Community 3

Which of the following situations best describes when a person would most likely be very unhappy and perhaps ill after retirement? (Select all that apply.) a. If their family total income is now less than when he or she was employed b. If the retirement was involuntary c. If the person's self-image was based on job role and status d. If the person has no outside interests or leisure activities e. If his or her spouse did not appreciate input into their schedules or activities f. If the person believes others are now taking credit for his or her achievements

B, C, D, E Retirement can be a happy occasion when it is planned and the person has many activities to which to devote time and energy. Retirement is often a happy occasion when planned and voluntary; however, the opposite may be true if it is involuntary. When older adults retire, they inevitably must cope with a change in social status; this may be difficult for people whose self-concept was based on job status. For retirees who are married, the spouse must also adjust to the changes related to retirement. For elders who have no hobbies or interests, this extra leisure time may be a source of boredom. Family income being less is not necessarily a stressor as many job-related expenses also disappear.

In which of the following clinical areas are nurses most at risk for workplace violence? (Select all that apply.) a. Acute care/intensive care units b. Community health clinics c. Emergency departments d. Geriatric units e. Psychiatric units f. Rehabilitation units

C, D, E In the health care field, the most frequent areas for the occurrence of violence are the emergency departments, psychiatric units, geriatric units, and waiting rooms.

Which of the following must be involved for an act to be considered a terrorist act? a. A commitment to a political or religious belief b. An attempt to force compliance with a particular set of religious or political beliefs and behaviors c. Fear, intimidation, and violence d. Violence resulting in plural deaths

C. Fear, intimidation, violence All terrorist acts include three key elements—violence, fear, and intimidation.

A nurse suspects that a client is depressed. Which of the following symptoms is most likely being exhibited by the client? (Select all that apply.) a. Paranoia b. Fatigue c. Irritability d. Difficulty concentrating e. Hallucinations f. Impulsivity

NS: B, C, D Symptoms of depression include the following: persistent sad, anxious, or "empty" feelings; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; irritability, restlessness; loss of interest in activities or hobbies once pleasurable, including sex; fatigue and decreased energy; difficulty concentrating, remembering details, and making decisions; insomnia, early-morning wakefulness, or excessive sleeping; overeating or appetite loss; thoughts of suicide, suicide attempts; aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Which of the following has shown a significant increase in usage among young people during the past five years? a. Use of marijuana b. Use of cigarettes c. Use of smokeless tobacco d. Use of alcohol

ANS: A One positive development is that teen use of cigarettes and smokeless tobacco has declined. The rate of current alcohol use among youths aged 12 to 17 was 13.6% in 2010, which was lower than the 2009 rate (14.7%). Marijuana is almost the only licit or illicit drug showing significant 5-year increases.

Which of the following scenarios involves a student who may be susceptible to problems secondary to substance dependence? (Select all that apply.) a. As soon as the student stepped outside the classroom, she lit a cigarette and inhaled deeply. b. The athlete was very proud of all the medals he had won in wrestling, even if he was worried about managing his anger outside of the gym. c. The car proceeded into the college parking lot, slowed, and stopped; the driver leaned out and vomited onto the street, then shut the door and proceeded into a parking space. d. The student had a splitting headache so took two aspirins out of the "care package" his mom had sent him over the holidays. e. The students met each night in a dorm room and proceeded to share several "herbal" cigarettes. f. The young woman in the student cafeteria ordered a third large cup of coffee and, hands shaking, continued to study for her examination.

ANS: A, B, C, E, F Use of steroids may have influenced a generation of teenaged athletes to put themselves at risk. Evidence also points at behavioral changes among those using steroids leading to an increased potential for suicide and aggressive and risky behaviors among steroid users (the athlete who is worried about managing his anger). Substance dependence is defined as three (or more) of the following criteria being exhibited anytime within the same 12-month period: (1) Tolerance, either a need for markedly increased amounts of the substance to achieve the desired effect, or a diminished effect with use of the same amount; (2) Withdrawal, either the characteristic withdrawal syndrome for the substance or the substance is taken to relieve or avoid withdrawal (the young woman who is shaking while drinking coffee); (3) The substance is taken in larger amounts or over a longer period than planned; (4) There is a desire or unsuccessful efforts to cut down or control usage; (5) Much time is spent obtaining, using, or recovering from use of the substance; (6) Involvement in important activities are decreased (students meeting in a dorm room each night to share "herbal" cigarettes); (7) Continual use despite knowledge of having a persistent or recurrent physical or psychological problem caused or exacerbated by the substance (the student smoking a cigarette immediately after leaving class, despite knowing the dangers of tobacco, and the driver vomiting into the street). Taking two aspirin out of a care package would not indicate that the student is susceptible to substance abuse problems.

Which of the following best describes the practical importance of the classifications of metropolitan, micropolitan, and noncare areas? a. Classifications are used for congressional policy-making and funding decisions. b. Metropolitan areas gained importance because of their large population. c. Micropolitan areas are now recognized for their crucial role in society. d. The new system emphasizes the extent of rural (noncare) areas.

A The new core-based statistical areas (CBSA) system includes two categories of counties: (1) metropolitan areas and (2) micropolitan areas. Counties that are neither metropolitan nor micropolitan are called "outside CBSAs," also known as noncare areas. Metropolitan areas contain at least one urbanized area of 50,000 or more people. A micropolitan area contains a cluster of 10,000 to 50,000 persons. Because the metropolitan statistical area classification is used extensively for congressional policy-making and funding decisions, there could be serious ramifications for health care financing within rural market areas.

Which of the following do expert rural nurses report as benefits of their work? (Select all that apply.) a. Ability to develop close relationships and give holistic care b. Being able to practice in the community where one lives c. Constant challenges d. Continual growth as an expert generalist e. Higher salary than in urban areas f. Intensity of purpose

A, B, C, D, F Positive aspects of rural nursing include the ability to give holistic care, to know everyone well, and to develop close relationships with the community and with coworkers. Autonomy, professional status, and being valued by the agency and community have been reported components of positive job satisfaction. The rural nurse is a generalist, and generalist is not synonymous with boring. Interviews with rural nurses show that they feel an "intensity of purpose" that makes rural nursing distinctive. Nurses living and practicing in the same place have a strong sense of integration and continuity between practice and community.

Which of the following best describes why for-profit managed care organizations (MCOs) have not begun to move into rural areas to increase the number of persons served? (Select all that apply.) a. High startup and administrative costs are needed. b. A large number of elderly are on Medicare or Medicaid, which results in low reimbursement. c. Managed care has not yet had time to go beyond major population centers. d. MCOs are waiting until federal reimbursements for underserved rural health areas become higher. e. The population is too small and too spread out. f. Rural health areas are too geographically unattractive and lack any recreational possibilities for managers to want to work there.

A, B, C, E MCOs recognize the risks to expanding into rural areas. Risks are probable high startup and administrative costs. Managed care has yet to move into much of rural America because of small dispersed populations, few visits per individual, and large numbers of elderly on Medicare with low-level reimbursements that do not make the aggregate financially attractive to MCOs. It is not likely that federal reimbursements for underserved rural health areas will become higher. The lack of attractive living for managers has not been a reason why MCOs have not moved into rural areas.

Which of the following is the drug of choice for treating persons with alcohol withdrawal? a. Antabuse b. Benzodiazepines c. Methadone d. Naltrexone

ANS: B Benzodiazepines are considered effective tools for alcohol withdrawal because they decrease the likelihood of seizures and delirium. The use of Antabuse is rare today because of serious safety issues. Naltrexone is a long-acting narcotic antagonist traditionally used as an adjunct in the treatment of opiate dependence. Methadone is the treatment of choice in withdrawal from heroin or other opiates.

A female student was extremely upset over her test results. She thought she had studied thoroughly, but her test grade would be totally unacceptable to her parents. Her friend said, "Come on, it's just the first course test. You'll do better on the next one. Let's go out and have a drink. You'll feel much better." After the first drink, how will the upset student most likely feel? a. A bit nauseous b. More relaxed and comfortable c. Ready to have a second d. Very thirsty

ANS: B If one expects a certain effect, such as relief, one is more likely to feel it after use of a drug. The satisfied expectancies may set up neural pathways that are interpreted as pleasurable. It is unlikely that the student will feel nauseous or very thirsty after the first drink. The student may feel ready to have a second, but that would be related to the relaxation and comfort experienced with the first drink.

A woman was bragging about her 12-year-old son who was quiet and spent a lot of his time in his room building model airplanes, gluing and painting pieces. Which of the following may be concerning to the nurse? a. Being preadolescent, he needs education on sexual growth and development. b. He may be inhaling fumes from the aerosol paints and glues. c. Twelve-year-olds are not usually quiet; he needs a mental health consult. d. Twelve-year-olds need physical exercise, and he is not getting any sitting around.

ANS: B Inhalants are fumes from a range of substances such as glues, aerosols, butane, and paint thinner. These products are inexpensive, legal, and easy to obtain, making them attractive to younger adolescents who have less access to illicit drugs. The nurse should first consider the age and safety of the child. Thus, it is appropriate for the nurse to consider that the child may be inhaling the fumes while working with these products. This should be the immediate concern of the nurse. Once this issue has been addressed, the nurse may want to consider the child's need for additional physical activity, limited interactions with peers, and need for education about growth and development.

A registered nurse is discovered stealing a patient's narcotic medication for personal use. Which of the following is most likely to happen to the nurse? a. The nurse can be sued by the patient for pain and suffering (because the patient did not get the medication prescribed). b. The nurse who shows acceptance of a drug problem may be allowed limited practice under supervision while undergoing treatment and monitoring. c. The nurse will go to jail like any criminal caught stealing. d. The nurse will lose employment, as well as the license allowing professional practice.

ANS: B Physicians, nurses, dentists, and pharmacists are vulnerable to substance abuse; alcohol or narcotic use is most common. Their increased access to drugs, belief in pharmaceutical solutions, and work-related stress place them at increased risk for substance abuse. Typically, they gain access to drugs through their work settings by diverting medications for their own use or by abusing drugs obtained by prescription. State regulatory boards discover the abuse by these health care professionals after drug theft or when the effects of their substance abuse impair their professional functioning. Most states have rehabilitation programs for health care professionals that consist of treatment and monitoring. They are allowed to retain their professional licenses during treatment. The threatened loss of their professional license to practice may be a good motivator to break through their denial of the problem and encourage them to seek treatment.

Which of the following provides the best description of severe mental illness (SMI)? a. Having been clearly diagnosed with at least two mental health disorders within the past year b. Having a diagnosable mental disorder with moderate functional behavior in a specific area of lifestyle at any time during the past year c. Being unable to function in society due to a mental illness d. Being convicted of several impulsive crimes during the past year

ANS: B SMI occurs in adults who currently or at any time during the past yearhave a diagnosable mental, behavioral, or emotional disorder with moderate, severe, or extreme functional behavior in specific areas of lifestyle. These mental health disorders afflicting persons who are 18 years of age or older present emotional or behavioral functioning that is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration.

Which legislation has increased funding for treatment and rehabilitation for substance abuse? a. Drug Abuse Prevention and Control Act b. Anti-Drug Abuse Acts of 1986 and 1988 c. Omnibus Transportation Employee Testing Act d. Harrison Narcotic Act of 1914

ANS: B The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation; the 1988 act created the Office of National Drug Control Policy.

Which of the following are the causes of mental illness? (Select all that apply.) a. Excessive amounts of brain serotonin, dopamine, and γ-aminobutyric acid b. Genetic inheritance combined with neurochemical and metabolic changes c. Living through a severe disaster, whether manmade or natural d. Physiological abnormalities in the brain structure e. Posttraumatic stress syndrome (PTSD) f. Social isolation, rejection, and/or stress

ANS: B, C, D, E, F Genetic expressions, combined with neurochemical and metabolic changes and environmental insults, may result in the display of mental disorder characteristics. Evidence indicates that structural brain abnormalities can be related to some mental illnesses, such as schizophrenia, depression, and Alzheimer disease. Natural and manmade disasters, such as hurricanes, floods, violence, terrorism, war, and the global economic crisis are profound stress-inducing events that can lead to mental illness. Researchers reported high levels of PTSD among survivors.

Which of the following best describes how people with mental illness are viewed by the general public? a. Individuals in need of assistance b. Criminals who need to be institutionalized c. Lazy, weak, and immoral d. Contributing members of society

ANS: C Throughout history, the symptoms of mental illness have been perceived as permanent, dangerous, frightening, and shameful. People with a diagnosis of mental illness have been described as lazy, idle, weak, immoral, irrational, and, too often, criminal.

Which of the following behaviors best represent the definition of mental health? (Select all that apply.) a. Currently enjoys receiving unemployment benefits b. Frequent dates, although most relationships are short term c. Happily married and successful parent of three children d. Just promoted with more responsibilities and increased salary e. Lives alone in a small apartment f. Set up a memorial fund for research after death of a family member

ANS: C, D, F In 1999, the Surgeon General's Report on Mental Health defined mental health as a state of successful performance of mental function that results in productive activities, fulfilling relationships with others, and an ability to adapt to change and cope with adversity. The correct behaviors represent the ability to maintain employment and relationships, and to adapt to change, including adversity. The incorrect responses demonstrate behaviors that do not support mental health - enjoyment in receiving unemployment benefits, short-term relationships, and living alone.

Which of the following behaviors is a warning that a person is no longer just using a drugs recreationally but is abusing drugs and becoming addicted? a. The person decides to try a new drug, claiming to be curious. b. The person is using the drug more frequently than before. c. The person joins a friend in using drugs in a social situation. d. The person is less able to control frequency and amount of indulging.

ANS: D A major step from initiation to continued use to abuse is the stage of transition. Transition is seen when there is a change in total consumption, frequency, and occasions of use. Drug use is now more than just social use, with the person beginning to lose control.

Which of the following best explains what children of alcoholics do when they become adults with families? a. They do not touch alcohol because they know the problems it brings. b. They do not use alcohol but may use other drugs. c. They manage to use alcohol in social situations but not otherwise. d. They themselves are at high risk for becoming alcoholics.

ANS: D Adult children from dysfunctional families often carry these roles and coping mechanisms into adult life, with many becoming substance abusers or partners of substance abusers. The children of alcoholics are four to nine times more likely to experience alcohol use disorders than are children of nonalcoholics.

Which of the following best describes why it is crucial to never use the label of "addiction"? a. Labeling invites ridicule by other people. b. Labeling someone avoids actually taking action to correct the behavior. c. Labels have a tendency to remain throughout the person's life. d. Labels influence self-perception, and behavior will begin to fulfill the label.

ANS: D Broadly labeling all habitual or compulsive behavior patterns as addiction or dependence may obscure the fact that interventions could precede the development of addiction. For example, interventions may be needed in cases where use has become misuse and a problem is evident. It is also becoming increasingly evident that specific interventions may be needed for each separate addictive problem (e.g., overeating and gambling). Moreover, in each specific group, there is wide individual diversity

Which of the following is crucial during the detoxification phase of the addiction process? a. Controlling the environment so drugs cannot be obtained b. Maintaining a therapeutic relationship with the client c. Maintaining communication with the client's family d. Managing the acute withdrawal symptoms

ANS: D Detoxification is best described as a short-term treatment intervention designed to manage acute withdrawal from the substance. It involves medical management to reduce the adverse side effects of the substance and help stabilize the client. Addressing acute withdrawal symptoms is of utmost importance in detoxification.

Which of the following drugs is being widely manufactured within the United States? a. Cocaine b. Heroin c. Marijuana d. Methamphetamine

ANS: D Marijuana is grown, not manufactured. Methamphetamine is easily made from the fertilizer anhydrous ammonia. Cocaine and heroin are grown elsewhere and smuggled into the United States.

Which of the following age groups has the highest prevalence of binge drinking and heavy drinking? a. Adults aged 45 to 65 years b. Adult business persons, aged 25 to 45 years c. Both genders of depressed elderly, aged 65 years and up d. Young adults aged 18 to 25 years

ANS: D Nearly one quarter (22.6%) of persons aged 12 or older participated in binge drinking (about 58.3 million people). Heavy drinking was reported by 6.2% of the population aged 12 or older, or 15.9 million people. Among young adults aged 18 to 25 in 2011, the rate of binge drinking was 39.8%. The rate of alcohol use among youths aged 12 to 17 was 13.3% in 2011. Youth binge and heavy drinking rates in 2011 were 7.4 and 1.5%, respectively. Binge and heavy drinking is less likely to occur in adults aged 25 to 65 years or the elderly who are 65 years old and older.

Which of the following preventable health problems is the cause of more deaths, illnesses, and disabilities than any other? a. Use of tobacco b. Obesity c. Sexually transmitted diseases (STDs) d. Substance abuse

ANS: D Perhaps no other health-related condition has as many far-reaching consequences in contemporary Western society as substance abuse. These consequences include a wide range of social, psychological, physical, economic, and political problems. Drug abuse and addiction have negative consequences for individuals, families, and communities. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs exceed $600 billion annually. This includes approximately $193 billion for illicit drugs, $193 billion for tobacco, and $235 billion for alcohol. These numbers in dollars do not describe the extent of public health and safety implications. Substance abuse is the cause of more deaths, illnesses, and disabilities than the use of tobacco, obesity, and STDs.

A family was dependent on the dad for financial support, and now he is in treatment for alcoholism. The wife asks you how long this will take. Which of the following would be the most appropriate response by the nurse? a. "Don't worry about length of time. Focus on helping him avoid alcohol." b. "It all depends on how badly he wants to hold the family together as opposed to enjoying the relief of drinking again." c. "Once an alcoholic, always an alcoholic. He'll have to avoid liquor the rest of his life." d. "Remaining in treatment is crucial; it must last long enough to produce stable behavioral changes."

ANS: D Remaining in treatment for an adequate time is crucial for treatment effectiveness. It must last long enough to produce stable behavioral changes.

Which of the following best explains why experts are now distinguishing between use and misuse? a. It is easier to discuss use than to accuse persons of being drug addicts. b. Expansion of drug treatment programs has prevented some people from becoming totally addicted. c. Persons using prescription drugs are "users," not "misusers." d. Some persons may use drugs and not become dependent on them.

ANS: D Research has revealed that problems associated with substance use may or may not relate to classically or clinically defined dependence or addiction. Many are turning to recovery before they have developed physiological dependence. Thus, many in the field have begun to differentiate between use and misuse (misuse being interchangeable with abuse), and these terms now appear in the literature. Drug treatment programs are far fewer than the need.

A student said she wanted to discuss an issue with the nurse but that it was confidential. Therefore, she asks the nurse to promise as a professional to keep this a secret. She then shares that her roommate is very depressed; her older sister committed suicide, and she is planning on killing herself if she does not pass her final examinations. Which of the following actions should be taken by the nurse? a. As a professional who made a promise, the nurse teaches the student how to recognize if her roommate is getting ready to actually do it and the phone number of the suicide hot line. b. As secrecy was promised, the nurse can only encourage the student to encourage her roommate to seek help. c. The nurse should give the student brochures and information plus the suicide hotline phone number to share with her roommate. d. The nurse should stress that one cannot keep a secret when someone's life is at stake and immediately go to assess the roommate.

ANS: D Suicide is preventable. Most people want to live but sometimes cannot see any other alternative. Now that the nurse knows the roommate is talking about suicide, the nurse cannot agree to keep the secret but must intervene and seek immediate help.

Which of the following was the primary recommendation of the New Freedom Commission on Mental Health report for the mental health service delivery system? a. Advised the president to drastically increase funding for mental health b. Increased scholarships and grants to health care professionals willing to specialize in care of the mentally ill c. Suggested the federal government take over responsibility for mental health care for all citizens d. Called for a shift from a fragmented nonsystem to an integrated comprehensive approach to care delivery

ANS: D The commission acknowledged that mental illness comprises the only type of illness that defies a comprehensive delivery approach. This is due to the way the state and local governments organize, manage, and carry out distinct treatment systems, making comprehensive care impossible in the larger health care system. Thus, the commission called for a shift in the fragmented system to an integrated comprehensive approach to mental health care delivery. The commission did not suggest a drastic increase in funding or scholarships or suggest that the federal government take over responsibility for mental health care for all citizens.

"I don't understand," the woman said. "It's my husband who is the alcoholic, not me. Why are you asking me to get involved in his treatment?" Which of the following is the most appropriate response by the nurse? a. "You are codependent. You will need to learn how to function independently." b. "You are an enabler covering up for your husband, and you have to learn how not to do that." c. "You are as ill as he is, just in a different way. You also need treatment." d. "You have been hurt by his drinking; you will need support as you try to help your husband stop drinking."

ANS: D The family has suffered the effects of substance abuse emotionally, socially, economically, physically, and spiritually. The family's wounds must be acknowledged and treated for the substance abuser to return to an environment supportive of recovery. Although the wife may be a codependent or an enabler, labeling her will not help her learn to change and help her husband change.

A nurse is picking up her child from nursery school when the day care teacher says to her, "One of the boys we care for does not seem able to sit still and listen, but is always running around and getting into things. His parents are not worried. His mother said her brother was the same way when he was a kid. Since you are a nurse, do you have any ideas on how I can calm him down?" Which of the following would be the most appropriate response by the nurse? a. "I'm not a pediatric nurse; I really don't know what to tell you." b. "I'm sorry you're concerned, but being impulsive and very physically active is quite normal for 3- to 4-year-old children." c. "Tell the parents he has to see the doctor as he's not doing well in nursery school." d. "Why not suggest that it's time for him to have a complete assessment and suggest the physician call you for an update on how he is doing in nursery school?"

ANS: D The three major characteristics of attention-deficit hyperactivity disorder/attention-deficit disorder (ADHD/ADD) are inattention, hyperactivity, and impulsivity. Although parents may notice symptoms and signs, it is often teachers who recognize the behaviors consistent with ADHD/ADD and suggest referral for assessment and treatment. Suggesting a referral is the most appropriate response for the nurse because of the symptoms that have been reported.

Which of the following best explains why anyone would ever experiment with an illegal substance? a. As a way of rebelling against parental authority b. Because it is forbidden c. For the thrill of it—without getting caught d. Friends are encouraging it

ANS: D Users often describe a progression that began with initiation through social interactions. Particularly among adolescents and young adults, evidence suggests that substance use and abuse often occur in the context of social interactions. Thus, it is likely that friends are encouraging it. This response is more likely than experimentation because of getting a thrill, doing something that is forbidden, or a way to rebel against parental authority.

