV infection? a. African-American homosexual men b. Hispanic IV drug abusers c. White homosexual men d. White lesbians

ANS: C The largest number of new HIV infections in 2009 (11,400) were in white men who had sex with other men (MSM), and this was followed by black MSM (10,800).

2. Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear results will be positive. b. They avoid the problem (maybe it will go away). c. They dont recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

ANS: C When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV.

11. Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? A. Tell all staff to call 911 if the nurse is not in the building. B. Arrange to always be available, even if only by phone. C. Create and share an emergency plan with all teachers and staff. D. Wear a pager so that the nurse can come as soon as humanly possible.

ANS: C Create and share an emergency plan with all teachers and staff. The American Health Association recommends that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 574-575

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

ANS: C Emergency departments and psychiatric units Nonfatal violence in the health care worker's workplace is a serious problem that seems to be underreported. Much of the study of health care worker violence has been in psychiatric settings and emergency departments. DIF: Cognitive Level: Understand (Comprehension) REF: p. 593

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.

ANS: C Exhaustive inventory of chemicals and industrial hazards is completed. The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of company and community. The nurse is often a key person on the disaster planning team. The potential for disaster must be identified; this is best achieved by completing an exhaustive chemical and hazard inventory of the workplace. The MSDSs and plant blueprints are critical for correctly identifying substances and work areas that may be hazardous. Worksite surveys are the first step to completing this inventory. DIF: Cognitive Level: Remember (Knowledge) REF: p. 601

1. According to the American Academy of Pediatrics, which of the following activities are expectations for a school health nurse? A. Ensuring that children with health problems are accepted by their peers B. Driving children home if parents can't pick them up C. Giving emergency care in the school or during school events D. Giving medications as needed if children are ill

ANS: C Giving emergency care in the school or during school events School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school; keeping track of the state-required vaccinations that children have received; carrying out the required screening of the children based on state law; and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics. DIF: Cognitive Level: Understand (Comprehension) REF: p. 569

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

ANS: C Having employees use safety measures and personal protective equipment Various control strategies are used to eliminate or reduce exposure and hence risk. Engineering controls can reduce worker exposure by modifying the exposure source. Administrative controls reduce exposure through job rotation, workplace monitoring, and employee training and education. Personal protective control is the last resort and requires the worker to actively engage in strategies for protection such as use of gloves, masks, and gowns to prevent blood/body fluid exposure. External controls—the way equipment is built or manufacturing processes are established—are controllable and much more effective than asking a great many individuals to engage in behaviors that they may not want to do (such as using personal protective equipment). Humans are much less programmable than external controls. DIF: Cognitive Level: Analyze (Analysis) REF: p. 599

2. Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? A. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. B. Most nurses prefer to be employed in hospitals giving direct care. C. Most school districts are unable to afford a nurse in every school. D. School districts and taxpayers see no need for nurses in schools.

ANS: C Most school districts are unable to afford a nurse in every school. In Healthy People 2020, objective ECBP-5 states that there should be one nurse for every 750 children in each school (U.S. Department of Health and Human Services, 2010). Most schools have not achieved this objective. In 2006, approximately 40% of the nation's schools met that standard. The new objective is that 44.7% of the country's elementary, middle, junior high, and senior high schools have this many nurses by 2020 (U.S. Department of Health and Human Services, 2010). Having fewer nurses in the schools means that the nurses are expected to perform many different functions. It is therefore possible that they are unable to provide the amount of comprehensive care that the students need (Croghan, 2009). DIF: Cognitive Level: Understand (Comprehension) REF: p. 569

5. A young woman had been away from home several years before she returned home sick and disheartened. Her mother called a nurse to help. Which of the following behaviors would suggest that the caregiver who arrived was a parish nurse? A. Advanced nursing practice education and skills B. Compassionate, skilled, dedicated touch C. Offered a prayer with the daughter and mother D. Willingness to do whatever was needed by mother or daughter