A college student visits the student health center and tells the nurse that his roommate is talking about killing himself, has given some of his possessions away, and he believes the roommate has a gun. Which of the following actions should be taken by the nurse? a. Ask the student why he is telling this story; what does he expect the nurse to do? b. Call the police immediately, and have the student tell them the story. c. Call the roommate, and set up an appointment for him to come to the student health center to discuss how things are going in his life right now. d. Call the roommate, ask if he is thinking of killing himself, and, if so, how is he thinking of doing that? e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive.

ANS: E Whenever an individual exhibits suicide warning signs, nurses should refer the person to a mental health clinic or provider as soon as possible. This may involve taking emergency action by calling the local emergency services number in the community and staying with the person until help arrives.

Which gender perceives and reports having better health? a. Females b. Males c. No difference between genders in perceived health status d. Perceived health status varies strongly by individuals more than gender.

B. Males Despite the differences in mortality rates, men tend to perceive themselves to be in better health than women. In the National Health Interview Survey, which asked people to rate their health status, men were more likely to rate their health as excellent or very good as opposed to fair or poor.

Which of the following is the leading cause of death for women in their first trimester? a. Anesthesia b. Ectopic pregnancy c. Hemorrhage d. Pulmonary embolism

B. ectopic pregnancy According to the Centers for Disease Control and Prevention, ectopic pregnancy is the leading cause of maternal death in the first trimester. Historically, the leading cause of maternal death had been pulmonary embolism, followed by pregnancy-induced hypertension, ectopic pregnancy, hemorrhage, stroke, and anesthesia.

Which of the following problems depends on the responses of other people and therefore cannot be measured? a. Disability b. Handicap c. Impairment d. Injury

B. handicap In comparing these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis. Table 21-1 points out that both impairment and disability may be objective and measurable, whereas handicap is neither, because it is an experience related to the responses of other people.

Which of the following actions would public health professionals want to use as primary prevention against widespread community violence? (Select all that apply.) a. Women seen in emergency departments should be asked about abuse b. Courses for prisoners about avoiding violence and resolving conflict c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence f. Home visits to elderly clients should include screening for elder abuse

C, D, E The goal of primary prevention is to stop violence, abuse, or neglect before it occurs. Education plays a major part in primary prevention and may include parenting and family wellness, and anger management or conflict resolution. Professionals should increase their awareness of violence, identification of cases, and provision of early treatment. The nurse can work in or with the community to educate citizens about the problem of violence, potential causes of violence, and available community services. Screening is secondary prevention, and courses for those already known to be violent are tertiary prevention

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

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

Which of the following best describes what proportion of children live in a single-parent family? a. Fewer than 10% b. 11%-15% c. 16%-20% d. 21%-26% e. More than 30%

E. More than 30% In 2012, 34% of all U.S. children lived in single-parent homes

Which of the following factors results in rural residents having less access to health care than urban dwellers? (Select all that apply.) a. Employment opportunities may be low paying and seasonal. b. There are greater distances to travel and limited choice of health care providers. c. Health care providers prefer to work in higher-paying urban settings. d. Rural residents are less likely to have health insurance. e. Rural persons' economic resources are tied up in land, not easily accessible cash. f. Rural persons believe in self-sufficiency and self-care, not asking others for help.

A, B, C, D A recent Institute of Medicine study reported rural medical access problems in these areas, with some hospital and pharmacy closures; greater distances to travel for physician services; and limited, if any, choice of providers. Rural residents were more likely than urban residents to lack insurance. Two thirds of the persons living in the most rural counties are low-income families. Having economic resources invested in land and believing in self-sufficiency and self-care are not reasons why rural residents have less access to health care than urban dwellers.

Although violence seems endemic in human society, which of the following causative factors could be reduced if society agreed action was necessary? (Select all that apply.) a. Access to firearms b. Alcohol and other drug abuse c. Dysfunctional families with lack of emotional support d. Intolerance of those with a different religious ideology e. Media video games, television shows, and movies f. Pacifism as a belief system

A, B, C, D, E Pacifism is a belief in peaceful resolution of conflicts and refusal to participate in war. All other factors are universally recognized factors that contribute to violence. These factors are poverty, unemployment, economic dependency; polydrug and alcohol abuse; dysfunctional family and/or social environment and lack of emotional support; media influence (e.g., violent video games, television shows, and movies); access to firearms; political and/or religious ideology; and intolerance and ignorance.

A son did not know what to get his mother for her birthday. She refused most gifts, saying they were just something more for her to take care of. Assuming the mother did not have these, which of the following would be a very helpful gift? (Select all that apply.) a. Purchase a new front door with a large peephole so she can see who is ringing the doorbell b. Arrange for Social Security check to be deposited directly into the bank c. Add bars on all the house windows for added security d. Buy a shredder for the mother to use on all personal documents e. Install caller ID on her telephone f. Have strong deadbolts installed on all outside doors

A, B, D, E, F Measures can be taken to lessen the risk of crime happening to the elderly person. In the home, safety measures include making sure that door and window locks are strong. The elder should note who is at the door before opening the door. The elder can get caller ID service for the telephone; if no number or individual is identified, the elder may choose not to answer the call. Identity theft is on the increase, and elderly individuals are particularly vulnerable. To avoid this problem, Social Security and monthly pension checks should be deposited directly into a bank account. Any information that is sent to the home with credit card offers, personal information, and so forth should be shredded so that the information cannot be used illegally. Bars on doors and windows need to be installed with caution, because they may increase the risk of harm in the event public officials need to access the home as a result of fire or need to gain access to assist the elderly person who may be injured from a fall or may be ill.

Which of the following best describe why it is crucial that nurses who focus on the care of individual patients also be able to work with families? (Select all that apply.) a. Anytime a person is ill, his or her whole family is affected. b. By understanding the family, understanding of the individual is improved. c. Families often are very demanding if they feel their loved one isn't receiving the best care possible. d. Individuals depend on their families for care and support. e. Most important decisions are made by families as a whole, not individuals. f. Risks caused by genetics or environment affect the whole family, not just the individual.

A, B, D, F Reasons that it is important for nurses to work with families include that the family is a resource in giving care to its members and working together on health promotion and wellness activities; any dysfunction (illness, injury, separation) that affects one family member will affect the whole family; the nurse can often identify a health problem that involves risks for the entire family. Finally, understanding the whole family helps the nurse understand and provide more holistic care to the individual.

Which of the following factors make family nursing particularly challenging? (Select all that apply.) a. The health care system primarily focuses on care of individuals. b. Insurance reimbursement focuses on illness care and treatment of individuals. c. Family members are not always consistent in what they tell the nurse. d. More variables to be considered when completing an assessment e. Number of chronic comorbidities f. Most theories focus on intervention with individuals.

A, B, F Families have challenging health care needs that are not usually addressed by the health care system. Instead, the health care system most frequently addresses the individual. Traditionally, nursing has relied heavily, if not solely, on theoretical frameworks from the disciplines of psychology or social psychology, which target individuals.

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

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

Which of the following actions should a nurse take to ensure personal safety when engaging in home visits? (Select all that apply.) a. Always sit between the client and the exit, and, when in doubt, leave the situation b. Be sure of the correct address and always have a GPS system c. Carry a cell phone and drive in a well-maintained car with a full gas tank d. Have enough money that you can buy your way out of trouble e. Only accept assignments within a few blocks of your own home f. Take self-protection courses such as karate and carry a weapon for your own defense

A, C Plan ahead with the correct address, directions, and information about who will be in the home; tell the office where you will be and check in regularly; carry a cell phone, possibly a pager, and a small amount of money; dress for function and mobility, wear a name tag, and be sure your vehicle is in good repair with a full gas tank and emergency equipment. Carrying a weapon typically results in the weapon being used against you.

Which of the following guiding rules or principles would most likely be followed by a nurse caring for persons with disabilities? (Select all that apply.) a. Adopt the client's priorities b. Change care according to the most recent research findings c. Care for the disability and then for the whole person d. Know community resources thoroughly e. Support the client's decisions f. When in doubt, listen

A, D, E, F Data from interviews conducted with nurses who provide care to persons with disabilities revealed principles such as do not assume anything; adopt the client's perspective; listen and learn from the client; gather data from the perspective of the client and family; care for the client and the family, not the disability; be well informed about community resources; and become an advocate by letting clients choose.

An elderly woman shared that she had six different physicians, each focusing on one particular health problem. Which of the following would be of immediate concern for the home health nurse? (Select all that apply.) a. Whether the client has a family physician who was coordinating her care b. Whether the physicians communicate with each other c. If each physician was prescribing medications, what drug interactions might be occurring? d. Were all these health care providers licensed physicians? e. Who was helping her with transportation to all these physicians? f. Would all these physician visits add up to more than what Medicare would reimburse the client?

A, C The client needs a family physician or a nurse case manager who is coordinating her care and ensuring that the medications are not having interaction effects. A pharmacist might also do this, but the client may be using several different pharmacies. Errors associated with preventable adverse drug events occur most often at the stages of prescribing and monitoring (i.e., the same medication[s], or different medications for the same condition, being prescribed by different health providers).

Which of the following best describes why there are more long-term consequences (such as death) to a driver injured in a truck accident in a rural area than a driver injured in a truck accident in an urban area? (Select all that apply.) a. Rural drivers are more likely to speed over long distances than urban drivers. b. Rural drivers are not as skilled with vehicles as urban drivers, so they are more severely injured in a crash. c. The urban driver is taken immediately for care, whereas the rural driver might be injured on an isolated field and not found by anyone for hours. d. Urban drivers are more likely to use their seat belts than rural drivers. e. Urban drivers are probably rushed to an emergency department, whereas the rural driver lives far away from emergency services, often over bad roads and possibly through severe weather. f. Urban drivers trade their vehicles in rather frequently, whereas rural drivers keep their vehicles for as long as they can make them run, so the vehicles are much less roadworthy

A, C, D, E Getting patients from the place of injury to the trauma center within the "golden hour" is frequently not possible in rural areas because distance, terrain, climatic conditions, and communication methods produce barriers. Some rural facilities are more than 1 hour away by air from the nearest trauma center or tertiary care hospital. Driving at high speeds, driving long distances, driving in winter conditions, not using seat belts, and consuming alcohol have been cited as contributing to greater levels of injury deaths and disability by rural residents in the West. There is no evidence to suggest that rural drivers are not as skilled as urban drivers or that their vehicles are less roadworthy.

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

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

In comparison with mental health care in urban areas, which of the following best describes how mental health care in rural areas differs? (Select all that apply.) a. Access to care is more limited or not available at all locally. b. Cost for treatment is typically reimbursed at a lower rate. c. Depression is frequently not recognized or is not treated. d. Ethnic and racial disparities exist. e. Primary health care professionals accept responsibility for mental health treatment. f. The suicide rate is notably higher.

A, C, E, F In rural areas adjacent to a small city, suicide rates were 31% higher than suburban rates and 43% higher in rural areas that were not adjacent to small cities. Decreased access to mental health services for treatment of depression may contribute to these higher rates. Because of the lack of qualified mental health care providers, rural residents often receive services from primary care providers. Ethnic and racial disparities exist whether in urban or rural health care.

A family member tells the nurse that she is worried about her grandmother driving. Which of the following would be most appropriate for the nurse to suggest? (Select all that apply.) a. Avoid rush hour traffic. b. Buy and drive a very large heavy car. c. Do not converse with any passengers. d. Drive more slowly. e. Drive only during daylight. f. Leave the radio turned off.

A, C, E, F Some interventions older adults could implement are limiting their driving to daylight hours, planning their trips to avoid rush hour, not listening to the radio, and avoiding talking with passengers. Purchasing a large, heavy car and driving more slowly are not appropriate actions to assist an elderly person with driving.

A nurse was excited about being the only staff member in the public health department in a small rural area. Which of the following problems would the nurse most likely encounter? (Select all that apply.) a. There is no one with whom to collaborate or exchange ideas. b. There will be no physician available to tell the nurse what needs to be done. c. No feedback can be obtained from others. d. The nurse may only be able to offer services supported by federal funds. e. The nurse will have to raise local funds to support the department. f. There will not be any epidemiologists or sanitarians to help

A, D, F Many smaller local health departments do not have the economic base to employ other professional public health providers, such as physicians, epidemiologists, sanitarians, and nutritionists at the local level. The lack of additional onsite public health providers poses two problems. First, the ability to collaborate with others about potential or actual public health problems is decreased or nonexistent. Second, the ranges of services provided are less comprehensive. Often, these small facilities can only offer federally funded programs with few locally funded services. The nurse should be able to think independently to determine what needs to be done and should be able to work without physician direction. Feedback can be obtained from the population that the nurse is serving. Local, state and federal funds may all support the services that the nurse is providing. It is unlikely that the nurse will need to raise funds to support the work of the department; there should be local funding available for this nurse's position.

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

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

A man was crying and said, "I didn't mean to do it. She just got me so angry I lost control. It will never happen again." The woman said, "It was my fault. I shouldn't have upset him." Then, looking at the nurse, the woman added, "Please don't report this. It will never happen again." Which of the following is the most appropriate response by the nurse? a. "Abusers don't stop unless intervention occurs. I have to report it." b. "If you're sure it won't happen again, I'll let it go this time." c. "Legally, I'm required to put this in the medical record." d. "The decision is up to the physician, not me."

A. "Abusers don't stop unless intervention occurs. I have to report it." It is a common myth that abusers will stop the abuse on their own. Professional intervention is required to break the cycle of abuse. The only way to effectively begin breaking the cycle of abuse is to report the incident. The nurse has a professional responsibility to report the abuse, just as the physician does. Documenting the information in the medical record will not initiate stopping the cycle of abuse

A nurse was creating an ecomap for a family, which consisted of a 3-year-old girl, an 8-year-old boy, and their mother. Which of the following questions would be useful for the nurse to ask? a. "Are you involved with any groups or resources in the community?" b. "Can you tell me about your extended family wherever they live?" c. "Have you thought about what would happen if you needed help?" d. "What were the causes of death for your older family members?"

A. "Are you involved with any groups or resources in the community?" The ecomap is another classic tool that is used to depict a family's linkages to their suprasystems. The nurse can note people, institutions, and agencies significant to the family with some notations as to the nature of the ties that exist. Knowing what resources the family is currently able to assess will help the nurse know what resources to suggest to the family

A nurse asked of a family, "Could each of you tell me what you typically do during the week?" Which of the following would the nurse most likely say to follow up such an open-ended question? a. "Could you tell me about what you do at your job?" b. "Do you believe those choices are the best use of your free time?" c. "How do you feel about those activities?" d. "Is there anything you would like to do differently?"

A. "Could you tell me about what you do at your job?" Both of these questions pertain to data collection for the family health tree. The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination.

Which of the following persons would be called chronically homeless? a. A person has been homeless for more than a year b. A person who lives with a roommate when between jobs c. A person who has been staying with friends or family for an extended period of time d. A person has been residing each night in a homeless shelter for almost 3 months

A. A person has been homeless for more than a year The chronically homeless individual is defined as an unaccompanied adult who has been homeless for an extended or numerous periods and has one or more disabling conditions.

A man came for follow-up care to the free clinic, explaining that he had applied for a job based on his education and years of previous work experience, but, being in a wheelchair, he was turned down. Which of the following responses would be most appropriate for the nurse? a. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." b. "No one would want to hire a handicapped person, so you can continue to come here for free care." c. "Because it can be expensive to obtain the necessary equipment to help you do that job, the employer has every right to refuse to hire you." d. "The law says, if a handicapped person applies, he or she has to get hired even if an able-bodied person also applies."

A. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." The Americans with Disabilities Act (ADA) became law in 1990. This landmark civil rights legislation prohibits discrimination toward people with disabilities in everyday activities. The ADA guarantees equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications. A qualified individual with a disability must meet legitimate skill, experience, education, or other requirements of an employment position. The person must be able to perform the essential functions of the job.

A young son was so physically fidgety that his mother was seriously embarrassed by his inability to be quiet and involved in the interview. Which of the following comments by the nurse would be the most helpful? a. "Isn't it marvelous how much energy your son has?" b. "Is there something your son could be doing for you that would use some of that energy?" c. "Is your son always so fidgety? Have you discussed his behavior with his pediatrician?" d. "Why don't you let your son go to his room until we're finished?"

A. "Isn't it marvelous how much energy your son has?" Sending the son to his room might be seen as punitive and would remove him from being informed about interventions planned and decisions made. A compliment reinforces family strengths and tends to further progress toward open trusting relationships. The comment took a flaw (physically fidgeting) and reframed it as an asset (high energy)

A nurse eagerly explained to a long-term disabled male client the most recent relevant research related to his care. The client, rather than express appreciation, said, "I prefer to have my care given this way." The nurse explained that research suggested an alternative approach was more clinically effective, but the client said, "I am more comfortable during the day if my care is given this way." Which of the following actions should be taken by the nurse? a. Accept that the client knows what works best b. Ask the nursing supervisor to review the research with the client c. Give evidence-based care according to current research findings d. Negotiate a compromise between patient preferences and research-based approach to care

A. Accept that the client knows what works best A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. The nurse must ask the client what works best for him or her and what goals the client is pursuing. Research is based on probabilities of effectiveness with large groups, but individuals may have a different unique reaction to any intervention.

Which of the following describes what has been identified by public health experts as the number one priority in rural areas? a. Access to health care b. Access to education c. Access to telecommunications d. Access to better-paying employment opportunities

A. Access to health care Bolin and Gamm (2003) reported that access to health care was the number one priority identified by the majority (73%) of rural health care leaders. Although access to education, telecommunications, and well-paying employment are important, they have not been identified as the number one priority in rural areas.

Which of the following concerns can a nurse as a citizen help address? a. Advocating for removal of environmental and social barriers to needed services b. Continuing to engage in political action to increase funding for care for the handicapped c. Recognizing that it is better to offer to help than to wait for a person with handicaps to have to ask for assistance d. Needing to not stare or ask personal questions of a person with a disability

A. Advocating for removal of environmental and social barriers to needed services In the National Agenda for the Prevention of Disabilities model, disability occurs when a person's physical or mental limitations, in interaction with physical and social barriers in the environment, prevent the person from taking equal part in the normal life of the community. Confronting environmental and social barriers to needed services can frustrate and exhaust many people with disabilities and their families. The nurse—as a citizen and a concerned professional—can advocate for removal of such barriers. This issue is the most important for the nurse to address, allowing the nurse to partner with clients and families affected by disabilities to remedy barriers that negatively affect quality of life for this population.

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

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

Which of the following was suggested by the National Healthcare Disparities Report of 2008 (NHDR) as one reason that there are such disparities in health care outcomes inside the health care system? a. Care provider bias and poor communication exist. b. Funding is inadequate to give appropriate care to persons with disabilities. c. Many people do not seek care until it is almost too late. d. There is a national shortage of care providers.

A. Care provider bias and poor communication exist. The NHDR explains that, within the scope of health care delivery, disparities are due to differences in access to care, provider biases, poor provider-patient communication, poor health literacy, and other factors. This report did not address that there is inadequate funding to provide appropriate care, that people seek care too late, or that there is a national shortage of providers.

A woman was seen in the emergency department with a greenstick broken arm and chest bruises. She explained she fell up a staircase at home while carrying laundry to the bedrooms. Besides assessing for other injuries, which of the following actions should be taken by the nurse? a. Ask about and educate regarding intimate partner violence (IPV) b. Assess for use of alcohol or other drugs that might have been a causative factor in the fall c. Get the patient an x-ray examination to determine location and severity of the break d. Immediately apply ice and immobilize in a sling

A. Ask about and educate regarding IPV IPV, formerly known as domestic violence, is a pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim, such as a spouse, ex-spouse, boyfriend or girlfriend, ex-boyfriend or ex-girlfriend, or date. These behaviors may include battering resulting in physical injury, psychological abuse, and sexual assault that contributes to progressive social isolation and intimidation of the victim. Abuse is typically repetitive and often escalates in frequency and severity. IPV crosses all ethnic, racial, socioeconomic, and educational lines. About 30% of women and 1% of men report experiencing physical forms of IPV at some point in their lives. Thus, the nurse must assess for IPV.

A nurse was trying to decrease the amount of respiratory illness in the community. Which of the following approaches should be used by the nurse? a. Attend each farmworkers' meeting and listen to how they perceive and discuss their problems b. Offer to teach the farmers' spouses how to protect their families, such as having the farmer shower and change clothes before coming into the house c. Suggest the community work together to obtain a community college so farmworkers could be educated for other employment opportunities d. Teach children in the school system the importance of seeking employment in cities rather than staying on the farm

A. Attend each farmworkers' meeting and listen to how they perceive and discuss their problems Using informal networks in the community is essential. The involvement of informal networks and local leaders in planning health interventions is crucial. To be able to do that, the nurse must first listen to how the community perceives its problems.

The current school year is now over, and the school health nurse spends time summarizing the records of all the children who had come into the school health office during the past school year. Which of the following best explains the rationale for this action? a. Because analysis can help establish priorities for future health programs b. Because annual reports are expected by the school board c. Because it's very personally rewarding to see all the help one has given throughout the year d. Because the nurse has to justify the school health office budget for each year

A. Because analysis can help establish priorities for future health programs Community health nurses (CHNs) are employed in ambulatory care centers, occupational health and school sites, housing complexes, day care programs, residential treatment and substance abuse programs, and other official and nonofficial agencies. At each of these sites, CHNs meet families and can assess and intervene at the family and community levels The challenge is to focus not only on individual students but extend practice to the whole school community of children. Fiscal constraints hold the nurse accountable for the best delegation of scarce resources. In times of limited budgets, the school health nurse, on the basis of the most frequent problems presented in the office, can draw conclusions as to what are the major health needs of children in the community. On the basis of those conclusions, health programs can be planned to maximize health promotion and disease prevention in the school.

For which of the following groups is homicide the leading cause of death in the United States? a. Black males aged 15 to 34 years b. Black children aged 1 to 14 years c. White children aged 1 to 14 years d. White males aged 15 to 34 years

A. Black males 15-34 yo For black males aged 15 to 34 years, homicide is the leading cause of death. Homicide is the second leading cause of death among black males aged 1 to 4 and 10 to 14 years, compared with white males, where homicide is the third leading cause of death in ages 15 to 29 years.

An ambulance medic reported a client was on the way with a traumatic brain injury (TBI). Which of the following symptoms would the nurse expect this client to display? a. Blurred vision and a headache b. Hypotension and tachycardia c. Irregular heart rate d. Fecal incontinence

A. Blurred vision and a headache TBI symptoms may be mild, moderate, or severe. Symptoms of mild TBI include headache, confusion, light-headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, and a change in sleep patterns or thinking. Moderate or severe TBI may demonstrate the same symptoms as mild TBI plus a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. The other symptoms are not indicative of TBI.

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

A. Cataracts Among older adults, the three most common pathological eye conditions are cataracts, macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally clear lens of the eye. Age is the single greatest risk factor for cataracts. By age 65 years, some degree of lens clouding has developed in half of all Americans, although it may not impair vision. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with near vision, generally occurs in the 40s.

Which of the following compositional factors influences rural health needs? a. Demographics of the people living in an area b. Local environment c. The geography of the area d. The political and social institutions in the community

A. Demographics of the people living in an area There is a growing emphasis on the distinction between context, which is defined by the characteristics of places of residence, and composition, which is the collective health effects that result from a concentration of persons with certain characteristics. Problems in rural areas are compositional when they derive from individual characteristics of groups of people residing in rural settings. Examples of compositional sources of health disparities include such characteristics as age, education, income, ethnicity, and health behaviors. The environment, geography, and political and social institutions are considered to be characteristics of place.

Which of the following insights is being stressed by advocacy groups regarding persons with disabilities today? a. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. b. Handicapped persons have as much right to social support as nonhandicapped persons. c. It is recognized that an individual may be limited by an environmental barrier in society. d. Impairment is a result of society's reaction more than mental or physical condition.

A. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. Nearly all definitions identify an individual as disabled on the basis of a physical or mental impairment that limits the person's ability to perform an important activity. The complementary possibility—that the individual is limited by a barrier in society or the environment—is never considered. Advocacy groups are stressing that environment and the reactions of others are as crucial as the actual physical or mental limitation.

Which of the following theoretical approaches would be most useful to the nurse who wants to improve patient-provider communication and address the gap between what providers discuss and what families want to know about? a. Ecological framework b. Network therapy theory c. The Kentucky Partnership model d. Transaction model

A. Ecological framework The ecological framework is a blend of systems and developmental theory with an individual's understanding of his or her environment. Kogan and others investigated parent-health care provider discussions of family and community health risks during well-child examinations, as well as the gaps in issues discussed by the practitioner and the information the parent desired. The results indicate the need for better communication and education between health care providers and clients.

Which of the following best explains why companies do not build work places in rural areas where people are anxious to find full-time employment? a. Employers need highly educated and skilled employees. b. Managers do not want to be transferred into a rural area where they will not fit in and will not be comfortable. c. Rural persons do not work as hard as urban dwellers. d. Smells emanating from farms are unacceptable to persons working inside.

A. Employers need highly educated and skilled employees. Counties that have a low-wage economy have difficulty providing the infrastructure needed to provide education for low-wage families. They therefore have difficulty attracting new employers who might contribute to the economic development of a rural area but need a more highly educated workforce. Rural workers are known for their strong work ethic, but they may not have the educational skills that are necessary. Smells from farms is not a typical reason as to why companies do not build in rural areas.

As a concerned citizen and professional, a nurse encourages the local senators and representatives to support expansion of health clinics for the poverty stricken. Which of the following locations is in most desperate need? a. Rural areas where migrant and seasonal farmworkers (MSFW) labor b. Inner city poverty-stricken neighborhoods c. Near elderly low-income housing units d. Inside high schools in poverty-stricken neighborhoods

A. Rural areas where migrant and seasonal farmworkers (MSFW) labor In general, MSFW may have the poorest health of any aggregate in the United States and the least access to affordable health care. Thus, a location that serves this population would be most important.

A daughter tells the nurse that her mother is frequently confused, but what is really upsetting is that she is incontinent during the night. "All I do is watch her and wash sheets," the daughter says. Which of the following suggestions should the nurse provide to the daughter? a. Explain about respite care or the need to ask other family members to help so the daughter can have some time off b. It's time to have her mother go into a nursing home where they can give her the care she needs. c. Refer the daughter to Adult Protective Services so responsibility for her mother's care may be assumed by an agency prepared for such tasks d. Teach the daughter how to establish a toileting routine for the mother to help control the incontinence

A. Explain about respite care or the need to ask other family members to help so the daughter can have some time off The best approach—because the daughter is willing to share her feelings with you—is to see whether there is anyone else in the family to help so the daughter can be less overwhelmed. If the mother has Alzheimer's, any number of resources are available for respite for the caregiver, support groups for both client and family, and day care facilities for the client. Adult Protective Services assists in cases of abuse. The daughter is stressed and may become an abuser if assistance is not found. A toileting routine would probably not be successful during the night. Although a nursing home is possible, many families cannot afford such care or do not want a family member sent there.

A female student is at a fraternity party where alcohol is flowing freely, the music is loud, and people are dancing and talking. Most people seem to be having a great time. What action should the student take, if anything, when she overhears two men talking about having put ketamine in a girl's drink? a. First get out of there, then call the campus police and report what was heard b. Nothing, because she had no idea which woman was targeted or even if she drank what was given to her c. Talk to the two men about the dangers and side effects of ketamine d. Watch to see if any young women pass out or are otherwise impaired

A. First get out of there, then call the campus police and report what was heard The text talks about date rape drugs including ketamine. The first priority is to keep oneself safe, so leaving would be prudent. Ideally, the police will allow the report to be made without sharing who reported the potential problem. Doing nothing, talking to the men, and watching young women at the party will not protect the females at the party from unknowingly consuming the ketamine.

Which of the following best describes the problem with the viewing disability based on the Nagi model? a. Functional limitations are used to determine if an individual is disabled. b. Functional limitations are not easily objectified and measured. c. The model does not distinguish between genetic limitations and limitations imposed by injury or illness. d. Persons are or are not limited according to choices they make.

A. Functional limitations are used to determine if an individual is disabled. The Nagi model uses functional limitations, which have been defined and are measureable, to determine whether an individual is disabled. However, the current paradigm considers the environmental barriers and the perspectives of the onlooker when considering if an individual is disabled. Thus, the other options do not address the limitation of using only functional limitations.

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

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

Which of the following is an appropriate conclusion to draw from research based on network therapy theory? a. Nurses can help at-risk populations access or build support systems. b. Problems in our health care system are worsened by specialization and fragmentation. c. Social class places limitations on access to health care. d. The family is culturally anchored in American beliefs.

A. Nurses can help at-risk populations access or build support systems Network therapy theory involves changing the network of families, be it extended family or friends, who tend to maintain a dysfunctional status quo in the nuclear family. The nurse can help the family replace or expand their network with other resources from the wider system that would be able to provide more support and enhance family functioning

Which of the following best describes the risk for violence among females in the United States today? a. One of top five causes of death from age 1 to 44 years b. One of top 10 causes of death, especially among girls aged 1 to 4 years c. One of the top 10 causes of death, especially among women aged 15 to 24 years d. One of the top 10 causes of death, especially among vulnerable elderly

A. One of top 5 causes of death from 1-44 yo Among all females, homicide ranks in the top five causes of death among ages 1 to 44 years. Homicide is the third leading cause of death among females in the age groups of 1 to 4 and 20 to 29 years, is the fourth leading cause of death in the 5 to 14 year age group, and ranks fifth in the 30 to 34 year age group.

A nurse was becoming very frustrated at the ongoing stream of farmworkers with respiratory problems each spring. Which of the following actions should be taken by the nurse? a. Provide community education on herbicides and other chemicals spread each spring with information on self-protective measures, such as respirators. b. Fight to get farmers to quit spreading chemicals on their fields each spring. c. Suggest that farmers spray water on the fields immediately after the chemicals are spread to reduce dust in the air. d. Tell farm workers to obtain different employment. e. Try to get farmers to reduce the amount of chemicals used on their fields.

A. Provide community education on herbicides and other chemicals spread each spring with information on self-protective measures, such as respirators. Environmental health issues in rural communities, such as pesticide exposure or health hazards from point-source factory emissions, are more effectively assessed and remedied on a community level than on a case-by-case basis. Nurses' involvement in helping people understand health problems in a larger context can be the genesis of change. It is not realistic to have farmers quit or reduce the spreading of chemicals, spray water on their fields after chemical application, or ask them to obtain different employment. Nurses must work with farmers so that they are able to use safe measures when applying the chemicals to their fields.

Which of the following is most likely to provide public health services to Americans residing in a rural community? a. Public health nurse b. Public health physician c. Epidemiologist d. Nurse practitioner

A. Public health nurse In a study of 99 local health departments in three rural states, Rosenblatt and colleagues (2002) found that public health nurses were the core provider of public health services. Many smaller local health departments do not have the economic base to employ other professional public health providers, such as physicians, epidemiologists, sanitarians, and nutritionists at the local level.

Which of the following underlying factors most likely contributes to homelessness? a. Substance abuse b. Unemployment c. Posttraumatic stress syndrome (PTSD) d. Severe mental illness

A. Substance abuse The text states that persons as active agents do make decisions that result in homelessness. These choices result in a shortage of affordable housing, insuf?9?cient income, and scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. However, these decisions are made in highly contextualized conditions, frequently addiction to alcohol and/or other substances. Substance abuse may in turn lead to unemployment which causes insufficient income. Additionally, PTSD and severe mental illness can cause substance abuse to occur.

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

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

Which of the following mood-altering substances are considered acceptable to use by current Western society? a. Alcohol b. Amphetamines c. Barbiturates d. Nicotine

ANS: A In general, alcohol use has gained more social acceptance than other drug use. Due to the known harmful effects of tobacco, it is not acceptable to use tobacco products, which contain nicotine. The use of amphetamines and barbiturates are not acceptable in Western society.

A man was told by his boss that his work had really gone downhill recently and he had to improve or the boss would have to let him go. His wife had moved out of the apartment. Obviously, the drug use was causing problems. Which of the following would cause the man to continue to use? (Select all that apply.) a. He had paid a lot for this stuff so he had just finished using what he had and then he had quit. b. He rationalized he was just hitting a rough spot and, as soon as he got over his wife's betrayal, he would quit using and his job would be fine. c. He tried to quit, but the withdrawal symptoms were so severe he could not. d. He verbalized quitting, but his new friends scoffed at him. e. His boss clearly did not understand what he was dealing with and had not a clue what pressure he was under—so ignoring him was the only option. f. He knew drug use made him legally handicapped so his boss could not fire him even if he wanted to.

ANS: A, B, C, D In the transition stage from substance use to substance abuse, there may be clear evidence that there are adverse effects. Rationalizations that deny the seriousness and consequences of the substance use are commonly constructed. Unpleasant physical and emotional withdrawal symptoms are strong motivators to continue use. Being in an environment where others are using will encourage the person to continue using to fit in (peer pressure). The boss clearly understands what is going on, which is why the situation has been addressed. It is unlikely that the drug would make him legally handicapped.

An African American male was addicted to drugs, received treatment, and now needs to resist abusing drugs again. Which of the following barriers exist for this individual? (Select all that apply.) a. Being arrested when caught rather than receiving treatment b. Difficulty obtaining employment c. Easy access to illegal drugs in the community d. Economic rewards for selling or distributing drugs to others e. Family demands, including children being physically active and noisy f. Pressure from drug-using friends to join them in social events

ANS: A, B, C, D, F Barriers to treating substance abuse and addiction problems in African Americans include poverty, underemployment, and unemployment; prevalence of both drugs and liquor stores within the community; allure and economic rewards of selling drugs; more likely to be arrested than treated; and unable to "change people and places" as advocated by 12-step programs. Family demands, including children being physically active and noisy, has not been identified as a common barrier in the African American population.

Which of the following scenarios would most likely suggest that the person may be engaging in substance abuse? (Select all that apply.) a. All the people in the elevator edged away from the student who reeked of tobacco smoke. b. She declined his invitation; all he ever seemed to do was go to bars and drink. c. Because of a family emergency, the student called the instructor to explain her absence and ask for the assignments for next week. d. The campus police were called to control the student engaging in public indecency and disorderly conduct. e. The officer pulled the driver over for apparently driving under the influence. f. The student told her friend she had too much to drink last night and to cover for her in class.

ANS: A, B, D, E, F Criteria for substance abuse are a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested in failure to fulfill major role obligations (the student who had too much to drink last night and is unable to attend class); substance-related absences; substance use in situations in which it is physically hazardous (e.g., driving an automobile when impaired); substance-related legal problems (e.g., arrests for substance-related disorderly conduct - driver being pulled over for driving under the influence); and substance use despite social problems caused by the effects of the substance (people moving away from the student who reeks of tobacco smoke, the student who declines an invitation, as all the other person does was want to go to the bars and drink). The student who is asking for an extension and explaining her absence because of a family emergency is not suggestive of a student engaging in substance abuse.

Which of the following way(s) can physicians enable drug abuse? (Select all that apply.) a. Prescribing psychoactive medications to a new patient who was claiming anxiety and insomnia b. Prescribing psychoactive medications to make a patient feel better during a time of situational stress c. Prescribing non-refillable small doses of psychoactive medications in response to short-term problems d. Refusing to prescribe psychoactive medications even if the patient has severe pain so the patient must seek self-medication with illegal substances or alcohol e. Suggesting psychoactive medications for pain relief after surgical treatment f. With drugs so available, the physician can use drugs for a temporary problem; feeling relief may lead to self-addiction.

ANS: A, B, D, F Health care professionals also can contribute to the initiation and continuation of substance abuse and dependency in various ways. One obvious way is the physician's role in prescribing psychoactive medications. The medical model advocates the treatment of symptoms by medication. The relief of pain, anxiety, and insomnia is not an exception. The addictive potential of narcotic analgesics and antianxiety agents is often ignored if quick symptom relief is the main goal. Undermedication or refusal to use "addictive" medicines can lead susceptible clients to self-medicate with illegal drugs or alcohol. A new patient requiring medications may raise suspicion, because drug abusers may go to many different physicians seeking prescriptions. It is not appropriate for psychoactive medications to be suggested for pain relief after surgical treatment.

Which of the following are basic components of 12-step programs to help treat addictive behaviors such as alcoholism? (Select all that apply.) a. A willingness to change b. Attempts to make amends for wrongs done to others c. Daily attendance at a self-support group meeting d. Open recognition of weaknesses and request for help from others e. Public explanation of sins and future plans for resisting temptation f. Recognition of personal strengths and weaknesses

ANS: A, B, F Mutual help groups are associations that are voluntarily formed and operate through face-to-face supportive interaction focusing on a mutual goal. They are usually organized by recovering substance abusers or those recovering from compulsive behavior patterns. The first mutual help group was Alcoholics Anonymous (AA). The early AA members developed 12 steps to guide the recovery process. Basic tenets of 12-step programs include an inventory of past shortcomings and strengths, willingness to change, and making amends. Daily attendance, open recognition of weaknesses and request for help from others, and a public explanation of sins and future plans for resisting temptation are not part of 12-step programs.

A man had managed not to drink for over two years, but today, when he was told his position was being eliminated, he drank himself into a stupor. Which of the following approaches should the nurse take with this client? a. Admit the man is an alcoholic and always will be b. Consider the relapse a learning opportunity and discuss options for coping with problems c. Have him arrested for disorderly conduct in the hope that jail will get his attention and scare him into avoiding future use d. Suggest inpatient treatment, where he will not be able to access alcohol

ANS: B Abstinence is difficult to maintain on a long-term basis. Therefore, an important area is relapse prevention, which aims to prepare the client for the relapse situation in the hope of preventing it or minimizing its impact on recovery. Relapses are reframed as learning opportunities, and the client makes plans for coping with negative mood states, meeting the challenge of craving, and stopping a relapse quickly if it should occur.

A young teenager was habitually engaging in binge drinking with friends on weekends. Which of the following would be a long-term concern of this behavior? a. He might have to drive to get together with them and then drive home after drinking. b. Legal drug use almost always precedes use of illegal drugs. c. Obesity is a major health problem, and alcohol is very high in calories. d. The teenager's parents are obviously a dysfunctional family.

ANS: B All of the answers could be reasons for concern, although young teenagers are too young to drive. Parents are not necessarily dysfunctional on the basis of just the information given. Although obesity is an issue, a more immediate concern would be the fact that use of legal substances (e.g., tobacco, alcohol) almost always precedes use of illegal drugs.

Which of the following best explains why having parity in insurance coverage does not always help persons with depression? a. Many persons find that the medications do not relieve symptoms. b. Most depressed persons do not seek treatment. c. Most depression is situational, and having insurance does not change the situation. d. Psychotherapists will not accept the low reimbursement offered by insurance plans.

ANS: B Although effective treatments and medications exist, most people (almost two thirds) with depressive illness do not seek help. Parity in insurance coverage helps for depressed persons who are encountering situational depression to receive services and promotes care being provided by a variety of providers.

A patient with severe panic attacks refuses to come to the mental health clinic to get help even after being assured there is no charge for the initial assessment. Which of the following provides the best explanation for this behavior? a. People know that the treatment is to confront your fears in small doses, and the very idea is overwhelming and frightening. b. Such persons have anticipatory anxiety, so they try to avoid situations that may lead to a panic attack, such as leaving their house. c. The recurring symptoms such as tachycardia, chest pain, nausea, and sweating are seen as symptoms of a physical illness, not a mental illness. d. They are too depressed to take action.

ANS: B As the avoidance behavior intensifies, the client begins to withdraw further to avoid being in places or situations from which escape may be difficult. Individuals with agoraphobia frequently progress to the point where they cannot leave their homes without experiencing anxiety.

Which of the following best explains why drug abusers so often relapse? a. Drugs are widely available. b. They lack a supportive environment. c. They remember how fantastic they feel immediately after using. d. Drugs make them feel better about life.

ANS: B Because many abusers lack a supportive environment, the potential for relapse is increased. The availability of drugs, remembering the immediate fantastic feeling of using, or feeling better about life while using are not the primary explanations for why drug abusers relapse.

Which of the following best describes how brain imaging scans are being used? a. To deliver electroconvulsive therapy to high-risk individuals b. To help detect and diagnose medical disorders and illnesses c. To help determine treatment options for mental disorders d. To help determine the effects of psychotherapy

ANS: B Brain imaging scans, also called neuroimaging scans, are being used more and more to help detect and diagnose a number of medical disorders and illnesses. Currently, the main use of brain scans for mental disorders is in research studies to learn more about the disorders. These researchers study healthy brain development, effects of mental illnesses, or effects of mental health treatments on the brain. Brain scans alone cannot be used to diagnose a mental disorder, such as autism, anxiety, depression, schizophrenia, or bipolar disorder (NIMH, 2010). Brain neuroimaging helps researchers study healthy brain development, effects of mental illnesses, or effects of mental health treatments on the brain.

A patient had a distorted thought pattern, which led to very uncomfortable feelings and inappropriate behaviors. Which of the following types of therapy would most likely be successful? a. Behavioral therapy b. Cognitive-behavioral therapy c. Family therapy d. Group therapy

ANS: B Cognitive-behavioral therapy may be used in individual, family, couples, or group therapy. The goal is to identify and correct distorted thought patterns that can lead to troublesome feelings and behaviors. In comparison, behavioral therapy uses learning principles to change thought patterns and behaviors systematically; it is used to encourage the individual to learn specific skills to obtain satisfaction. Family therapy involves problem-solving sessions with members of the family. Group therapy involves a small group of people with similar problems who, with the guidance of a therapist, discuss individual issues and help each other with problems.

Which of the following events occurred in 1965? a. State mental hospitals were created. b. The mentally ill were deinstitutionalized. c. Electroconvulsive therapy was discovered to help depression. d. Community mental health centers for outpatient care were established.

ANS: B Deinstitutionalization is the release of institutionalized people, especially mental health patients, from an institution for placement and care in the community and was initiated in 1965. From 1955 to 1980, the number of mentally ill patients in state facilities fell from 559,000 to 154,000 because patients moved back out into communities. The Community Mental Health Centers Act of 1964 provided federal support for mental health services. The act supported measures to implement facilities to care for those who were mentally retarded and to construct community mental health centers. The creation of state mental hospitals and the discovery of electroconvulsive therapy occurred before 1965.

A client has refused to stop drinking alcohol. Which of the following actions should be taken by the nurse? a. Ask a physician to admit the patient to the acute care hospital. b. Attempt harm reduction to help the client reduce drinking. c. Cease giving care because the client is totally noncompliant. d. Seek to have the patient admitted as a mental health client.

ANS: B Harm reduction remains controversial although some see it as a paradigm shift with the potential to significantly improve treatment results. Harm reduction is often the only option that will preserve a therapeutic relationship when people continue to use or drink problematically. Attempting the use of harm reduction is preferred over admitting the patient to an acute care hospital, ceasing to provide care, or having the patient admitted as a mental health client.

Which of the following best describes a professional enabler? a. A spouse who has been enabling an abuser for several years b. A physician who provides narcotic analgesics to patients on a regular basis c. A clergyman who offers to take an abuser to an Alcoholics Anonymous meeting d. A child who is a caretaker for her substance abusing mother

ANS: B Health care professionals also can contribute to the initiation and continuation of substance abuse and dependency in various ways, becoming professional enablers. One obvious way is the physician's role in prescribing psychoactive medications. The medical model advocates the treatment of symptoms by medication. The relief of pain, anxiety, and insomnia is not an exception. The addictive potential of narcotic analgesics and antianxiety agents is often ignored if quick symptom relief is the main goal. Long-term goals for the treatment of medical problems and nonmedication management of pain and anxiety are more thoughtful approaches.

Which of the following best explains why health professionals and educators are stressing total abstinence of drugs instead of teaching appropriate social use? a. Federal funds are available to schools if abstinence is stressed. b. If students perceive a drug as harmful, fewer actually try it. c. It is easier to avoid a substance altogether than to try to control the dose. d. This education is consistent with our American culture.

ANS: B Primary prevention for adolescents is typically focused on education aimed toward complete abstinence. Education plays an important role. A striking feature is the strong adverse relationship between perceived risk and drug use. For all drugs, with no change in drug availability, when students perceive a drug as harmful, fewer students actually use it. Thus, it is important for health professionals and educators to stress total abstinence. Federal funding is not available to schools if abstinence is stressed. This type of education stressing an abstinence only perspective is not consistent with the American culture.