ANS: C Offered a prayer with the daughter and mother Although all options hopefully would occur, the spiritual dimension of health care is central to the practice of parish nursing. Both nursing functions and pastoral care functions are performed by parish nurses, whose visits often involve prayer and reference to scripture, symbols, sacraments, and liturgy of the faith community. DIF: Cognitive Level: Apply (Application) REF: pp. 539-540

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

ANS: C Secondary prevention This does not meet the criteria for injury prevention because the injury has already occurred. The nurse is engaging in secondary prevention when providing treatment for the injury. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the foreign body from developing. DIF: Cognitive Level: Apply (Application) REF: p. 595

4. Which of the following principles is central to the role of the parish nurse? A. Advanced nursing practice education and skills B. Faith consistent with the community and its leadership C. Spiritual dimension of care D. Willingness to serve anyone in need

ANS: C Spiritual dimension of care Although all options would be helpful, the spiritual dimension of health care is central to the practice of parish nursing. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 539-540

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.

ANS: C This data will help identify patterns in the risk factors associated with a particular subgroup. When health data are considered collectively, the nurse may determine some patterns in risk factors associated with the occurrence of particular injuries and illnesses in a total population of clients. There is no mention of consent, so the nurse should not be collating research data. Grants for funding typically require current client data rather than trends. DIF: Cognitive Level: Analyze (Analysis) REF: p. 596

26. 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.

ANS: C, D C. Effects of chemicals can be cumulative. D. Interactions of chemicals are typically unknown. Of the approximately 2 million known chemicals in existence, less than 0.1% have been adequately studied for their effects on humans. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. A variety of chemicals are found in the body tissues of the general population. Daily, low-level doses of chemicals may be below the exposure standards but may still carry a potentially chronic and perhaps cumulative assault on workers' health. Predicting human responses to such exposures is further complicated because several chemicals are often combined to create a new chemical agent. Human effects may be associated with the interaction of these agents rather than with a single chemical. Another concern about occupational exposure to chemicals is reproductive health effects. DIF: Cognitive Level: Understand (Comprehension) REF: p. 591

4. A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test. b. A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure. c. A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood. d. A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml.

ANS: D AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

A population-level tertiary prevention intervention typically performed by nurses and aimed at controlling communicable diseases is: A. HIV test counseling. B. needle-exchange program. C. partner notification. D. standard precautions teaching.

D. standard precautions teaching.

3. A client was clearly very relieved when an HIV test came back negative. Thank goodness. Ive had sex several times without a condom, and when one of my friends said he was sick, I think I panicked. Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV-free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks. All persons who have an STD test should be counseled about risk-reduction activities before and after the test is done.

10. A family shared their concerns, including sexual issues, in strictest confidence with a faith community nurse. When the nurse returned to the church office, the pastor asked why the family wanted to see her. Which of the following statements would be the best response by the nurse? A. "Because you are my supervisor, I will summarize what was said for you." B. "I will include that information in my report to our church's wellness committee." C. "They just wanted me to assess their health needs and make some suggestions." D. "The family had some issues they wanted to discuss in confidence, which I will keep in confidence."

ANS: D "The family had some issues they wanted to discuss in confidence, which I will keep in confidence." Issues of privacy and confidentiality as well as record management should be discussed upon accepting a position. Regardless, if the nurse agreed to keep the information confidential, the nurse is morally obligated to do so. If the practice is to share all information with the pastor, then the family must be told this before they choose to share any information with the nurse. DIF: Cognitive Level: Apply (Application) REF: p. 543

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?"

ANS: D "Where do you work and what do you do there?" All of these questions are appropriate during a routine physical. However, the question often omitted is, "Where do you work and what do you do there?" The occupational health history is an indispensable component of the health assessment of individuals. Because work is a part of life for most people, including an occupational health history in all routine nursing assessments is essential. DIF: Cognitive Level: Apply (Application) REF: p. 595

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?"