A family was very pleased with how well their child was doing now that he was on medication. They congratulated the nurse on getting their child help and said they were so impressed that the nurse was able to cure him. Which of the following would be the most appropriate response by the nurse? a. Congratulate them on being so supportive to their child through this ordeal. b. Stress that the medication is controlling the symptoms and their child will continue to need their support. c. Thank them for their recognition of the role you—and all nurses—play in promoting health. d. Verbalize your observations of how well their child is doing.

ANS: B Psychotherapeutic medications do not cure mental illness; they act by controlling symptoms. Thus, it is important for the nurse to stress to the family that the medication is controlling the symptoms and the child needs their continued support. Both of these factors are important for the long-term success and treatment of the child.

Which of the following trends in drug use is being seen among young adults? a. Decrease in the use of illegal cocaine derivatives b. Expansion in the misuse of prescription drugs c. Large increase in the use of steroids and methamphetamines d. Increase in the overall use of all types of drugs

ANS: C A disturbing trend is the large increase in the use of methamphetamines, steroids, and inhalants by young people. Among young adults aged 18 to 25, the rate of current nonmedical use of prescription-type drugs in 2011 was 5%, which was lower than the rate in the years from 2003 to 2010.There was a decrease from 2005 to 2011 in the use of cocaine among young adults, from 2.6% to 1.4%. Overall drug use, particularly among adolescents, has declined.

After his family and employer confronted a man with all the problems his drinking was causing, he agreed to go into treatment. However, the wife asks, "But if we are forcing him to go into treatment, wont'he just resent us and keep on drinking?" Which of the following would be the most appropriate response by the nurse? a. "He may resent you, but the relationship between the two of you was being ruined by his drinking anyway." b. "Isn't this better until waiting until he has lost his job and you're forced to seek a divorce?" c. "Treatment can still be effective, even if you're forcing him into it." d. "You're right; it's harder to treat the problem when the person is being forced into treatment, but what choice did you have?"

ANS: C Although individuals who are forced to enter treatment may not be willing to admit the severity of the abuse, they can still benefit from exposure to the treatment program and eventually begin recovery. Treatment does not need to be voluntary to be effective.

Which of the following best summarizes the symptoms of a person with bipolar disorder? a. Chronic, unrealistic, and exaggerated worry about life b. Ongoing hallucinations and delusions c. Changes in mood from depression to mania d. A persistent abnormally elevated or irritable mood

ANS: C Bipolar disorder refers to a group of mood disorders that present with changes in mood from depression to mania. The depressed phase is manifested by symptoms seen in major depressive disorder. The manic phase is characterized by a persistent abnormally elevated or irritable mood, impaired judgment, flight of ideas, pressured speech, grandiosity, distractibility, excessive involvement in goal-directed activities, few hours sleeping, and impulsivity. These symptoms may co-occur with psychotic features, such as hallucinations and delusions. Generalized anxiety disorder is characterized by chronic, unrealistic, and exaggerated worry and tension about one or more life circumstances lasting 6 months or longer.

Which of the following females would be at greatest risk for developing bulimia nervosa? a. A 13-year-old who is constantly snacking on food from her backpack all day b. A 14-year-old student who is known as a nerd c. A 15-year-old cheerleader who wants to be a professional ballerina d. An 11-year-old student with the highest Grade Point Average (GPA) in the school

ANS: C Bulimia nervosa typically begins in adolescence or during the early 20s, usually in conjunction with a diet. High school and college students, as well as members of certain professions that emphasize weight and/or appearance (e.g., dancers, flight attendants, cheerleaders, athletes, actors, models), are at a high risk. Based on these descriptors and the typical characteristics of a person who has bulimia, the 15-year-old cheerleader demonstrates the greatest risk.

Which of the following mental illnesses is most frequently diagnosed among adults in the United States? a. Acute stress disorder b. Bipolar disorder c. Depression d. Schizophrenia

ANS: C Depression is the most frequently diagnosed and one of the most disabling mental illnesses in the United States. Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. Acute stress disorder, bipolar disorder, and schizophrenia are not diagnosed as frequently as depression.

Which of the following was required by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008? a. That alcoholism be recognized as a disease and treatment be given in residential facilities b. That drug addiction be accepted as a mental health diagnosis and addicts be treated rather than jailed when caught c. That health insurance must cover treatment for mental illness on the same terms and conditions as physical illness d. That community clinics must treat clients for mental illness just as they treat prisoners who have a physical illness

ANS: C In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted. The law requires health insurance to cover treatment for mental illness on the same terms and conditions as physical illness. This law does not require that alcoholism be recognized as a disease, that drug addiction be accepted as a mental health diagnosis, or that community clinics must treat clients for mental illness.

A 14-year-old girl came with her family to the clinic as her father picked up his medication. The girl became anxious and said she had to go home soon to clean the house and start dinner. Which of the following would the nurse most likely suspect from this interaction? a. As Freud pointed out, girls try to take over the wife role with their dad. b. The girl did not want to admit her dad was a drug addict and was trying to get away from an uncomfortable environment. c. The girl is taking on the role of hero with responsibility for caretaking functions. d. The girl was afraid she would be seen with her dad, a known drug addict, in a public place.

ANS: C In the case of substance abuse, a major purpose of the system is to deny the substance abuse of the affected family member and keep it a "shameful" family secret. Generally, ego boundaries between the family members are weakened or nonexistent, with enmeshment of the members and an intolerance of individual differences. Rules are rigid and communication is unbalanced; the dynamics are either always conflicting or always superficially pleasant. Children may become involved in a "role reversal" in which they act as caretakers of their parents.

Which of the following would be most upsetting for American families when their loved one, after serving in Iraq or some other battlefield, returns home? a. Many families, especially those with children, do not want guns in the house. b. Reabsorbing them into the family structure is challenging and difficult. c. The suicide rate is twice as high as among nonveteran adults. d. They must use the Veterans Affairs medical system for medical care.

ANS: C Male veterans in communities are twice as likely to die by suicide as their civilian counterparts. There is nothing to support that these veterans will have guns in their homes. The veterans will be able to use the Veteran Affairs system for medical care and there may be challenges with their return home, but that should not be as upsetting as the risk for suicide for their loved one.

Which of the following is the most commonly used illegal mood-altering substance? a. Cocaine or crack ecstasy b. Heroin c. Marijuana d. Methamphetamine or speed

ANS: C Marijuana was the most commonly used illicit drug. In 2011, there were 18.1 million past month users. Between 2007 and 2011, the rate of use increased from 5.8% to 7.0%, and the number of users increased from 14.5 million to 18.1 million

Which of the following is the treatment of choice for treating heroin addicts during withdrawal? a. Acamprosate b. Benzodiazepines c. Methadone d. Naltrexone

ANS: C Methadone is the treatment of choice in withdrawal from heroin or other opiates. As a detoxification agent, methadone is dispensed over an 8-day period in a tapering dose. Dosage is dependent on the degree of opiate withdrawal symptoms present. Benzodiazepines are used for alcohol withdrawal, and Antabuse is no longer used. Naltrexone may be used to supplement methadone

A nurse is working in a community setting caring for persons with mental health problems and their families. Which of the following is the most important and critical task for this nurse? a. Be an advocate by writing letters to legislators demanding more resources for care for the mentally ill b. Encourage all those involved to fight the community's tendency to stigmatize the mentally ill and their families c. Establish supportive interpersonal relationships with all those involved d. Lobby for increased funding for care of the mentally ill

ANS: C Perhaps the most critical impact made by the nurse in a community setting is through the establishment of interpersonal relationships with clients. Establishing supportive relationships is the first step in the role of the community mental health nurse as coach for mental and physical health promotion. After a supportive relationship has been established, the nurse will be more knowledgeable about the needs of the population and will be a better advocate and lobbyist for the population.

Which of the following females would be at greatest risk for developing anorexia nervosa? a. A young woman who had been badly hurt in a car accident and is now living with her grandparents but managing to retain her high school Grade Point Average (GPA) b. A young woman who is a fantastic athlete but acts out and does what she feels is best, regardless of what others think c. A "good girl," obedient to her parents' wishes, who always agrees with peers in her clique and strives to do everything perfectly d. A student under a lot of stress from family events at home but who has good coping skills and recognizes that she is coping with major life changes

ANS: C Risk factors for eating disorders are perfectionism, low self-esteem, stress, poor coping skills, sexual/physical abuse, poor self-image, dependency on others' opinions and deference to others' wishes, and being emotionally reserved. Based on these descriptors and the typical characteristics of a person who has anorexia, the "good girl" demonstrates the greatest risk.

Which of the following best explains what experts believe is the causative factor in the decline in total alcohol consumption? a. Americans prefer less dangerous mood-altering substances. b. Increased "sin" taxes on alcohol and tobacco nationwide c. Less social tolerance and no-drinking-while-driving campaigns d. So many movies about teenaged drinking make alcohol look adolescent.

ANS: C The decline in alcohol consumption through the 1990s and into the twenty-first century is attributed to less tolerant national attitudes toward drinking, increased societal and legal pressure and action against drinking and driving, and increased health concerns among Americans. The decline does not have to do with Americans choosing other mood-altering substances, increased taxation, or the media.

A person with obsessive-compulsive disorder (OCD) knows the ritual is senseless, but is unable to stop. Which of the following best explains why he does not quit doing the ritual? a. As rituals become habit, others will worry about the person if he or she suddenly stops engaging in the ritual behavior. b. Engaging in rituals allows the individual to feel in control. c. If the compulsion is resisted, anxiety increases. d. Rituals, even if nonsensical, are comforting and reassuring.

ANS: C The person with OCD feels compelled to engage in some ritual to avoid a persistent frightening thought, idea, image, or event. Obsessions are recurrent thoughts, emotions, or impulses that cannot be dismissed. Compulsions are the rituals or behaviors that are repeatedly performed to prevent, neutralize, or dispel the dreaded obsession. When the individual tries to resist the compulsion, anxiety increases.

Which of the following best explains why most states have the legal drinking age set at 21 years old? a. At 21 years of age, most Americans consider a person an adult. b. College is completed, and employment has begun by 21 years of age. c. Most 21-year-olds are self-supporting and no longer dependent on parents. d. The alcohol-related death rate rose alarmingly when drinking age was lowered to 18 years.

ANS: D Alcohol use was highest during the 1980s, when states lowered the drinking age to 18 years of age. Lawmakers became alarmed at the increased rate of drinking and the increased number of alcohol-related deaths among 18- to 25-year-olds after lowering the drinking age and therefore reversed the decision. During the late 1980s, alcohol use declined after the minimum drinking age was reinstated to 21 years of age. Thus, the significance of the legal drinking age of 21 has to do with the problems experienced when the legal drinking age was lowered to 18, not that 21-year-olds are considered to be "adults", employed, or self-supporting by this age.

In which of the following ways is methamphetamine different from and more dangerous than other mood-altering substances? a. The drug itself is highly combustible, so both makers and users have suffered severe burns when injecting it. b. Methamphetamine helps users become more productive and energetic so people find it helpful at work and home and want to continue using it. c. It provides more pleasurable effects more quickly than other mood-altering drugs, so persons become addicted more quickly. d. Severe neurological changes occur in the brain very quickly, often even with the first dose.

ANS: D Methamphetamine appears to damage the brain in ways that are different from, and more severe than, damage from using other drugs. Currently, there is a rudimentary understanding of ways it affects the brain, but it is known that profound neurological changes occur even with first administration. Methamphetamine is highly combustible, and makers have suffered severe burns when manufacturing it. The pleasurable effects of methamphetamine leads to users having increased energy, a sense of euphoria, and increased productivity. However, it also causes an increased heart rate, insomnia, excessive talking, excitation, aggressive behaviors, anxiety, convulsions, paranoia, and brain damage. Prolonged use results in tolerance and physiological dependence. Because of the physiological dependence, users may feel powerless in having a choice in whether they use the drug or not. Its increased popularity is related to it appearing in mass quantities because of the ease in which fertilizer anhydrous ammonia can be converted to methamphetamine.

A nurse asked a family if they'd work with her to create a family genogram. The mother asked, "Why would you want to know so much about our family?" Which of the following would be the most appropriate response by the nurse? a. "A genogram helps you see how some problems run in families. Your children will need to know this." b. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." c. "Please be assured you don't have to answer any question you don't want to answer." d. "Why would you want to keep your family members secret? Is there some problem?"

B. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." A genogram is an excellent opening to the discussion of family history and possible hereditary health problems. It may also point to a need for health education. Some families may be sensitive to the sharing of such information, but obviously any patient can answer with however much or little he or she wishes to share

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

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

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

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

The 7-year-old boy's hands were badly burnt; it was suspected that his mother had forced his hands into boiling hot water after she caught him masturbating. The staff did not want the mother to be allowed near the boy. Which of the following statements would be made by the nurse to encourage the staff to interact more objectively with the mother? a. "If we won't let the mom near, who does the child have for support at this painful time?" b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." c. "The child may feel responsible; we have to let the mother fix their relationship." d. "We need to encourage the mother to continue parenting him or the boy will become a ward of the state."

B. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." Most child maltreatment occurs within the family. Risk factors for child maltreatment include but are not limited to special needs children (children with disabilities, mental retardation, or chronic illness), children less than 4 years of age, family history of violence, substance abuse, poverty, and social isolation. Thus, it is most important that the staff provide support to the mother. The purpose of allowing the mother with the child is not for additional support for the child or mother, rather the recognition that the mother may have a history of abuse as well and needs assistance to change the patterns of behavior that have been learned through her own life experience

A nurse came limping into work with a huge cast on her right leg and asked to have an assignment for a week or two that did not require driving. The nurse said, "I never realized how difficult it is to get some places without two good legs. Now I know how persons with disabilities must feel!" Which of the following would be the most appropriate response from the nursing supervisor? a. "I'm sure you'll be even more understanding and supportive now." b. "Not really; you'll be out of that cast in a few weeks." c. "What a great opportunity to attend some support groups for people with disabilities and share with us which ones are most helpful." d. "Why don't you just take some sick leave rather than try to work with that leg cast?"

B. "Not really; you'll be out of that cast in a few weeks." Those who have a temporary disability have a very different experience than those who are permanently disabled. Although they may experience frustrations, they view it as a temporary problem and a temporary setback. The other responses address this temporary disability as if it is similar to a permanent disability, which it clearly is not.

Which of the following questions is crucial to ask very early in a family interview? a. "Do you see any way this problem could have been avoided—so future problems could be prevented?" b. "What do you all, as a family hope to achieve during your time with me?" c. "What would you like me to do for you today?" d. "Would you like to know my perception of what our goals together should be?"

B. "What do you all, as a family hope to achieve during your time with me?" Therapeutic questions are key questions that the nurse uses to facilitate the interview. One important basic theme is to determine the family's expectations of the interview or home visit.

Which of the following best describes what is meant by cohabitation? a. A living arrangement in which one adult is employed and the other is unemployed b. A living arrangement in which an unmarried couple in a long-term relationship lives together c. A living arrangement between two members of the same sex d. A living arrangement between two single mothers with children

B. A living arrangement in which an unmarried couple in a long-term relationship lives together The most comprehensive definition of cohabitation is a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage. One of the key aspects of this definition is the long-term relationship which is not mentioned in the other definitions.

A nurse is completing a first assessment interview with a family after entering the family's apartment for the first time. Which of the following would be crucial for the nurse to remember? a. Analyze the power relationships before focusing on needed information b. Be on best behavior with manners and courtesy, starting with a self-introduction c. Determine as soon as possible who makes decisions within the family d. Evaluate the safety of the immediate environment for self and the family

B. Be on best behavior with manners and courtesy, starting with a self-introduction Manners are common social behaviors that set the tone for the interview and begin the development of a therapeutic relationship. The nurse introduces himself or herself by name and title and always addresses the client and family members by name (i.e., Mr., Mrs., or Ms., unless otherwise directed by client).

An 80-year-old woman lived with her eldest daughter, the daughter's husband, and their three children. On this visit, the nurse noted the woman looked dehydrated and seemed depressed. Both wrists were red and scabbed. When asked if she was all right, the woman protested she was fine and her daughter took good care of her. Which of the following actions should be taken by the nurse? a. Begin the paperwork to have the elderly woman put in a nursing home b. Discuss respite care and other stress relief measures with the daughter c. Report the elder abuse to the state department of aging d. Review with the total family how to share responsibilities for the woman's care

B. Discuss respite care and other stress relief measures with the daughter Working with victims of elder abuse, the nurse must establish rapport and trust. The nurse should remember that competent adults have the right to make decisions about their own care, including staying in an abusive situation. The nurse should support the family in examining potential respite care options and support groups for the elderly woman and her caregivers

Which of the following best describes why a nurse would ask about the meals of all family members, rather than focus on a nutritional history for the post-myocardial infarction patient? a. It is assumed that all family members eat the same food at the same time each day. b. Lifestyle choices among family members are usually consistent. c. Many parents eat whatever their children don't rather than throw away good food, so the nurse should know what the children eat. d. The nurse was afraid to assume that whoever cooked would only prepare one meal for everyone to share.

B. Lifestyle choices among family members are usually consistent. The family remains the focus because families experience similar risk factors (i.e., physiological, behavioral, and environmental). Family health practices influence lifestyle habits among family members. Consequently, although family members may or may not eat together, they will have a tendency to make similar choices.

Which of the following describes a dimension of the social determinants of health (SDH) defined within Healthy People 2020? a. Employment b. Education c. Gender d. Income

B. Education Five broad dimensions of SDH are defined within Healthy People 2020 as: (a) Economic Stability, (b) Education, (c) Social and Community Context, (d) Health and Health Care, and (e) Neighborhood and Built Environment. Each of these dimensions includes key issues that identify more specific factors (U.S. Department Health and Human Services Healthy People 2020, 2013). Employment, gender, and income are not addressed as dimensions of the social determinants of health within Healthy People 2020.

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

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

A male strong firearms advocate stressed his guns were for self-protection and he wanted all criminals to know his family had loaded guns in their home. Which of the following best explains why a nurse would not support his actions? a. Criminals carry more powerful and illegal guns. b. Guns in the home typically result in dead family members and friends. c. His children may be less careful than the adults in the family. d. Less trained individuals might think the guns were unloaded.

B. Guns in the home typically result in dead family members and friends. Concern about firearms arises when it has been shown that guns kept in the home for self-protection are more likely to kill a family member or a friend than an attacker. Furthermore, the presence of a gun in the home triples the risk for homicide in the home, increases the risk of suicide three to five times, and accidental deaths by four times

Which of the following statements best describes how firearm injuries are different in rural areas as compared with urban areas? a. In rural areas, firearm deaths occur more frequently because of purposeful, rather than accidental, shooting. b. In rural areas, firearm injuries occur more frequently in the home. c. In rural areas, firearm injuries occur more frequently during official hunting season, whereas the frequency does not vary in urban areas. d. In rural areas, firearm injuries are more frequently fatal than in urban areas.

B. In rural areas, firearm injuries occur more frequently in the home. In rural counties, nonfatal firearm injuries occur most often at home compared with urban counties, where injuries occur most often in the streets.

Which of the following best describes the current perspective on how communities should treat persons with disabilities (PWDs)? a. Be supportive of PWDs and try to reduce environmental barriers b. Maximize opportunities for PWDs to work and otherwise contribute to community life c. PWDs have civil rights just as other citizens do. d. Recognize that PWDs deserve our support both financially and otherwise

B. Maximize opportunities for PWDs to work and otherwise contribute to community life Contemporary disability policy minimizes disadvantages and maximizes opportunities for PWDs to live productively in their communities. Early American public policy viewed PWDs as "deserving poor" who required governmental protection and provision, with little capacity for self-support or independence.

A nurse needed to help a child who was not behaving consistently with the requirements of the new preschool program that began that fall. Which of the following actions would be most appropriate for the nurse to perform? a. Meet with the child each day to let the child have a safe play environment without the regular program frustrations b. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school c. Meet with the child's teacher to brainstorm ways to help the child cope with school requirements d. Point out to the child that if behavior doesn't improve, the child won't be able to play with all the other children at the school

B. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school The teacher can be assumed to be an expert in dealing with small children. If the problem is defined as a child not behaving within expectations, the most effective approach would be to discuss with the parents how to help the child. Systems theory provides direction in understanding how health care providers can expand family capacity by changing parenting and therefore changing child behaviors.

Which of the following facts is noteworthy about adolescent males who are driving without a license in the countryside? a. Most had driver's education classes but have not yet earned the money to pay for their driver's license test. b. Most were Hispanic or black from a rural area. c. Most were practiced in driving large farm machinery and were just going from one section of the farm to another section. d. Most were practicing their driving skills with their parent in the car

B. Most were Hispanic or black from a rural area Researchers studied the prevalence of unlicensed teenaged drivers compared with licensed drivers and found that they were more likely black or Hispanic and live in rural areas. There is not any research in the text that supports that the other responses are accurate

For which of the following groups is suicide the second leading cause of death? a. People aged 15 to 24 years b. People aged 25 to 34 years c. People aged 35 to 65 years d. People over age 65 years

B. People 25-34 yo For people between the ages of 25 and 34 years, suicide is the second leading cause of death, and it is the third leading cause of death in people aged 15 to 24 years

A woman is in the emergency department for the fifth time this year, each time with more severe injuries. Which of the following is the primary responsibility of the nurse? a. Insist she be discharged to a safe shelter where the perpetrator cannot find her b. Provide information regarding safe shelters and sources of support c. Report the assault and battery to the local police department so the perpetrator is arrested for the crime d. Treat the injuries and inform the woman she may be killed if she stays with the perpetrator

B. Provide information regarding safe shelters and sources of support Working with victims of intimate partner violence (IPV) requires the nurse to establish rapport and trust; deal with issues of confidentiality honestly; provide current information regarding shelters and sources of support; and recognize and accept that clients may "choose" to stay in an abusive relationship. Because the nurse wants to establish rapport and trust, it would not be in the best interest of building this relationship if the nurse insist that she go to a safe shelter (rather the nurse should provide her the necessary information) or inform the woman she may be killed (rather the nurse should recognize and accept that the client may "choose" to stay in an abusive relationship). Additionally, the nurse should recognize that even if the assault is reported, it may be denied by the woman and will not result in an arrest of the perpetrator

A family agreed to bring all the children in to the clinic at one time to begin to catch up on the children's immunizations, but they didn't keep their appointment. Which of the following conclusions by the nurse would be most accurate? a. Obtaining immunizations might have been the nurse's goal, not the family's. b. Some barrier or restraint interfered with the family's ability to come. c. The family had other, more important priorities. d. The nurse didn't adequately emphasize the importance of obtaining immunizations.

B. Some barrier or restraint interfered with the family's ability to come. Families most frequently served by the community health nurse are disadvantaged in that they are unable to buy health care from the private sector. However, constraints to obtaining needed health and social services are well documented and may come from characteristics of health and social services rather than individual family limitations. The nurse should note those constraints that prevent full use of the resource such as hours of service, distance and transportation, availability of interpreters, and criteria for receiving services

A professional strongly encouraged institutionalization so the parents could focus on care of their other family members. Which of the following suggestions would be appropriate for the nurse to make to the parents? a. As the expert pointed out, institutionalization will reduce family stress. b. The child has a right to an education in the least-restrictive setting. c. The child will eventually adapt to whatever choice the parents make. d. The choice of what to do is entirely the parents'.

B. The child has a right to an education in the least-restrictive setting. It is a given that it is the parents' choice. As an advocate for the child, you can explain that children have a legal right to an appropriate public education based on the child's needs in the least-restrictive setting.

A 6-month-old infant was brought in unresponsive by both parents. X-ray examination showed evidence of shaken baby syndrome. Which of the following persons is most likely responsible? a. The babysitter b. The dad c. The grandparents d. The mom

B. The dad In approximately 65% to 90% of abusive head trauma cases, also known as shaken baby syndrome, the father or the mother's boyfriend is the perpetrator

When making a home visit, a nurse is usually expected to focus attention on the ill family member. But whom would the nurse possibly focus on instead? a. The children who are being affected by the stress of the situation b. The ill family member's primary caregiver c. The spouse of the ill family member d. The neighbors of the family who may be able to help

B. The ill family member's primary caregiver Changes in family patterns, fears, emotional responses, and expectations of individual family members can be assessed in the family interview. Special needs of the primary caretaker (i.e., often the spouse, daughter, or daughter-in-law) must be assessed

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

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

A school nurse brought a young boy back into a private office and asked him to remove his shirt. Fresh welts across his back were seen. Which of the following would most likely cause the nurse to be concerned about the parents? (Select all that apply.) a. The child had a tendency to act out frequently and really did "ask for it." b. The parents did not like their own child and had trouble hiding that fact. c. The parents were dealing with a lot of stress and lacked support. d. The parents were themselves abused as children. e. The parents may be substance abusers. f. The parents probably did not have health insurance for the boy.

C, D, E Most often, the perpetrators of maltreatment are parents and victims themselves from a cycle of abuse. The two dominant characteristics of abusive parents include a history of substance abuse and abuse from their own parents. They may be stressed by poverty, illness, or disability, and they may lack social support systems or coping skills. In cases of abuse, it is unlikely that the child "asked for it". Because of a possible past history of abuse or substance abuse, parents may be more likely to abuse their own children, it would not be because they do not like their own child. Not having health insurance for the boy would not play a role in whether he was being abused.

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

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

Which of the following would be good rules to use when interacting with a person with disabilities? (Select all that apply.) a. Apologize for slips of the tongue such as saying "Do you see?" to a blind person b. Be friendly to guide dogs, including petting them and offering to get them fresh water c. Notice similarities between yourself and the person with a disability d. Take hold of a blind person's arm to assist them in dangerous situations, such as crossing a busy street e. Volunteer the most recent research findings related to the person's disability f. With someone who is blind, announce who you are and why you are there when you enter the room

C, F Rules include do not offer expert advice or assistance based on what you think the person needs or can do; do not grab the arm of a person who is blind but let the person take your arm so the person does not lose his or her balance; do not pet a working dog; do seek out similarities and shared interests; do inform the person who is present; say goodbye when leaving; and treat the person very much like an able-bodied person.

A 36-year-old woman had diabetes diagnosed at a free health-screening program at a large employer. Which of the following should be emphasized by the nurse when helping the woman make an appointment at the diabetic clinic for follow-up testing and treatment? a. "Bring a food diary of everything you've eaten for one week with you to the appointment to help with future meal planning." b. "It's really not that hard to learn how to inject insulin, and it really doesn't hurt." c. "Please encourage all your family members, including your parents, to be tested for diabetes as well." d. "They'll teach you how to manage your meals and medications to stay healthy."

C. "Please encourage all your family members, including your parents, to be tested for diabetes as well." Although the nurse might make any of these comments, it is particularly important that the rest of the family also get tested. Any problem that affects one or more family members probably affects other family members and the family as a whole. Commonalities in risk factors and diseases shared by family members can lead to case finding within the family. Because families often choose similar foods and engage in similar lifestyle behaviors, they all are at similar risk for problems such as diabetes. The earlier the diagnosis and treatment, the more likely it is that secondary problems can be avoided.

A rape victim says to the nurse, "He said he loved me; he had been so nice; he said he wanted to show me how much he loved me. And then he...." Which of the following is the most appropriate response by the nurse? a. "Anyone can lose control; I'm sure he'll never do it again." b. "I'm not sure he loves you; he may just have wanted easy sex." c. "Rape isn't about love or even sex; it's about power and control." d. "You shouldn't have gone up to his room alone when the two of you had both been drinking."

C. "Rape isn't about love or even sex; it's about power and control." Intimate partner abuse is about control, not anger. The objective of abuse is to exert power and control over the victim

Which of the following best explains why there are so few hospitals in rural areas? a. Few nurses and physicians enjoy the rural lifestyle. b. Historically, hospitals began in large urban areas and have slowly expanded outward but have not yet reached all rural areas. c. Rural areas have very low population density. d. Rural residents do not trust hospitals, preferring to receive care from neighbors and friends

C. Rural areas have very low population density. Although 75% of U.S. counties are classified as rural, they contain only 20% of the U.S. population. The population density is too low to support a large hospital. There are providers available to serve the population and residents are accepting of health care services, but not as many services are needed because of the lower population density.

A nurse was teaching a class on good hygiene at a local day care center when one child volunteered, "I have two mommies." Which of the following would be the most appropriate response by the nurse? a. "Don't tell anyone; that's a secret." b. "That's nice—why did you share that?" c. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." d. "Which mommy is your real mommy?"

C. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." The Human Rights Campaign (2009) urges that health professions acknowledge all types of families including gay, lesbian, and even grandparents as heads of family.

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

C. A client who may well have hearing or vision problems or both Visual and hearing impairment are among the most common age-related conditions affecting the elderly population. The prevalence of vision impairment in individuals over the age of 65 years is: 17% of individuals 65 to 74 report some form of vision impairment and 26% of individuals over the age of 75 report some form of vision impairment. A study by physicians at Johns Hopkins University in Baltimore, MD, found hearing loss prevalence in patients 70 years and older to be 60%. Thus, the nurse should be anticipating the needs of the client rather than being concerned about the potential factors that the client may be upset about.

Which of the following persons will have the most difficulty in obtaining adequate support services to find a long-term home? a. An alcoholic homeless person b. A homeless person who has a limited support system and is unemployed c. A homeless person who has a mental illness and is an alcoholic d. A mentally ill homeless person

C. A homeless person who has a mental illness and is an alcoholic For a sizable proportion of the homeless, severe mental illness exists along with the problems of alcohol or other types of substance use. Like physical health problems, serious mental illnesses and minor emotional problems occur more frequently among the homeless population than in the general population. High rates of alcohol and drug use exacerbate the existing acute and chronic physical and mental health problems. These coexisting problems can make it harder to assist the homeless person.

Which of the following best describes how many households with at least one child with a disabling condition would a school nurse working in an elementary school expect to see? a. About 5% b. About 10% c. About 15% d. About 20%

C. About 15% About 15.1% of households with children have at least one child with a special health care need (disabling condition).

Which of the following best describes why all citizens should care about young people joining gangs? a. Gangs are beginning to be seen in suburban areas. b. Gangs are responsible for destroying lives and property in inner cities. c. Gangs commit as much as 90% of all crime in some communities. d. Gangs help give the young person protection, respect, and sense of belonging.

C. Gangs commit as much as 90% of all crime in some communities It is estimated that gangs are responsible for approximately 48% of all crime and up to 90% in some areas. These crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder. Gangs exist throughout the country, in urban and suburban areas. Destruction of lives and property is not the major reason why citizens should be concerned with gangs. Although gangs do give young persons protection, respect, and sense of belonging, the major concern would be the amount of crime that is associated with gangs.

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

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

Which of the following is an accurate definition of impairment? a. A disadvantage resulting from a disability that prevents fulfillment of an expected role b. A restriction or inability to perform an activity in a normal manner c. An anatomical, mental, or psychological loss or abnormality d. A defect that affects society on a macro level

C. An anatomical, mental, or psychological loss or abnormality A disability, resulting from an impairment, involves a restriction or inability to perform an activity in a normal manner or within the normal range. An anatomical, mental, or psychological loss or abnormality is an impairment. A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role. In a comparison of these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis.

Which of the following best describes the incidence of abuse among pregnant women? a. It is too difficult to determine the actual incidence of abuse among this population. b. It is estimated that approximately 1 out of every 10 women experiences abuse. c. Approximately one out of every six women has been abused by a partner. d. Abuse does not occur among pregnant women.

C. Approx 1 out of every 6 women have been abused by partners Pregnancy does not protect women from the danger of abuse. Indeed, pregnancy may increase stress within the family and provoke the first instances of battering. It is estimated that one in six pregnant women have been abused by a partner

Beyond gathering needed information for future interventions, which of the following purposes is served when the nurse interviews the family? a. Assessing the safety of the immediate environment before further planning can be done b. Establishing a process for the nurse and the family to make decisions c. Engaging in focused planned conversation, which has healing potential in itself d. Focusing on giving compliments to make the family feel good about themselves

C. Engaging in focused planned conversation, which has healing potential in itself The second key element in the interview is the therapeutic conversation. This type of conversation is focused and planned and engages the family. The nurse must listen and remember that even one sentence has the potential to heal or help a family member. Every encounter, whether brief or extended, has "healing potential."

Which of the following best describes why some advocacy groups have taken a strong stand against physician-assisted suicide? a. Ethical belief that life is always preferable to death b. Emphasis that there is always hope for a research breakthrough or discovery of a new treatment intervention c. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions d. Helping someone die is murder, plain and simple

C. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions Because people have previously been killed because they had a disability, some advocacy groups, such as Not Dead Yet, have taken a strong stance against physician-assisted suicide, fearing it will lead to the early or forced death of people with disability. Ethical and personal beliefs and emphasizing the hope for a new treatment have not been stands taken by advocacy groups against physician-assisted suicide.

Which of the following are examples of the internal structure of the family? a. Ethnicity and race b. Extended family members c. Gender and rank order of birth d. Social class and religion

C. Gender and rank order of birth Internal structure of the family refers to such items as family composition, gender, rank order (by age and sex), subsystems through which the family functions, and boundaries or who is in and who is not in the family system. Extended family members are part of the external structure.

Each evening, a newly disabled man becomes angry when his wife, just home from her new full-time job, does not have dinner on the table at 6 PM. Which of the following actions would be most appropriate for the nurse to take? a. Allow the wife to express her frustration and anger to you b. Explain to the husband that he is going to have to begin learning how to cook c. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone d. Suggest to the children who are old enough that they prepare some simple meals during the week with the mother doing the fancy cooking only on weekends

C. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone Roles refer to established patterns of behavior for a family. It takes other family members to keep a person in a particular role. Traditional roles are being challenged and are evolving with economic changes. Formal roles may come into conflict with roles set by family members. The husband has major life changes to which to adjust, as do all the other family members. His anger is a symptom of the painfulness of major life changes. The nurse can help the family members recognize the problem in preparation for addressing the issues.

Which of the following groups is the fastest-growing component of the rural population? a. Disabled adults b. Elderly women c. Hispanic children d. Retirees

C. Hispanic children Today, the proportion of Hispanic children is the fastest-growing component of the rural population, regardless of region.

Where is youth violence most likely to occur? a. At home b. At recreational facilities c. In inner city schools d. In fast-food facilities where young adults are employed

C. In inner city schools Youth-related violence is more concentrated in minority communities and inner cities, causing a disproportionate burden on these communities. Children are often not taught peaceful ways of resolving differences and learn by default from what they observe on television and in movies. Consequently, schools have become a common site for

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

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

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

C. Level of involvement with physical and/or sexual abuse In the 1990s, research clearly documented the extraordinary histories of violence, from childhood through adulthood, among women experiencing homelessness. High numbers of homeless women report histories of foster placement as children and exposure to violence as both children and adults. This research has not documented the differences in educational opportunities, gender relationships, and skills necessary for paid employment.

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

C. Lisa may be developmentally delayed. Homeless children have higher rates of physical, mental health and behavior, and educational problems than children in the general population. All children are not always respectful and do not always have their homework done and may act out behaviors seen on television.

Which of the following are particularly prevalent in rural areas (more so than in urban areas) of the South? a. Falls and motor vehicle accidents b. Less use of seatbelts and more drinking of alcohol c. Obesity and sedentary lifestyle d. Suicide and homicide

C. Obesity and sedentary lifestyle Rural residents in the southern states are more likely to be obese, smoke more heavily if they do smoke, use smokeless tobacco, and engage in sedentary lifestyles. Rates of motor vehicle accidents and suicide are higher in rural areas, although not necessarily the South. Additionally, there is a decreased use of seatbelts and increased use of alcohol in rural areas; however, the textbook mentions that these rates are higher in the rural West than in the rural South. The rates of falls and homicide are not addressed in the textbook.

A family has recently learned that their child will be permanently disabled. The parents do not deny the disability, but do not fully realize its impact. Which of the following levels of adjustment are the parents experiencing? a. Self-actualization b. Normalization c. Ostrich phase d. Special designation

C. Ostrich phase Ulrich and Bauer (2003) propose that the adjustment to disability experience occurs in four levels as parents gradually become aware of the impact of their child's disability. These levels include: (1) the ostrich phase, where parents do not deny a disability, but do not fully realize its impact; (2) special designation, when parents begin to realize their child has a special need and seek help; (3) normalization, when parents try to make the differences between their child and children without disabilities less apparent, and may actually request a decrease in services; and (4) self-actualization, when parents do not view being different as better or worse, just different, and support their child in learning about his or her disability, along with how to be a self-advocate.

Which of the following is a major barrier to a nurse caring for the family as a whole? a. Families often don't want to know what is wrong with their loved one. b. Nurses don't know how to care for families. c. Reimbursement is paid only for services given to an individual. d. The family often isn't available when the nurse is giving care.

C. Reimbursement is paid only for services given to an individual. As a result of the current era of cost containment, constraints on the community health nurse will increase. Reimbursement is almost entirely calculated for services rendered to the individual and thus is a major constraint toward moving toward planning care for the family as a unit.

Which of the following best describes how the federal government tries to both encourage and support rural health clinics under the Community Health Centers (CHC) program? a. Allowing tax deductions for charitable contributions to rural health clinics (RHCs) b. Donating equipment and supplies to establish such clinics c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise d. Requiring recipients to serve in a rural health clinic for 3 years in exchange for financial assistance while in school

C. Reimbursing both Medicare and Medicaid at a higher rate than otherwise The CHC program, administered by the U.S. Public Health Service, benefits underserved areas and populations. RHCs are designed to improve access to primary care. As an incentive to rural communities to apply for RHCs, Medicare and Medicaid are reimbursed at a higher rate than usual

A 4-year-old child is seen in the emergency department with a spiral fracture of the right arm. X-ray examination shows previously broken and healed bones. Which of the following is the immediate responsibility of the nurse? a. Call social services to immediately set up foster care for the child b. Provide information about parenting and anger management classes c. Report the child abuse to the local legal authorities d. Try to establish rapport and trust with the child's family

C. Report the child abuse to the local legal authorities Spiral fractures are only possible from abuse, because they require a wringing motion to occur. When working with victims of child abuse, the primary obligation of all health care providers is to protect the child. The abuse must be reported as a legal and ethical obligation.

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

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

Which of the following best describes how Migrant Health Centers (MHCs) under the Migrant Health Program are often different from other clinics? a. Care is restricted to those who can document that they are employed in agriculture. b. They are much better funded than typical rural clinics. c. Staff are typically bilingual and bicultural. d. They welcome illegal immigrants to receive care.

C. Staff are typically bilingual and bicultural. The MHCs and the Migrant Health Program provide comprehensive nursing and medical care and support services to migrant and seasonal farm workers and their families from many countries in Latin America and the Caribbean. Bilingual, bicultural health personnel, including lay outreach workers, use culturally appropriate protocols for providing primary care, preventive health care, transportation, dental care, pharmaceuticals, and environmental health. The funding at the MHC may not be any different than other rural clinics. Their primary purpose is not to provide care to illegal immigrants, rather to migrant and seasonal workers.

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

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

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

C. The number of people in homeless families is increasing. The U.S. Department of Housing and Urban Development reported the following numbers of people in the total population and subpopulations who used shelters or transitional housing between October 1, 2010, and September 30, 2011: 4,469 individuals, a decrease of 11% since 2007; 537,414 people in families, an increase of 13.5% since 2007. According to the U.S. Department of Education: 1,065,794 homeless students were enrolled during the 2010-2011 school year an increase of 11% over the 3-year period 2008-2009 to 2010-2011.

Which of the following statements best describes how working on a farm is different from working in a factory? a. Factories have more dangerous dust than farming dust. b. Farm chemicals are more immediately fatal than most industrial chemicals. c. The worksite and the home are the same. d. Workers on farms, unlike those in factories, can bring dangerous substances home on their clothing, which expose their families.

C. The worksite and the home are the same. Farming is unusual because the home and the worksite are the same. Several types of farming activities are associated with higher-than-expected occurrences of acute and chronic respiratory conditions. Individuals with long-term exposure to grain dusts, such as grain elevator workers and dairy workers, have diminished respiratory function and increased frequency of respiratory symptoms. Occupational asthma and more exotic fungal or toxic gas-related conditions occur in higher frequency in agricultural than nonagricultural populations. Exposure risks to children and spouses may be heightened when farmers wear contaminated clothing and boots into the home, but the same can happen in several industries.

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

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

Which of the following statements best describes how a family can meet the needs of society? a. By living and existing in the wider community b. By meeting the needs of the individual family members c. Through procreation and socialization d. Through productivity seen in employment positions

C. Through procreation and socialization The family fulfills two important purposes. The first is to meet the needs of society, and the second is to meet the needs of individual family members. The family meets the needs of society through procreation and socialization of family members.

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

C. To afford housing, they need a job that pays at least three times minimum wage. In many areas of the country, wages needed to afford housing are three to five times higher than the federal minimum wage of $7.25 per hour.

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

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

Which of the following best describes the purpose of the Vulnerability Index? a. To identify those most at risk of becoming homeless b. To determine the underlying cause of homelessness among vulnerable populations c. To identify and prioritize the need for housing among the homeless d. To determine what resources should be provided for vulnerable populations

C. To identify and prioritize the need for housing among the homeless Homeless service providers, concerned about the high risk for mortality among "street" homeless population constructed the Vulnerability Index, a screening tool for identifying and prioritizing the need for housing.

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

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

A male nurse is enjoying a very hot summer day at the zoo when he notices a family approaching. An elderly member of the family is moving very slowly and being scolded by another adult, saying "You are not sick. Let's keep moving." The nurse touches the elderly adult who has a flushed face and notices clammy and moist skin. What should the nurse say to the adult? a. "I'm a nurse, and your family member needs to go to the emergency department right now." b. "I'm a nurse, and your family member has heat stroke. I'm calling 911." c. "Take your family member to the air-conditioned restaurant, and have him drink a cold soda immediately." d. "Take your family member to the air-conditioned restaurant, and let your family rest for a while."

D, "Take your family member to the air-conditioned restaurant, and let your family rest for a while." There is not enough evidence to be quite sure what is wrong with the elderly adult, but clearly the elderly person is suffering from being in the hot sun for a period of time. The elderly adult—and probably the rest of the family as well—needs to be moved to a cooler environment and be made to lie down and rest. Drinking chilled water (not soda with caffeine) would also be helpful. In that cooler environment, the nurse can assess the situation to determine whether further action should be taken.

A son explained to the home health nurse that since his mother died, his father did not seem to have any interest in life and had even told his son he was considering suicide. Which of the following would be the most appropriate response by the nurse? a. "If he really wants to kill himself, he will, and there really isn't anything you can do to stop him." b. "If you talk to him about it, you're strengthening the idea." c. "People who talk about suicide rarely do it, so don't worry." d. "Suicide is a serious concern; let's talk to his doctor about what you've noticed."

D. "Suicide is a serious concern; let's talk to his doctor about what you've noticed." Suicide is a serious health concern related to the elderly, who account for 18% of all suicides. Elder suicide is associated with depression, chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Warning signs to watch for in the elderly are loss of interest in things or activities that are usually found enjoyable; cutting back from social interactions, self-care, and grooming activities; not following medical regimens (e.g., going off diets, not taking prescriptions); experiencing or expecting a significant personal loss (e.g., death of spouse or friend); feeling hopeless or worthless; putting affairs in order; giving things away; making changes in will; and stockpiling medications or obtaining other lethal means for committing suicide. The most significant warning sign is any expression of intent. Because the father is at high risk for suicide, the son must discuss the problem with the father's physician so that care can be obtained.

A nurse is explaining why migrant farmworkers experience cultural barriers when trying to receive care. Which of the following would the nurse include in this explanation? a. "As illegal immigrants, they are not eligible for tax-paid health care." b. "Families who travel in isolation seeking agricultural work do not mix with their employers or other members of the community." c. "Mexicans who speak primarily Spanish and cannot understand English." d. "Usually perceived as outsiders, they are from many countries and cultures."