ANS: D "Where were you previously employed and what did you do there?" All of these questions are appropriate during a routine physical for a person who has retired, because they relate to current problems, recreation, and mental health. However, the most crucial question is, "Where were you previously employed and what did you do there?" The occupational health history is an indispensable component of the health assessment. All persons should be questioned about their employment history. To describe only a current status of "retired" may lead to the omission of needed data.. Even for retired persons, the nurse must ask about employment history, because many problems take years to manifest in signs and symptoms. DIF: Cognitive Level: Apply (Application) REF: p. 596

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.

ANS: D It provides a cost savings to the company. A significant increase in the number of health promotion and employee assistance programs offered has occurred. Health promotion programs focus on lifestyle choices that cause risks to health such as obesity or smoking. Employee assistance programs are designed to address personal problems (e.g., marital/family issues, substance abuse, financial difficulties) that affect the employee's productivity. Such efforts are cost effective for businesses. DIF: Cognitive Level: Understand (Comprehension) REF: p. 595

14. A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? A. Ask the student if abuse has occurred. B. Call in the named student and ask him to remove his shirt. C. Discuss the conversation with the student's parents. D. Notify the legal authorities.

ANS: D Notify the legal authorities. When the nurse identifies a child who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school's principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information. DIF: Cognitive Level: Apply (Application) REF: p. 576

b

In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

5. Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? A. Teacher shortages have required nurses to be increasingly involved in teaching life skills. B. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. C. States are requiring nurses to screen and to teach life skills. D. Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children.

ANS: D Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children. School health nurses were originally involved in this capacity in 1987 after the CDC began funding schools for HIV-prevention education programs. This program was so successful that it was expanded to include programs to teach children prevention of other chronic illnesses caused in part by risk factors such as poor diet, lack of exercise, and smoking. The schools are actively involved in helping the children practice problem solving, communication, and other life skills so that they can reduce their risk factors for health problems. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

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

ANS: D Psychosocial norms of the setting The employee will only be safe if the employee uses the PPE. If the employee doesn't use the PPE or uses only part of the equipment, then the employee will be at risk. The primary determination of whether the PPE is used correctly and used all the time is the psychosocial norms of the setting. If others are careless in PPE use, then such carelessness is the norm. If everyone is extremely careful to use their PPE, then that is the norm in that setting. DIF: Cognitive Level: Apply (Application) REF: p. 594

11. A father confides to the parish nurse that his wife has been hurting their 3-year-old daughter. The nurse examines the daughter and finds evidence of physical abuse. In the parish nurse role, which of the following actions should the nurse take first? A. Contact the pastor for guidance in handling this situation. B. Recommend that the family be removed from the faith community. C. Refer the family to pastoral services for counseling. D. Report the findings to child protective services.

ANS: D Report the findings to child protective services. As an advocate of client and group rights, the nurse identifies and reports neglect, abuse, and illegal behaviors to the appropriate legal sources. This is necessary regardless of the feelings of the pastor or the father because the nurse is bound legally to report abuse to a child, confirmed or suspected. Referral for counseling is appropriate; however, the child's present state of well-being is paramount. Parish nurses must obey the nurse practice act and laws of the state. DIF: Cognitive Level: Apply (Application) REF: p. 543

7. Which of the following statements suggests that faith community nursing is a nationally recognized specialty of nursing? A. Academic programs now offer a clinical specialty in parish nursing. B. Faith community nurses are increasingly receiving salaries for their efforts. C. Faith community nursing is being adapted in other countries and to non-Christian faiths. D. Scope and standards of faith community practice have been developed and revised.