D. "Usually perceived as outsiders, they are from many countries and cultures." Cultural, linguistic, economic, and mobility barriers all contribute to the nature and magnitude of health problems observed in farmworkers. Cultural and linguistic barriers are the most overt because many of the communities where farmworkers work consider them outsiders. A common misconception among U.S. health care providers is that these farmworkers are from Mexico, with Spanish as their primary language. Farmworkers originate from many communities in Mexico, the Caribbean, and Central and South America, and they may speak English, the language of their home country, or several languages

A mother says to the nurse, "I know I should be feeling an empty nest sadness now that our youngest has left for college—but mainly I'm dying to turn his room into my craft room. Do you think that's normal for a mom? I really do love my kids." Which of the following would be the most appropriate response by the nurse? a. "Hmm, that is unusual. Would you like me to make an appointment with a psychologist for you?" b. "Maybe you've always wanted to be an artist and now you can, so enjoy the feeling—and the room!" c. "You're probably trying to put a positive spin on the situation to keep feelings of sadness at bay." d. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." e. "Would you like to talk about how you feel?"

D. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." To assess the family, the community health nurse must comprehend developmental phases and the struggles that families experience while going through them. The mother is recognizing the stage of launching family that occurs when the youngest child leaves home. The development requirement of this stage of life includes establishment of independent identities for parents—such as focusing on becoming a crafts person.

A young man rolled his wheelchair up the ramp into the clinic to the desk where the intake nurse greeted him. After welcoming him to the clinic, which of the following should be the initial question asked by the nurse? a. "Are you a vet home from the war?" b. "Can I help you into the treatment room to see the nurse practitioner?" c. "Do you have any family with you to help today?" d. "What brings you to the clinic today?"

D. "What brings you to the clinic today?" The client should be asked what is needed just as any other client would be. A veteran would more probably be at a Veterans Affairs (VA) clinic, and there is nothing in the statement to imply that the clinic is part of the VA medical system. Because the man made it into the clinic, it is doubtful he would need help into the treatment room. Not all persons live with families. The handicap may be unrelated to why he is at the clinic. He may be ill or merely need immunization or other health promotion activity.

The nurse has started to complete a family health tree. Which of the following questions would be most helpful as the nurse works with the family to promote their health? a. "Can you tell me the cause of death of your older relatives back several generations?" b. "Do you know of any chronic health problems any of your relatives or their spouses have had?" c. "What concerns do you have about your family's health?" d. "What do your family members do to keep in shape and handle stress?"

D. "What do your family members do to keep in shape and handle stress?" The family health tree is based on the genogram of the current generations—that is, parents, their children, and their own parents. Spouses and past generations aren't included. The family health tree provides a mechanism for recording the family's medical and health histories. The nurse should note causes of death of deceased family members, genetically linked diseases, and lifestyle-related risk factors (i.e., by asking what family members do to "handle stress" and "keep in shape"). The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination

A man had been in an extended-care facility for five weeks and was now home. His wife tells the nurse, "He's trying to take up where he left off but we've adapted to not having him home. He keeps thinking things will be just as they were when he left, but they aren't." Which of the following would be the most appropriate response by the nurse? a. "Are the changes making him uncomfortable or are the rest of you uncomfortable?" b. "Do you want me to talk to him and try to explain?" c. "How can we make things as they were before he left?" d. "You all adapted to running the house without him; it will be challenging now to adapt back."

D. "You all adapted to running the house without him; it will be challenging now to adapt back." Family functional assessment, or how family members behave toward one another, is divided into two categories. The first is instrumental functioning, which refers to routine activities of daily living. This area takes on important meaning for the family when one member of the family becomes ill or disabled and changes were made. When the family member is better, the family must again adapt to changes, even if the change is to return to the original mode of functioning. It will help the family to be able to recognize the problem; labeling it makes it more manageable.

Which of the following describes the most important need of every school-aged child with a disability? a. A teacher who understands the child's needs b. An advocate within the school system c. An assessment with comparison with developmental milestones d. An individualized education plan (IEP)

D. An IEP A child should have all of the above items, an advocate in the school nurse, a teacher who understands, an assessment including comparison with developmental milestones, as all of these are components of an IEP with goals, cooperatively developed with the parents, to help the child succeed in school. The IEP describes the goals, as well as any special support needed to help achieve them. The IEP is the most comprehensive answer.

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

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

Which of the following best describes the typical perpetrator of homicide? a. A person trying to engage in rape with the woman fighting back b. A person who wanted money and she refused to give it to him c. A stranger d. An intimate partner

D. An intimate partner Over 50% of the victims were killed by someone they knew. Notably 37% of female murder victims are killed by an intimate partner. Thus, the typical perpetrator would be an intimate partner. It would be less likely to be a stranger, someone who wanted money, or someone trying to engage in rap

Which of the following best explains why more nurses do not report violence against themselves to authorities? a. Assumption that the nurse somehow "asked for it" by not being cautious enough or alert enough to avoid it b. Assumption that nothing would be done about the situation anyway c. Assumption that nurses can accept anything, from taking blame to being scapegoats for when outcomes are not positive d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job

D. Assumption that patients and families cannot be held responsible; being assaulted is part of the job Workplace violence tends to be higher in some service-oriented work environments, including health care. Such violence is widely believed to be underreported, perhaps in part because of beliefs that it is an expected part of certain jobs.

Which of the following would be true for a county to be defined as having persistent poverty? a. At least 10% of the population has been in poverty for at least the last 10 years. b. At least 10% of the population has been in poverty for at least the last 20 years. c. At least 20% of the population has been in poverty for at least the last 20 years. d. At least 20% of the population has been in poverty for at least the last 30 years.

D. At least 20% of the population has been in poverty for at least the last 30 years. Persistent poverty is defined as counties in which 20% of the population has been in poverty over the last 30 years.

Which of the following best describes why hate crimes involving violence are often considered worse than other crimes involving violence? a. Because hate crimes cannot be avoided because one cannot change one's race or religious or sexual orientation b. Because hate crimes often are committed by groups rather than individuals c. Because more damage is typically done in a hate crime than in a typical assault and battery d. Because the crime is personal, attacking the victim's identity

D. Because the crime is personal, attacking the victim's identity Hate crimes are crimes based on an individual's race, sexual orientation, religious beliefs, ethnic background, or national origin. Hate crimes may include rape, sexual or physical assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate crimes attack an individual's identity, the emotional effects are compounded.

Which of the following factors is strongly predictive for homelessness among women veterans? a. Having a previous criminal conviction b. Being a mother c. Having a high school education d. Being unmarried

D. Being unmarried Additional research has demonstrated that being unemployed, disabled, or unmarried strongly predicts homelessness among women veterans. Having a high school education, being a mother, and having a previous criminal conviction are less predictive of homelessness than marital status.

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

D. Hand the husband pencil and paper and ask him to draw a clock Clients with Alzheimer's disease are unable to draw a normal clock. As a test for Alzheimer's disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. The clock drawing test is an easily administered, low-cost screening tool, which is useful. This should be the first action taken by the nurse to screen the client for Alzheimer's disease and take appropriate action as necessary.

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

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

What has research suggested is a barrier to college students eating healthy? a. Lack of access to an exercise facility b. Lack of access to a primary care provider c. Lack of knowledge of the benefits of healthy eating d. Lack of knowledge related to food preparation

D. Lack of knowledge related to food prep Young adults, though identified as underinsured and having limited access to primary care, are identified as a group knowledgeable about the benefits of healthy eating. This age group (20-31) has been identified in numerous national surveys to not regularly engage in healthy eating habits especially eating below the recommended daily servings of fruits and vegetables and a diet high in fast foods. Earlier studies among college students identified the following barriers: cost, stress, lack of knowledge related to food preparation, and peer influence and lack of time to balance busy lives.

Which of the following was the result of the passage of the American Recovery and Reinvestment Act of 2009? a. A few employers accepted the extra funds and employed more people with disabilities (PWDs). b. Large numbers of employers accepted the extra funds and employed more PWDs. c. Employers still refused to employ PWDs. d. Little change has occurred.

D. Little change has occurred. Employers willing to hire PWDs may receive monies provided through the American Recovery and Reinvestment Act (2009). However, little improvement in employment levels has been seen.

A public health nurse is working in a rural clinic. On the basis of risk, which of the following would be the priority group for care? a. African American adults b. Adolescents c. Elderly women who live alone d. Migrant and seasonal farmworkers (MSFW)

D. Migrant and seasonal farmworkers (MSFW) In general, MSFW may have the poorest health of any aggregate in the United States, and the least access to affordable health care. Eighty-?9?ve percent of the MSFW are Hispanic, Latino, or African American.

Which of the following employment opportunities are among the most dangerous? a. Food processing, textiles, and transportation b. Highway construction, ranching, and public utilities c. Large mechanized factory positions d. Mining, forestry, and fishing

D. Mining, forestry, and fishing Industries with the highest death rates were mining, agriculture, forestry, and fishing, followed by construction, transportation, and public utilities.

Which of the following problems was the Ticket to Work and Work Incentives Improvement Act (TWWIIA) designed to address? a. Employers trying to avoid hiring persons with disabilities b. Employers resenting being forced to hire persons with disabilities c. Persons with disabilities not being able to receive on-the-job training d. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports

D. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports Typically, people with disabilities could qualify for such benefits as health care, income assistance programs, and personal care attendant services only if they chose not to work. To address employment and benefit issues for persons with disabilities, in December 1999, the TWWIIA was signed into law. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work.

Which of the following factors would cause a geographic area to be called a frontier area? a. Arbitrary distinction recognizing the Great Plains, Intermountain areas, and Alaska b. Geographically located in the West, specifically the Great Plains states c. High death rate from use of guns (homicide or suicide) d. Population of fewer than six persons per square mile

D. Population of fewer than six persons per square mile Areas are classified as rural for populations with fewer than 45 persons per square mile and as frontier for geographic areas with fewer than six people per square mile. Many counties of the Great Plains, Intermountain West, and Alaska are designated frontier. Not all mountain areas are rural (the Appalachian mountain area is not), and geographic location alone does not make an area rural.

Which of the following best describes an unexpected result of the decrease in funding to traditional public and private forms of health care? a. Emergency departments where patients can't be turned away are overwhelmed with patients needing nonemergency care. b. Grants are increasingly being requested to pay for care. c. More people don't receive needed health care in a timely manner. d. Programs are developed as a result of community efforts.

D. Programs are developed as a result of community efforts Most of the choices are expected consequences of decreased funding. What is unexpected is the increase in the number and type of models being created, as traditional public and private models of health care decline because of funding and shrinking resources. The programs develop in part as the result of community efforts.

Which of the following best explains why the rural population is growing when young persons from rural areas consistently are moving to urban areas to seek employment? a. Adults engaged in all the physically demanding farming tasks have longer life spans than people in urban areas. b. Farm families continue to have a higher birth rate than urban families. c. Many formerly migrant worker Hispanics are settling in rural counties. d. Retirees and other urbanites able to conduct business through telecommunication and travel are moving in.

D. Retirees and other urbanites able to conduct business through telecommunication and travel are moving in. Recent demographic changes in rural areas have also included an influx of retirees and others from urban areas who are able to live in rural areas and conduct business through telecommunication and travel. The other responses do not support the current reason for the increase in the rural population.

Which of the following differences is found in parish nursing in a rural area as opposed to parish nursing in an urban area? a. Rural parish nurses are less likely to be involved in case management or care coordination than their urban counterparts. b. Rural residents are more grateful for the nurse's assistance because there are so few health resources in rural areas. c. Rural residents are typically less committed to traditional values or a strong religious faith. d. Rural residents may discuss health concerns with the nurse wherever they meet, whether in church or the local market.

D. Rural residents may discuss health concerns with the nurse wherever they meet, whether in church or the local market. In urban settings, contact with parishioners was primarily at the church, whereas contacts in rural settings were most often in the home, on the phone, or in other community-based settings.

A nurse saw there was a need for a hospice facility in a rural area, because so many of the residents were quite elderly and death was common. Which of the following best explains why the community would not immediately see the wisdom of the nurse's suggestion? a. Change is always difficult; the nurse just needs to keep reinforcing the need for such a facility. b. The nurse did not tell residents how much their taxes would need to go up to support such a facility. c. Residents were fearful of confronting death in such an open way. d. Rural residents prefer to use their informal social support networks when help is needed.

D. Rural residents prefer to use their informal social support networks when help is needed. Limited availability and accessibility of formal health care resources in rural areas combined with self-reliance and self-help traits of rural residents have resulted in the development of strong rural community informal care and social support networks. Rural residents are more apt to entrust care to established informal networks than to new formal care systems. It is unlikely that creation of such a facility would impact their taxes. The nurse needs to partner with the community to implement the change process while building upon the community's strengths, beliefs, and values systems.

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

D. Serious illnesses or disability creates high medical bills, which may lead to homelessness In 2011, of households with an annual income less than $25,000, 25.4% had no health insurance. Lack of health insurance is a significant factor in creating homelessness. A serious illness or disability can lead to a downward spiral as a result of job loss, use of savings to pay for care, and inability to pay rent.

Which of the following are the most frequent problems suffered by the chronically homeless? a. Chronic conditions such as hypertension, bronchitis, and emphysema b. HIV/AIDS and other sexually transmitted diseases, tuberculosis, and hepatitis C c. Respiratory infections, trauma, and skin disorders d. Severe mental illness and substance abuse disorders

D. Severe mental illness and substance abuse disorders Chronically homeless people may well have many physical conditions, but the primary problems that lead to their homelessness are severe mental illness and substance use disorders.

Which of the following best describes the proportion of the U.S. population that is made up of persons with a long-lasting condition or disability? a. The number is about 5% and increasing. b. The number is about 10% and stable. c. The proportion is about 15% and stable. d. The proportion is almost 20% and increasing.

D. The proportion is almost 20% and increasing. In 2010, approximately 56.7 million (18.7%) of the 303.9 million civilian noninstitutionalized population aged 5 years and older had a long-lasting condition or disability. Further, it is important for health care policy makers and health care providers to recognize that the prevalence of disability is increasing.

A wife, who had just come home after major abdominal surgery, explained to the home health nurse that she was really worried about her husband. He had not been sleeping well or eating well, seemed to have no energy, and did not seem to enjoy anything including activities he used to love. Which of the following suggestions should the nurse give to the client? a. Ask what medications the husband is taking, because many medications can affect mood b. Explain her husband has probably been worried sick about her and the surgery, and she should reassure him frequently that she is OK c. Point out that many people get sad during the winter months and he should be fine when spring arrives, but in the meantime put full-spectrum light bulbs in all the household lamps d. Share that her husband seems depressed and that they should see his doctor immediately

D. Share that her husband seems depressed and that they should see his doctor immediately Depressed people may experience several or all of the following symptoms: changes in appetite or weight, changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt, and repeated thoughts of death or suicide. If any of these symptoms exist, the client should be referred to a physician for diagnosis. A physician can only make a diagnosis of clinical depression in the presence of five or more of the symptoms mentioned above.

A young woman rolled her wheelchair up the ramp into the clinic to the desk where the intake nurse greeted her. Which of the following should be the nurse's first response? a. "How can I help you?" b. "Who came with you today?" c. Compliment her on her skill with the wheelchair d. Sit so the nurse is on eye level with the young woman

D. Sit so the nurse is on eye level with the young woman Nurses who demonstrate understanding of the issues confronting people with disabilities should approach them on an eye-to-eye level, listening to understand. Moving to eye level should be the first action that the nurse takes before beginning a conversation with the client.

When a person was brought into the clinic in a wheelchair, the new nurse asked the patient if he felt a need for a priest. Which of the following best explains why the nurse would ask about spiritual health during the intake assessment? a. All patients have spiritual as well as physical needs. b. Medical personnel have to collaborate with religious leaders. c. People reach out for spiritual care when they have suddenly become ill. d. Some people perceive disabilities as punishment for sin.

D. Some people perceive disabilities as punishment for sin. There are four models for viewing disability including: (1) the medical model, (2) the rehabilitation model, (3) the socially constructed disability model, and (4) the moral model, which connects disability with sin and shame. The nurse apparently perceived disability as a result of sin not yet repented.

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

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

Which of the following best describes a proposed strategy to address the lack of health care professionals in rural communities? a. Advertise that there are more men than women in many rural areas to attract female nurses who want to be wives and mothers b. Offer free housing and office space to a professional who will come to live in the community c. Pay extremely high salaries to professionals willing to relocate d. Support local students obtaining an education while continuing to live at home

D. Support local students obtaining an education while continuing to live at home A solution proposed for the shortage of health care providers is for rural communities to "grow their own." A rural community, a group of small communities, or a county could support local students attending college and recruit students currently attending professional schools. The students make a commitment to work in the community in return for monetary support for their educations.

Record data demonstrated that there were a very large number of children in the school district whose insurance plan was the Children's Health Insurance Program (CHIP). Which of the following conclusions would be accurate for the nurse to make? a. There are a large number of parents who know how to abuse government programs. b. There are a large number of homeless families. c. There are a large number of unemployed poverty-stricken families. d. There are a large number of working, low-income parents.

D. There are a large number of working, low-income parents CHIP has greatly increased access to health care for many low-income children. The majority of these children live in families with working, low-income parents.

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

D. There should not be homeless persons in America. Kozol (1988) argued: "We would be wise to avoid the numbers game. Any search for the 'right number' carries the assumption that we may at last arrived at an acceptable number. There is no acceptable number. Whether the number is 1 million or 4 million, there are too many homeless people in America."

A nurse needed to do a quick assessment of a client's lifestyle behaviors to counsel appropriately. Which of the following strategies would be the easiest way to determine the elderly woman's nutritional status? a. Ask the woman to keep a food diary for 2 weeks and bring it to the clinic b. Have the clinic dietitian interview the woman about her eating habits c. Quiz the woman verbally as to her usual meals during the day d. Use the DETERMINE mnemonic

D. Use the DETERMINE mnemonic All the responses are good approaches. However, the nurse should take a broad view of what assets or barriers are involved in relation to nutrition. A nutrition checklist, described by the mnemonic DETERMINE, reviews warning signs and risk factors of poor nutritional health. (See Table 19-2 in the textbook for more information).

The mother confided in the nurse, "I don't think my child is improving." Which of the following statements would be the best response by the nurse? a. "My assessment shows your child is improving." b. "The children seem to be playing with and accepting your child." c. "The teacher reported to me that your child is doing much better." d. "What is causing your concern?"

D. What is causing your concern? Nurses should pay attention, particularly when parents intuitively whisper, "Something is not right." A well-meaning health care provider may attempt to reassure a concerned mother. However, this kind of response may create silence and delay further questions by the parent. Rather than decrease parental concern, it may increase anxiety. The nurse can serve as an intermediary, working among the family and the health care team, to address parental concerns and client goals.

Which of the following is the most frequent cause of farm fatalities and nonfatal injuries? a. Manure pits (methane poison) b. Power take-off augers c. Storage silos d. Tractors e. Very old and barely functioning trucks

D. tractors Agricultural machinery is the most common cause of fatalities and nonfatal injuries of U.S. agricultural workers, including on-farm fatalities among youth under 20 years of age (CDC, NIOSH Program, 2012). Tractor-related accidents, especially rollovers, are the most frequent causes of farm accidents and account for more than one fourth of farm fatalities.

Some of the medical staff thought an abused woman deserved what she got when she told them she was not going to a safe house following discharge from the emergency department. Which of the following information should the nurse stress to the medical staff? a. When the woman leaves the emergency department, her abuser will most likely be arrested. b. The woman probably feels fearful and helpless and, until her life is clearly threatened, nothing will probably change. c. The woman needs additional reinforcement that she would be safer in a domestic violence shelter. d. When a woman attempts to leave the situation, it is often when the abuser kills her.

D. When a woman attempts to leave the situation, it is often when the abuser kills her. The most dangerous time for the victim is when the victim leaves or attempts to leave the relationship, because it is seen as an erosion of the abuser's control. The victim is more likely to be killed at this time than at any other time in the relationship. It is unlikely the abuser will be arrested, even following this incident of violence. Because the woman is fearful for her life and recognizes the dangers that occur with leaving, she most likely will not leave the relationship. Additional education about the domestic violence shelter will most likely not change her mind to leave the situation

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

D. males Among all sheltered homeless adults, approximately 63% were men; 37% were women. Men were overrepresented compared with the general population. The sheltered homeless population is younger than the general population. Most homeless adults were between 31 and 61years of age; 22.1% were less than 18 years of age; and 3% were older than 62. In the general population, 16% were over age of 62. Minorities comprised 60% of the total sheltered population. More sheltered homeless people had disabilities than did members of the general population: 38.1% versus 15%.

From which of the following causes are rural residents twice as likely to die from in comparison with urban residents? a. Chronic diseases, especially cardiac problems and cancers b. Diabetes from the higher incidence of obesity c. Respiratory diseases (from pesticides and herbicides) d. Unintentional injuries

D. unintentional injuries Residents of rural areas are nearly twice as likely to die of unintentional injuries, including motor vehicle accidents, when compared with their urban counterparts. The rates of chronic diseases, diabetes, and respiratory diseases are more similar to that of urban residents.

Which of the following would be a problem for an older adult with a hearing loss? (Select all that apply.) a. Difficulty in finding a hearing aid that is unobtrusive b. Embarrassment at having to wear a hearing aid c. Hearing is not part of a routine health screening d. Long delays in getting an appointment to see an audiologist or otolaryngologist e. Medicare does not cover the costs of hearing aids f. The adult may withdraw, become isolated, and depressed

E, F In general, Medicare does not cover the costs of hearing aids; Part A covers hospitalization and Part B covers physician and outpatient services, qualified therapies, durable medical equipment, and some home health care services. Consequences of hearing loss may include withdrawal, isolation, and depression. Because of advances in technology, hearing aids are much smaller and less obvious than they previously have been. This leads to less embarrassment and noticeability for those who use them. Because loss of hearing is one of the most common conditions affecting older adults, it should be screened for as a part of routine health screening. There are typically not long delays in seeing a specialist for referral.

A family came in to discuss a problem with one of their children. Which of the following family behaviors would be concerning to the nurse? a. Each family member made supportive comments about each other. b. Every Sunday the family attends religious services together. c. Family members made humorous comments about their life together. d. The family seemed to rather quickly determine priorities for action. e. The family wanted the nurse to decide what they should do.

E. The family wanted the nurse to decide what they should do. Traits of a healthy family include open communication, ability to establish priorities, being supportive of each other, sharing a religious core, having a sense of humor, and knowing when to seek help. However, healthy families also engage in decision making and do not want others to make decisions for them.

Which of the following definitions of family would be the most useful for the nurse practicing in the community? a. A group of persons with shared convictions b. A social unit interacting with the larger society c. People descended from a common ancestor d. Persons related either by blood or by legal contract (marriage) e. Whoever the family says is in their family

E. Whoever the family says is in their family Although some believe even these definitions are too narrow, the widest definitions are "the members of the family are self-defined" and "the family is who they say they are."

A woman stumbled into the rural health clinic and explained that she had an incredible headache. She was sweating and began vomiting into the wastebasket by the intake nurse's desk. Which of the following diagnoses should be anticipated by the nurse? a. Acute adult panic disorder b. Acute alcohol intoxication c. Acute appendicitis d. Acute meningitis e. Acute pesticide poisoning

E. acute pesticide poisoning Signs and symptoms of acute pesticide poisoning are fairly clear, and most health providers in rural communities would recognize them. Common symptoms include headache, dizziness, diaphoresis, nausea, and vomiting. If left untreated, those affected may experience a progression of symptoms including dyspnea, bronchospasm, and muscle twitching. Deaths are relatively uncommon, but they do occur. The nurse is reminded that not all farm laborers are men. The symptoms that are being displayed are not typical of acute panic disorder, acute alcohol intoxication, acute appendicitis, or acute meningitis

Which of the following individuals is most likely to be the victim of violent crime? a. A 10-year-old white female b. A 15-year-old black female c. A 15-year -old black male d. A10-year-old white male

C. A 15-year -old black male Black males are the racial group most likely to be victimized. Violence is more likely to occur with an adolescent than a child.

Which of the following strategies would most likely increase attendance at a clinic aiming to improve men's health in the community? (Select all that apply.) a. Employing male nurses b. Having male-friendly space for socialization c. Having evening and weekend hours d. Having male-accepted nibbles and drinks (pretzels and light beer) e. Including lectures on male health each evening f. Providing male-accepted and respected activities such as poker

A, B, C, F Data demonstrated that usage of male clinics was highest with informal evening clinics directed by male nurses. Based on the social rather than medical model, Australian clinics promote well-being among older males by providing them with accepted and respected activities, as well as providing a male-friendly space for socialization. The room in which staff members see men has decor geared toward men. The data did not demonstrate that having male-accepted nibbles and drinks or including lectures on male health each evening were effective in increasing attendance at the clinic.

Which of the following strategies would be most helpful to implement with adolescent males at a high school? (Select all that apply.) a. A short required course on how to be a good parent b. Assistance in learning how to control emotions and behaviors c. Classes in male physiology, self-screenings, and influence of nutrition and exercise d. Encouragement to be involved in organized team sports involving both genders e. Recognition of reality factors such as the need to be employed after school hours f. Interpersonal communication with a male school nurse

A, C, F Some suggestions that may improve male health are information about how their bodies function, what is normal, what is abnormal, what action to take, and the contributions of proper nutrition and exercise; self-care instruction, including testicular and genital self-examination; help with fathering; and recognition that feelings of confusion and uncertainty in a time of rapid social change are normal and that they may mark the onset of healthy adaptation to change. Male nurses can be extremely effective in such an endeavor. Providing assistance in learning how to control emotions and behaviors, encouraging the involvement in organized team sports, and the recognition of reality factors would not be the most important strategies to implement with adolescent males?

Which of the following describe health hazards to which nurses in hospitals are exposed? (Select all that apply.) a. Anesthetic gases b. Dust c. Heat and chemicals d. Heavy lifting e. Infectious diseases f. Solvents and acids

A, D, E Hospital and other health care workers are exposed to infectious diseases, heavy lifting, radiation, skin disorders, and anesthetic gases. Dust may be a health hazard for those employed in textile and apparel. Launderers and dry cleaners may be exposed to heat and chemicals as a health hazard. Solvents and acids may be a health hazard for those employed in electronics.

A nurse is developing a community education program about how to prevent sudden infant death syndrome (SIDS). Which of the following information would be included in the presentation? (Select all that apply.) a. Always place a baby on his or her back to sleep. b. Use a semi-firm sleep surface. c. Allow the baby to sleep in a position that provides the most comfort. d. Allow the baby to sleep with a favorite toy or blanket. e. Do not let the baby get too hot during sleep. f. Avoid exposing the baby to cigarette or cigar smoke.

A, E, F Some of the recommendations to reduce the risk of SIDS include: always place a baby on his or her back to sleep, for naps and at night; use a firm sleep surface, covered by a fitted sheet; the baby should not sleep in an adult bed, on a couch, or on a chair alone or with anyone else; keep soft objects, toys, and loose bedding out of the baby's sleep area; do not smoke during pregnancy, and do not smoke or allow smoking around the baby; and do not let the baby get too hot during sleep

Which of the following is the most common sexually transmitted disease (STD)? a. Chlamydia b. Gonorrhea c. HIV d. Syphilis

A. Chlamydia In 2007, the Centers for Disease Control and Prevention reported that the most common STD was Chlamydia trachomatis infection, followed by gonorrhea. The spread of HIV and syphilis are also of concern, but these rates are not as high as they are for chlamydia and gonorrhea.

In a college health course, the question arose as to when a woman needs to see her health care provider for a Pap smear. Which of the following would be the most appropriate response by the nurse? a. "After you begin having intercourse or reach age 21, whichever is sooner" b. "Before having sexual intercourse, when you go to obtain your birth control" c. "If your periods change at all, go to see your health care provider." d. "If you have a vaginal discharge that's unusual, go right in for a Pap smear."

A. "After you begin having intercourse or reach age 21, whichever is sooner" Current guidelines recommend cervical cancer screening to begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age. So it will be important for the woman to have a Pap smear after beginning to have intercourse, or by the age of 21. It is not necessary to obtain a Pap smear before having sexual intercourse. A Pap smear may not be necessary for a change in periods or unusual vaginal discharge, these may be signs of other problems that will not be diagnosed through a Pap smear.

A young mother was very proud because she had been taking her 9-month-old with her to various garage sales where she had purchased a lot of toys for very little money. Which of the following would be the most appropriate response by the nurse? a. "Be sure there are no small pieces as young children can easily choke." b. "Fantastic. Saving money on toys will allow you to buy more fresh fruits and vegetables." c. "Toddlers love new toys; they will help with cognitive development." d. "You are doing an excellent job of giving your child lots of stimulation with new playthings."

A. "Be sure there are no small pieces as young children can easily choke." Infants and young children are at great risk for accidental injuries. The leading cause of injury death for children under the age of 1 year is accidental suffocation due to choking or strangulation. Thus, it is important for the nurse to talk with the young mother about the dangers of toys with small pieces. Safety of the infant should be the primary concern of the nurse in this situation. Saving money on toys will not necessarily allow the young mother to be able to purchase more fruits and vegetables. The infant is nine-months old and would not be considered a toddler yet. It is not apparent in this situation if the toys are age appropriate for the infant or would provide the appropriate amount of stimulation for a child at this developmental level.

When the school health nurse suggested the school health clinic include sexual counseling and free condoms if requested, an angry woman yelled, "Why do I care if some girls have no morals and sleep around?" Which of the following would be the most appropriate response by the nurse? a. "Because taxpayers spend billions each year for teenage moms and their babies." b. "Because your son may have to pay child support to that girl for the next 18 years!" c. "I understand your point of view, but since some parents don't teach their children morals, the school has to help." d. "We all should care for our neighbors and our neighbors' children."

A. "Because taxpayers spend billions each year for teenage moms and their babies." Preventing pregnancy among teenagers can reduce the dropout rate, welfare dependency, low birth weight, and infant mortality. According to an analysis by the National Campaign to Prevent Teen Pregnancy, the estimated cost of teen childbearing in the United States cost taxpayers (federal, state, and local) is at least $109 billion.

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

A. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" In 2009, 93% of Medicare enrollees aged 65 years and over resided in traditional community settings. Three percent resided in community housing with at least one service available, and approximately 4% resided in long-term-care facilities. The other responses do not support a therapeutic response by the nurse in this situation.

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

A. "Focus on eating properly and staying active." Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. As the woman was already getting an annual checkup, the nurse should stress nutrition and exercise.

A woman said, "I've never been retired before. I didn't plan it but it's OK. I'm still doing what I used to do otherwise; I go to church, make quilts for charity, and babysit my grandkids. Do you think I should be trying to find another job for a few years?" Which of the following would be the most appropriate response by the nurse? a. "For lots of people, retirement, even if unplanned, is much like life has always been." b. "It's okay to slow down at your age; why look for problems?" c. "You really need to get out of your house more and be more active, even if you don't get paid at the position." d. "Without a job, you really don't have an identity. Have you been to the unemployment office?"

A. "For lots of people, retirement, even if unplanned, is much like life has always been." The continuity theory of aging suggests that a person continues through life in a similar fashion as in previous years. Because the woman stated she is doing what she has previously done, and has not suggested any particular problems other than concern that what she is doing is acceptable behavior, she should be supported. The statement that best supports her decision states that retirement life is much like life has always been. The other statements do not support her current satisfaction with her activities in her life.

A nurse is on the treadmill exercising, when the woman next to her says, "You're a nurse. Explain to me how the scale says I've lost weight, but my waist and tummy just keep getting larger." Which of the following would be the most appropriate response by the nurse? a. "I'm concerned. You need to see your health care provider to follow up on this." b. "Muscle weighs more than fat so you're creating muscle while losing fat, but it takes a while for the body to redistribute the weight." c. "Tell me what you've been eating in the last week or so." d. "You're running so you're strengthening your legs and thighs, but to lose around your tummy, you have to exercise your abdominal muscles."

A. "I'm concerned. You need to see your health care provider to follow up on this." The most common sign of ovarian cancer is abdominal enlargement. A woman may complain that her skirts and slacks are getting tighter in the waist. Because ovarian cancer is a silent cancer that causes more deaths than any other pelvic malignancy, the woman needs to see her health care provider immediately for transvaginal ultrasonography and a blood test (CA-125). Thus, it is important to refer the woman to a healthcare provider and not try to minimize or rationalize the symptoms that she has reported.

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

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

A nurse is called by her sister, who tells her how wonderful it is that she knows the exact date her baby is coming because her doctor scheduled her for a C-section before his vacation. Which of the following would be the most appropriate response by the nurse? a. "A C-section is major surgery. Do you remember what the doctor shared were the risks for yourself and your baby?" b. "How marvelous to know the date; I'll plan to visit you in the hospital." c. "I'm so pleased. I know exactly when I'm going to be an aunt." d. "Why not wait until after your doctor comes back from his vacation?"

A. A C-section is major surgery. Do you remember what the doctor shared were the risks for yourself and your baby?" C-section involves the risks of any major surgery such as hemorrhage, infection, damage to adjacent structures, as well as risks associated with anesthesia. Long-term sequelae for women include pelvic pain, along with formation of adhesions and placental abnormalities that lead to complications in subsequent pregnancies. Risks to the neonate include higher incidence of persistent pulmonary hypertension and respiratory diseases. C-sections are not shown to improve outcomes for either mother or baby. Women should be made aware of the risks involved with interventions associated with birth and educated on how to best select their place of birth. The role of the nurse is to educate her sister that this is a major surgery and remind her of the risks involved. The other responses do not consider the importance of education needed for the client in this situation.

Which of the following is consistent with the American Academy of Pediatrics (AAP) recommendations for breastfeeding? a. A mother combines breastfeeding with the introduction of complementary foods until the infant is 1 year old b. A mother supplements breastfeeding with formula when then infant is 4 months old c. A mother stops breastfeeding her infant after introducing solid foods d. A mother asks her employer to allow her to bring her infant to work so that she may breastfeed

A. A mother combines breastfeeding with the introduction of complementary foods until the infant is 1 year old The AAP recommends exclusive breastfeeding for about the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.

Which of the following groups of persons is most likely to be able to access health care? a. Adults who work in large corporations b. Many employed women c. Older women on fixed incomes d. Young adults, aged 16 to 24 years

A. Adult who work in large corporations Adults who are employed and have health insurance are more likely to have access along with the ability to pay for care. Young adults aged 16 to 24 years often do not have health insurance. Older women on fixed incomes may have difficulty meeting copayments required by Medicare, so they may not have constant access.

A school nurse has identified that there has been an increase in sexually transmitted infections (STIs) among the adolescents attending the school. Which of the following interventions should be completed by the nurse? a. Arrange for the health department to come to the school to give information and treatment on a confidential basis b. Encourage the athletic coaches to distribute condoms in such a way that a boy can obtain them in private c. Have English teachers assign stories about the problems that result from adolescent pregnancy d. Have the bus drivers put a comic book about sexuality, STIs, and preventive measures on each seat

A. Arrange for the health department to come to the school to give information and treatment on a confidential basis Barriers to health care such as lack of transportation, concerns about confidentiality, and lack of access to preventive health services contribute to a high prevalence of STIs among teens. Having a free clinic in the school removes some of the barriers.

Which of the following is the leading cause of disability in the United States? a. Arthritis b. Car accident c. Falls d. Heart disease

A. Arthritis Arthritis is the leading cause of disability in the United States. Car accidents, falls, and heart disease are not among the leading causes of disability in the United States.

A woman was in the emergency department with a bruised and broken leg. She explained that she had accidentally opened the car door on a trip and the door had blown back on her leg. Her husband was very attentive, constantly asking the nurse to make his wife more comfortable. Which of the following actions should be taken by the nurse? a. Ask the husband to step out of the room while you get a urine specimen, and, after he leaves, ask the woman, "Have you ever been deliberately hurt by someone?" b. Call x-ray immediately, and prepare for the leg to have a cast applied. c. Put ice bags on the area until the leg can be repaired. d. Try to get an additional pain medication order from the physician.

A. Ask the husband to step out of the room while you get a urine specimen, and, after he leaves, ask the woman, "Have you ever been deliberately hurt by someone?" Abuse of women is often explained as accidental injury. Approximately 6% of visits made by women to emergency departments are for injuries that result from physical battering by their husbands, former husbands, boyfriends, or lovers. It is important for the nurse to understand the state laws related to reporting known or suspected domestic violence. The AMA and ANA advocate that all women should be assessed for intimate partner violence. Questions should be posed privately, in nonjudgmental specific terms (i.e., "Do you feel safe?" "Have you ever been hit, punched, slapped, or kicked?") with follow-up questions if the woman responds "yes." In this situation, with a questionable explanation for the injury and an overly attentive husband, it would be important to complete this assessment. This invention would be more important than calling for x-ray, applying ice, or administering additional pain medication.

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

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

Which of the following best explains why many elderly women do not prepare meals or do housework? a. Chronic diseases, especially arthritis and rheumatism, hinder their ability. b. Living in a nursing home does not require them to do so. c. They do not want to; their husbands can share in the work. d. With Social Security, they can afford to pay someone else to do these tasks.

A. Chronic diseases, especially arthritis and rheumatism, hinder their ability. Women are more likely than men to be disabled from chronic conditions. Arthritis and rheumatism, hypertension, and impairment of the back or spine decrease women's activity level. Women are likely to have difficulty performing activities such as walking, bathing or showering, preparing meals, and doing housework. The majority of elderly do not live in nursing homes, but are able to remain in their own homes. It is unlikely that they are not willing to do any work or want to pay someone else to complete these tasks.

A man has been off work because of a recent illness. Which of the following would be the most useful action for the employer to take to support this man? a. Encourage the man to return to work as soon as possible, possibly at something less physically demanding b. Reassure the man that he may have as much time off as he needs c. Share the man's need with other employees so that they may donate unused or unneeded sick time to him d. Suggest that other male employees visit the man at his home to help keep his spirits up and demonstrate he is not forgotten

A. Encourage the man to return to work as soon as possible, possibly at something less physically demanding Time away from work because of occupational injuries should be kept to a minimum. Males should be encouraged to return to work in an altered capacity rather than remaining away from work until the injury is completely healed. Employment keeps the man active during the day and also gives opportunity for socialization. Because the man should be encouraged to return to work, it would not be appropriate to request additional sick time from other employees or suggest that other employees visit him at home.

A woman with two young children is debating if she should try to work using child care or stay at home and care for her children. Based on the current trends, which decision is she most likely to make? a. Enter the work force b. Invite a relative to live with them to care for the children c. Negotiate with her husband so he stays home with the children d. Stay home with the children

A. Enter the work force Sixty-two percent of women with young children (younger than 6 years) work outside the home. Thus, it is most likely the woman will enter the workforce based on current trends. A working woman is less likely to have a spouse or partner to help with the home and children. Even when a spouse or partner is present, the burdens of housework and child care usually fall more heavily on women, regardless of ethnicity.

A man, who looked about 45 years old, gave a cashier at a grocery store the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers for some of the food he had just selected. Which of the following conclusions can be drawn from this scenario? a. He had a teenage daughter who was pregnant or with a young child. b. He met the requirement for Aid to Dependent Families. c. He really knew how to beat the welfare system. d. He was handicapped, although his handicap was not immediately apparent.

A. He had a teenage daughter who was pregnant or with a young child. WIC provides federal grants to states for the purpose of serving nutritionally at-risk, low-income pregnant and postpartum women and their children up to five years of age. WIC programs provide highly nutritious foods, nutrition education and counseling, and screening and referral to needed services. To be eligible, women and children must meet income guidelines established by each state, and a health professional must determine they are at "nutritional risk." Women and children who participate in Medicaid, the Food Stamp program, or the Temporary Assistance for Needy Families program are automatically income eligible for WIC. This man would not be eligible for WIC assistance himself because this program is for women and children.

Which of the following is the most serious complication of women having osteoporosis? a. Hip fracture b. Need to avoid sunlight c. Need to decrease weight-bearing physical activity d. Stooped posture

A. Hip fx The most serious complication of osteoporosis is hip fracture. Approximately 24% of people with hip fractures die of complications within a year.

Which of the following best explains how the Public Health Service (PHS) Act, Title X, has been helpful to families? a. It provides funds for family planning, including contraception. b. It created a child care subsidy to help adults obtain and retain employment. c. It provides housing for low-income families. d. It prevents utility companies from shutting off service and allows for bills to be subsidized.

A. It provides funds for family planning, including contraception. Title X of the PHS Act is the Family Planning Public Service Act, which helped 5 million women obtain family planning services in 2008. Since 1970, federally subsidized family planning funds have been available to clinics and health departments throughout the country. These facilities provide not only access to contraception but also routine preventive health services, education, and counseling. The program is an important part of the public effort to prevent low birth weight through addressing the relationship between lack of family planning and those at greatest risk for low-birth-weight infants (women who are adolescents, single, and/or low income). This program does not provide subsidies for child care or utility payments or housing for low-income families.

Which of the following best describes the screening tests that are completed on all newborns in the United States? a. It varies from state to state, somewhere between 0 and 25 tests. b. It varies from state to state, but all states have a common 26 conditions that are tested. c. Federal legislation mandates 29 tests. d. The number varies greatly by state and by hospital policy.

A. It varies from state to state, somewhere between 0-25 tests Every infant born in the United States is screened shortly after birth for a number of genetic disorders. Newborn screening is state-based so the number of conditions that babies are screened for varies from state to state. All U.S. states and territories currently test for 26 health conditions including phenylketonuria, galactosemia, congenital hypothyroidism, and sickle cell disease

Which of the following best explains why an employer would care about the health needs of local children? a. The children are the employer's future workforce. b. The employer needs positive media coverage and no scandals. c. The community will provide greater support to employers that have family-based policies. d. Staying home to take care of sick children will impact the productivity of the workplace.

A. The children are the employer's future workforce. Business and industry have an enormous stake in the health of the nation's children. A strong, productive workforce is ensured only when the health, social, and educational needs of the next generation of workers are met. Furthermore, health risks cost employers in lost productivity and increased health care costs. Avoiding scandal and negative media coverage would not be a reason why employers would care about the health needs of the local children. The community does not provide greater support to businesses that have family-based policies. Although, businesses want to keep their employees at work instead of at home taking care of ill children, businesses are concerned with more than just the children of their employees. All children in the local community are a concern for employers as these are the future workforce.

Which of the following is a biological explanation for gender differences in health status? a. Influence of hormones b. Different treatment by parents c. Random differences in genetic inheritance d. Social expectations of appropriate gender behavior

A. different tx by parents Random differences are random and do not have a systematic effect. Although parents do indeed treat male and female babies differently, that is an environmental effect, not a biological one. Similarly, social expectations are a sociological explanation, not a biological one. Several biological factors influence sex differences in mortality and morbidity rates, including genetics, effects of sex hormones, and physiological differences. Biological advantages for females may also exist later in life because estrogen protects against heart disease. Some evidence supports the hypothesis that men's higher testosterone levels contribute to men's lower high-density lipoprotein levels.

Which gender has higher morbidity rates with a higher prevalence of chronic diseases that cause disability and limitation of activities? a. Females b. Males c. No difference between genders in chronic health problems d. Prevalence of chronic diseases varies strongly by individuals more than gender.

A. females A chronic condition is a condition that persists for at least 3 months or belongs to a group of conditions classified as chronic regardless of time of onset. In general, women have higher morbidity rates than men. Women are more likely than men to have a higher prevalence of chronic diseases that cause disability and limitation of activities but do not lead to death.

Which of the following are factors that have led to the decrease in mortality of some cancers? (Select all that apply.) a. An increase in mortality rate among other cancers b. Early detection through emphasis on routine screening c. Fewer sexual partners with emphasis on monogamy d. An increased awareness of influence of lifestyle choices e. Legislation such as the Clean Air Act f. A decrease in tobacco use and smoking among women

B, D, F The good news is that healthy lifestyle changes and early detection and intervention have contributed to the decrease in mortality rates from some cancers. For example, the death rate for colorectal cancer has been decreasing for the past 15 years because of early detection and treatment (American Cancer Society, 2011). Lung cancer deaths are beginning to show a slight decline that parallels a decreased incidence of smoking by women over the age of 18 years. Certain health choices may reduce an individual's risk of cancer. Women could reduce their risk for cancer by never smoking or by quitting if they already use tobacco products. Eating a nutritious, plant-focused, high-fiber diet, along with adopting a physically active lifestyle and maintaining a healthy body weight protect against both heart disease and many cancers.