ANS: D Scope and standards of faith community practice have been developed and revised. The 2005 Faith Community Nursing: Scope and Standards of Practice revised the original 1998 document in describing the who, what, where, when, why, and how of the practice of faith community nursing. The most recent edition, released in 2012, focuses on faith community nurses but is also aimed at other healthcare providers, spiritual leaders, families, and members of faith communities. Specialty areas within professional nursing achieve a major milestone when the standards and scope common to that practice are recognizeD. DIF: Cognitive Level: Understand (Comprehension) REF: p. 541

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

ANS: D Sprains and strains In 2010, sprains, strains, and tears were by far the most frequent disabling conditions, accounting for 46.9% of days away from work (Bureau of Labor Statistics, 2011). DIF: Cognitive Level: Understand (Comprehension) REF: p. 592

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.

ANS: D There is no "safe" occupation or profession. Most adults spend about one third of their time at work. Every single industry grapples with serious hazard. No work is completely risk free. DIF: Cognitive Level: Apply (Application) REF: p. 586

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

ANS: D To continue employment and income with limited duty as a rehabilitation effort after an injury Rehabilitation strategies such as return-to-work programs after a heart attack or limited duty programs after a cumulative trauma injury are examples of tertiary prevention. Tertiary prevention is intended to restore health as fully as possible and assist individuals to achieve their maximum level of functioning. DIF: Cognitive Level: Analyze (Analysis) REF: p. 595

c

When meeting with a client and family, the home health nurse says, "We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve." In which of the following phases of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning

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

ANS: D To observe effectiveness of safety education and equipment The nurse may conduct an assessment of the workplace itself, which is known as a worksite walk-through or survey. Direct observation allows the nurse to learn about the work processes and the materials; the requirements of various jobs; the presence of actual or potential hazards; and the work practices of employees. Such information is directly useful in planning programs, assessing their effectiveness, and reinforcing safety with individuals who have been seen behaving in a less than safe manner. DIF: Cognitive Level: Apply (Application) REF: p. 596

The nurse in community health is aware that HIV-infected children should attend school, because the benefit of attendance far outweighs the risk of transmitting or acquiring infections. School attendance should be reconsidered when there is evidence of: A. availability of homebound instruction. B. cases of measles. C. lack of handicapped access. D. prejudice of teachers and/or students.

B. cases of measles.

A client presents at the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a day care center. These facts are important because: A. acute hepatitis B is self-limiting. B. hepatitis A outbreaks are common in facilities where staff change diapers. C. hepatitis C is the "silent stalker." D. persons with chronic liver disease are at greater risk for hepatitis A.

B. hepatitis A outbreaks are common in facilities where staff change diapers.

Many behaviors place individuals of all ages, genders, ethnicities, or any other factors at greater risk for sexually transmitted diseases (STDs). The nurse should include primary prevention interventions in all client encounters through the discussion of: A. partner notification. B. safer sex. C. standard precautions. D. STD testing.

B. safer sex.

A young female client visits a local clinic, seeking treatment for a urinary tract infection (UTI). During the assessment, the nurse conducts an extensive sexual history/activity screening to determine the risk for a sexually transmitted disease and potential complication of: A. genital warts. B. herpes simplex virus 1. C. pelvic inflammatory disease (PID). D. primary syphilis.

C. pelvic inflammatory disease (PID).

The primary prevention of hepatitis C virus (HCV) includes: A. counseling and follow-up of infected clients. B. routine testing for health care workers. C. screening of blood products. D. testing of high-risk individuals.

C. screening of blood products.

c

Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her family than to meet the needs of a dying adult? a. Children don't understand what it means to die. b. A child's death is harder for anyone to accept. c. Society does not expect death to occur in children. d. Families are not prepared to deal with death.

During the last stage of AIDS, many opportunistic infections proliferate in persons with weakened immune systems. HIV-infected individuals who live near one another in long-term care facilities, drug treatment facilities, and prisons should be carefully screened before admission because they are at greater risk for acquiring: A. fungal disease. B. invasive cervical cancer. C. oral candidiasis. D. pulmonary tuberculosis (TB).

D. pulmonary tuberculosis (TB).

d

Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC NOC c. Nursing Diagnosis Taxonomy d. The Omaha System

c

Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for extensive documentation? a. Advances in medical technology and pharmacology b. Increased number of lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s