Because of county need, a school nurse was transferred from a new suburban school to a large inner-city school in an older low-income neighborhood. Which of the following changes in role should be anticipated by the nurse? (Select all that apply.) a. An increased absentee rate because of infectious diseases b. Cooperating with the school meal program to be sure fruits and vegetables and other healthy choices are included c. Regularly checking each child for visible signs of child abuse d. Emphasizing to parents that their child cannot attend school until immunizations are done e. Need for lead poisoning screening and education f. Screening for head lice several times a year

B, E Because cheap food is often high in portion size and sugar and fat, school may be the only place where children have the opportunity to eat fruits, vegetables, and protein choices. Thus, it will be important to make sure these choices are included in the school lunch program. Because old neighborhoods often have lead pipes and old lead paint, lead screening is crucial in older neighborhoods, particularly low-income neighborhoods where parents have fewer resources and are often in aged housing. Stereotypes such as "only poor people get head lice" abound. Head lice do not respect socioeconomic class, so such screening might be done in any school. Similarly, child abuse occurs among families of all social economic classes. Free immunizations are available, so this is probably not as big a problem as stereotypes about the poor might suggest. Indeed it is usually in wealthier neighborhoods that parents are concerned about mercury poisoning and try to avoid having their children immunized. There is unlikely an increased absentee rate because of infectious disease, as these are not seen at an increased incidence in suburban versus urban neighborhoods.

Which single action has been most influential in changing men's health behaviors? a. Establishing well-man clinics during evening hours b. Legislative action c. Peer-reviewed journals such as the American Journal of Men's Health d. Running men's health ads during sports events e. The male consumer movement: seen in The National Organization for Changing Men

B, legislative action Health behaviors associated with the greatest change in a positive direction have been those influenced by legislative action (e.g., seat belt use, use of smoke detectors, and drunk driving laws). Well clinics, peer-reviewed journals, and the male consumer movement have not had as much influence on men's health behavior as legislative action.

A mother explained that she had just dropped her 3-year-old off at her own mother's so she could come in for the required examination for her new job. She excitedly shared her hopes that she would be able to afford a used car rather than having to ride a bus all the time. Which of the following would be the most appropriate response by the nurse? a. "I'm sure the exam won't show any problems. I'm so excited for you." b. "Don't forget to buy a child's seat when you get your car." c. "How do you think your child will adapt to you being at work all day?" d. "It's fantastic that you have a new job in this rough economy. Will your mother be able to continue to babysit?"

B. "Don't forget to buy a child's seat when you get your car." Motor vehicle injuries are the leading cause of death for children over the age of 1 year in the United States. Many injuries occur because adults fail to secure children in car seats in the back seat of the vehicle or to insist that older children buckle up. The most important step that a parent can take to ensure a child's safety in a motor vehicle is to correctly secure him or her into a car seat, or seat belt when the child is older, for each ride. Safety of the toddler should be the primary concern for the nurse in this situation. The nurse should focus on the safety of the child in the response. Telling the mother that the exam will not show any problems provides false reassurance to the mother, as problems may be detected. Asking if the woman's mother will continue to babysit or how the child will adapt to the mother being at work are not relevant as this is a required examination for her new job.

"I don't want to listen to another lecture on safe sex. Just give me my antibiotic and let me leave," said a defiant client. Which of the following would be the best response by the nurse? a. "As you wish. But can you tell me why you still engage in unprotected sex?" b. "Gonorrhea is becoming resistant to antibiotics. It's becoming difficult to treat you, and permanent damage to your body is occurring." c. "Our policy requires that we review how to protect yourself even if you have heard the information before." d. "These recurrent infections are damaging you inside; please consider using condoms."

B. "Gonorrhea is becoming resistant to antibiotics. It's becoming difficult to treat you, and permanent damage to your body is occurring." Gonorrhea is becoming resistant to all our current drugs. The Centers for Disease Control and Prevention has had to change its treatment guidelines. Also, persons with gonorrhea often have other sexually transmitted diseases (STDs) as well. This person has heard the lectures on safe sex and is not changing personal behavior. Upholding policy or appealing to the person's better emotions is probably ineffective. Many people have become complacent about STDs. The nurse is obligated to warn the patient that the infections are becoming resistant to pharmaceutical treatment.

A mother was concerned about her child dying of some childhood disease, because that is how some of her siblings died before her family came to the United States. Which of the following would be the most appropriate response by the nurse? a. "You should see your doctor immediately if you ever think your child is ill." b. "Your child has been immunized, so the biggest danger is from accidents." c. "You have made sure your child has all the right immunizations so you can quit worrying." d. "You're right to be concerned, since susceptibility runs in families."

B. "Your child has been immunized, so the biggest danger is from accidents." Childhood is generally a healthy time of life. The incidence of childhood disease has decreased because the majority of children receive a full complement of immunizations during infancy and toddlerhood. The leading threat to children's health is accidental injury and exposure to environmental toxins, abuse, and violence.

A nurse has recently learned of the death of a 22-year-old female friend. Which of the following would be the most likely cause of death? a. Complications of childbirth b. Accident or unintentional injury c. Cancer d. Cardiovascular disease

B. Accident or unintentional injury In the adolescent to early adulthood years, the leading cause of death for women is unintentional injuries (i.e., motor vehicle accidents, drug overdose). Complications of childbirth, cancer, and cardiovascular disease are not among the most likely causes of death of a 22-year old female.

Which of the following statements best explains why parents and nurses are often concerned about adolescents? a. Adolescents engage in sexual acts without using protection. b. Adolescents engage in very high-risk behaviors. c. Adolescents love driving but are not as skilled as they believe. d. Adolescents often experiment with alcohol or drugs.

B. Adolescents engage in very high-risk behaviors. In their struggle to gain independence and with their sense of immortality, many adolescents engage in risk-taking behaviors, including alcohol and drug abuse, early and unprotected sexual activity, unsafe driving, and participation in delinquent and violent activities that threaten their health. To say adolescents engage in very high-risk behaviors is the inclusive answer, because all other responses name only one problem.

A school nurse at a high school suggests that all students have an educational unit on newborn care in their required health class. Which of the following provides the best rationale for this suggestion? a. Because all adults should be knowledgeable in basic child care b. Because the first year of life is the most hazardous until old age c. To help convince students not to engage in sexual intercourse d. To demonstrate the incredible responsibilities in parenthood

B. Because the first year of life is the most hazardous until old age The first year of life is the most hazardous until the age of 65 years. Many parents, often out of ignorance, do intentional acts that were not meant to injure or kill the child. Many new parents feel unprepared to care for a newborn and lack knowledge of normal growth and development. Newborn education would not help convince adolescents not to engage in sexual intercourse. Although this education may show the responsibilities associated with parenthood and is important for all adults to have, the purpose of the education is to prevent injuries and accidents among the infant population.

Which of the following best describes why grandparents would be the primary caregivers for their grandchildren? a. Because they fell in love with the newborn and wanted that small person to be a part of their lives b. Because the parents were drug abusers or in the prison system c. Raising a grandchild is easier because grandparents have already been experienced parents d. Raising a child gives purpose to life for the grandparents

B. Because the parents were drug abusers or in the prison system Many older adults are faced with raising their grandchildren, often without the presence of the grandchildren's parents. Reasons include neglect related to parental substance abuse, abandonment, emotional and physical abuse, parental death, mental and physical illness, incarceration, teen pregnancy, and grandparents' assisting adult children who work or attend school.

Which of the following indicators would be most informative in assessing the health of a newborn? a. Apgar score at birth b. Birth weight and length of gestation c. Mother's education and income from employment d. When the mother began prenatal care at her local clinic

B. Birth wt and length of gestation Birth weight and length of gestation are the most important predictors of infant health. Although maternal education, income, and lack of prenatal factors are factors associated with preterm birth and low birth weight, at the time of birth it is most important to assess the weight of the infant and length of gestation. Using the Apgar score at birth is not as informative of a tool for assessing newborn health as the birth weight and length of gestation.

Which of the following best explains how marriage customs have remained unchanged over the last couple decades? a. Lesbian and homosexual adults are adopting children. b. Women are usually responsible for the children following a divorce. c. Single adults are adopting children. d. Women are trying to avoid spinsterhood. e. Women seek to marry at a young age.

B. Women are usually responsible for the children following a divorce. Today, as in the past, when a relationship ends in divorce or separation, more women than men have the responsibility of providing for themselves and their children. Differences today include that many women are delaying marriage and many are not marrying. Single-parent adoptions are legal; single women, including lesbians, are becoming adoptive parents.

school nurse is trying to determine health trends when making plans for health programming in the school for the upcoming school year. Which of the following would be the most appropriate action for the nurse to take? a. Conduct a survey in the community b. Do an online search of groups that might collect and analyze such data c. Examine records in the school health office to determine trends d. Interview local health officials regarding problems beginning to occur

B. Do an online search of groups that might collect and analyze such data The federal, state, and local governments and many national organizations collect and analyze data to track the well-being of children and adolescents. For example, the U.S. Department of Health and Human Services (USDHHS) generates a yearly report, Child Health USA, on more than 50 indicators of the well-being of America's children and youth. Such data are readily accessible online. A number of key indicators are tracked on a regular basis by the federal statistical system so that trends are revealed. State and local data also are used to track the well-being of children. The most efficient use of the nurse's time would be to use data that already exists rather than trying to create new data. This could be done by performing an online search for existing data. Once the existing data is collected, the nurse may then need to look specifically at the data at the school or create new data to examine new or existing problems.

Which of the following is the most likely reason for adult women to be injured? a. Automobile accidents b. Domestic violence c. Falling d. Stranger violence (theft, rape)

B. Domestic violence Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 years in the United States—more than muggings, car accidents, and rapes combined.

Which of the following is the greatest single cause of absenteeism from school and work among young women? a. A child's illness b. Dysmenorrhea c. Mental health disorders d. Upper respiratory tract infection

B. Dysmenorrhea Dysmenorrhea is the greatest single cause of absenteeism from school and work among young women and causes the loss of approximately 140 million working hours annually; therefore the economic influence of this condition is significant. A child's illness, mental health disorders, and upper respiratory tract infections do not cause as many days of absenteeism as dysmenorrhea.

A middle-aged woman was obese and being treated for hypertension; and her blood tests showed elevated triglycerides and low high-density lipoprotein (HDL). Besides recommending physical activity, which of the following nutritional guidance should be provided by the nurse? a. Buy a good diet book, and follow its advice. b. Eat fish and seafood such as salmon, halibut, tuna, and scallops at least three times a week. c. Use olive oil when you cook, especially if you are frying food. d. You have to lose weight, so stop all desserts and eat nothing but salads for 2 weeks.

B. Eat fish and seafood such as salmon, halibut, tuna, and scallops at least three times a week. Metabolic syndrome is a group of risk factors that have been linked to an increased risk of cardiovascular events. These factors include abdominal obesity (waist circumference greater than 35 inches in women), dyslipidemia (elevated triglycerides and low HDL), insulin resistance, and elevated blood pressure. The underlying etiology of metabolic syndrome is related to the combination of inactivity, obesity, and genetics. Nutritional advice should focus on weight loss, use of olive oil (but do not fry foods), and eating fish and seafood such as salmon, halibut, tuna, and scallops at least three times a week to increase omega-3 intake.

A woman vows to quit smoking and drinking immediately upon the surprising news that she is 2 months pregnant. Which of the following concerns would the nurse have for this woman? a. Those with whom she shares living quarters might smoke or drink. b. Fetal damage may already have occurred. c. Peers may encourage her to resume old habits, and peer pressure is very strong. d. She won't be able to keep her vow.

B. Fetal damage may already have occurred The fetus can suffer damage very early in pregnancy, even before a woman knows she is pregnant.

Based on theory, which of the following are men most likely to do when they become ill? a. Ask their female partner what action might be helpful b. Ignore symptoms or refuse to see them as symptoms of illness and act tough c. See their physician as soon as possible d. Talk to other men about what would be the best actio

B. Ignore symptoms or refuse to see them as symptoms of illness and act tough Boys are socialized to ignore symptoms and "toughen up." Men may be aware of being ill, but they make a conscious decision not to seek health care to avoid being labeled as "sick." Brown and Bond suggest that men lack somatic awareness and are less likely to interpret symptoms as indicators of illness. Because of this ignorance and lack of recognition that a problem exists, they are not likely to ask others what action to take or to see a physician for the problem.

Which of the following statements best explains why men are sicker on hospital admission than women? a. Men do not have access to care. b. Men do not seek treatment until they are very ill. c. Men have chronic conditions more than women. d. Men have more acute illnesses than women.

B. Men do not seek treatment until they are very ill. Males continue to delay medical treatment, resulting in men being sicker when they do seek health care. Because they are sicker, they require more intensive medical care. The main reason that they are sicker does not relate to the increased or decreased incidence of acute or chronic illness or lack of access to care, the delayed time in seeking treatment is what results in them being sicker at the time of hospital admission.

A nurse is caring for a woman, who has just found out she is pregnant. The woman begins crying and says, "But I'm not trying to get pregnant!" Should this response by the woman be concerning to the nurse? a. No, because women may not consciously be aware of an unconscious desire to be a mother b. No, because about half of all pregnancies in the United States are unintended c. No, because she admitted having unprotected sexual intercourse d. Yes, because pregnancy can usually be avoided by appropriate precautions

B. No, because about half of all pregnancies in the United States are unintended This response should not surprise the nurse because approximately half of pregnancies in the United States are unintended. Thus, it is important that women have good preconception health throughout their reproductive years to help ensure optimal fetal health and development should pregnancy occur.

Which of the following actions would improve a man's probability of obtaining health screenings and health-promoting education? a. Being active in organized sports b. Joining the military c. Seeking an andrology specialist physician d. Working for an employer that requires employees to have an annual physical exam

B. joining the military The medical specialty of andrology is considered too narrow. Many private insurance companies will reimburse for illness but not preventive care, such as education or health promotion activities. Men are socialized to view health as a resource that enables the body to work. Therefore good health practices and preventive care are sometimes available in large industries or organized sports (sports medicine). The most complete care is currently offered by the military.

Which of the following groups has the highest poverty rate in the United States? a. Married couples with several children b. Single female heads of household c. Single male heads of household d. Two adults cohabitating when one is unemployed

B. single female heads of household Women heads of households and their children are the poorest aggregate in the United States. This phenomenon is labeled "the feminization of poverty." In 2005, the poverty rate for single female heads of household was 36.9% compared to 17.6% for men. Thus, married and cohabitating adults are not the group that has the highest poverty rate in the United States.

Which of the following advantages do women have in relation to health screenings? (Select all that apply.) a. As the weaker sex, women are expected to be ill and see physicians more often. b. Employers often require health screening of their employees. c. Health care departments focus on maternal and child health. d. Women enjoy socialization during visits to health care providers. e. Women have more health screenings because of the need for birth control or physician visits related to childbearing. f. Women have more leisure time and can more easily see their health care providers.

C, E Maternal and child health is a major focus of many health departments, and there is not a medical or nursing specialty within a health department that routinely exists to specifically address men's health. Routine reproductive health screening has been expanded to include some general screening, such as testing blood pressure and urine and blood for chronic problems. Men do not have routine reproductive health checkups that include screening, which would detect other health problems at an early stage. Women see physicians more often because of the need for physicians related to childbearing, not because they enjoy the socialization with health care providers or have more time to complete these visits. Employers may require health screening of their employees, both male and female. Women enjoy socialization during visits to health care providers.

A man stated, "I used to work out at the exercise room at work, but now that I'm retired I sit and watch TV. My wife keeps nagging me to do something. What do you think I should be doing at my age?" Which of the following would be the most appropriate response by the nurse? a. "I think you should try to please your wife. What is it she wants you to do?" b. "It's okay to slow down at your age; why look for problems?" c. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" d. "You've worked all your life; you have a right to rest now."

C. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" The activity theory posits that activity is necessary to maintain life satisfaction and a positive self-concept. Physical activity is beneficial for the health of people of all ages, including older adults. Therefore, because the man has previously been physically active, he should continue to be physically active to maintain satisfaction with his life.

A mother was very proud that she had cut back smoking from two packs a day, which she had smoked for years, to only half a pack a day. Which of the following would be the most appropriate response by the nurse? a. "I wish all smoking moms could see your example!" b. "I'm so proud of you. You're down to only 25% of what you used to smoke!" c. "That must have been difficult, but you're probably still getting nicotine, so it's important you quit entirely." d. "Your baby will really appreciate your efforts at quitting, especially if you do not resume after the baby is born."

C. "That must have been difficult, but you're probably still getting nicotine, so it's important you quit entirely." Quitting is best. Merely reducing cigarette use during pregnancy may not be enough to benefit the fetus because women who cut back tend to inhale more deeply or take more puffs to get an equivalent amount of nicotine. The nurse's response must be supportive and recognize the mother's efforts but also continue to encourage total quitting.

A nurse has just been told by a friend that her physician has recommended a hysterectomy for fibroids in her womb. Which of the following would be the most appropriate response by the nurse? a. "Hysterectomies are the most common surgical procedure done on women; you'll be fine." b. "Tell your doctor to remove your ovaries as well so you will never have to worry about ovarian cancer." c. "There are other alternatives. Why don't you seek a second opinion just to be sure a hysterectomy is best for you?" d. "Uterine fibroids are very common so don't feel badly; you've already had your children, so there's no reason to keep your uterus."

C. "There are other alternatives. Why don't you seek a second opinion just to be sure a hysterectomy is best for you?" Hysterectomy is the second most frequently performed major surgical procedure among women of reproductive age, after C-section. The most common reason for hysterectomy is uterine fibroids. Optional procedures are becoming available to women. Myomectomy, or removing only the tumors with repair of the uterus, uterine artery ablation, and the use of a gonadotropin-releasing hormone to shrink the tumors can decrease the need for hysterectomy, but women may not know about these alternatives. Community health nurses function as advocates for women and can provide health education programs related to alternatives to hysterectomy, indications for hysterectomy, and oophorectomy, and information regarding the type of surgical approach and the purpose of a second opinion. Second opinions and higher levels of education tend to decrease the rate of hysterectomies. Thus, it is important that the nurse first encourage the friend to seek a second opinion rather than encouraging the procedure or ovary removal.

Which of the following is the most common cause of death among women after age 75? a. Accidents and unintentional injuries b. Cancer c. Cardiovascular disease (CVD) d. Diabetes and its complications

C. CVD About one in four Americans has one or more forms of CVD. One in ten women under age 60 years has some form of CVD; the ratio increases to one in three after age 65 years. CVD continues to be the number one overall killer of women. Accidents and unintentional injuries are the leading cause of death in the adolescent and early adulthood years for women. Cancer is the number one cause among women age 35 to 74. Diabetes and its complications are considered to be the fifth leading cause of death among women age 55 to 74, and the sixth leading cause of death among women age 75 to 84.

A school nurse is trying to decrease the effects of an incredible health crisis attacking school children. Which of the following actions would be most appropriate for the nurse to take? a. Arrange for booster shots to maximize immunization protection against childhood infectious diseases b. Arrange for swine flu and regular flu shots each year c. Establish recreational programs that encourage physical exercise each day d. For those whose parents give permission, teach adolescents about the need for abstinence or "safe sex"

C. Establish recreational programs that encourage physical exercise each day Childhood obesity has become a health crisis in the United States. Obesity has more than doubled in children and tripled in adolescents over the past 30 years. An estimated one-third of children are overweight or obese. Children who are overweight are more likely to develop cardiovascular disease, diabetes, bone and joint disease, sleep apnea, and face social discrimination which can lead to poor self-esteem and depression. Nurses can design and implement nutrition, healthy eating, and physical activities policies and standards in schools in order to address this health crisis. Immunizing against infectious diseases and the flu and teaching about the need for abstinence or "safe sex" does not address the obesity, which has become a health crisis throughout the United States.

Which of the following groups of children is at the highest risk to have poor health? a. African American children living in a suburb b. Asian children living in an outer urban area c. Hispanic children living in the inner city d. White children living in a rural area

C. Hispanic children living in the inner city Significant disparities persist in health status of white children versus children of color. However, children living in suburban areas and most outer urban areas experience superior access to health services compared with children living in rural areas and inner cities, especially if they are poor.

Which of the following best describes why infant mortality rate is used as an international comparison of a country's health status? a. Every country, regardless of other priorities, focuses on care of infants and their mothers. b. It is easy to obtain and compare such data. c. It reflects medical care quality and access and public health practice. d. The World Health Organization requires these data be reported to them each year.

C. It reflects medical care quality and access and public health practice It is an important marker because it is related to several factors, including maternal health, medical care quality and access, socioeconomic conditions, and public health practices. Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status.

When considering the benefits for the recipients, which is more beneficial: Medicaid or private insurance? a. Private insurance, because it is accepted by all providers, whereas Medicaid is not b. Private insurance, because it gives its beneficiaries more benefits than Medicaid gives c. Medicaid, because it includes early and periodic screening, diagnosis, and treatment services d. Medicaid, because it is available for all children

C. Medicaid, because it includes early and periodic screening, diagnosis, and treatment services Through the Early Periodic Screening, Diagnosis, and Treatment program, a child covered by Medicaid can receive a range of health and health-related services beginning in infancy. The program is designed to ensure availability and accessibility of health care resources and to help Medicaid recipients and their parents effectively use these resources. The program's services far exceed those usually covered by private insurance. Private insurance may not be accepted by all providers, as many insurance plans may limit the providers that can be seen under a certain insurance plan. Medicaid is not available for all children, only those from low-income families.

Which of the following best explains why some community health nurses find nursing models inappropriate for use in their clinical practice? a. Models are almost always based on meeting the needs of individuals, not groups. b. Models are too theoretical and not realistic. c. Models, developed for the middle class, do not fit low-income families. d. Models taught in nursing school are not remembered by nurses in practice

C. Models, developed for the middle class, do not fit low-income families. Because many models were developed for the middle class, they may not be useful to community health nurses working with low-income families.

Why do some researchers believe data regarding health behaviors may be inaccurate in relation to men? a. Men are not socialized to tell the truth when interviewed. b. Men do not know when they are ill. c. Most of the data are collected about and from women. d. Most of the data are collected by women.

C. Most of the data are collected about and from women. Males are less likely than females to participate in the data collection process. Women are often solicited in health surveys to report the health behavior of men. As proxies, they have a tendency to underreport behavior. Men may not want to participate and will make light of health problems. Males may conceal or suppress pain in an effort to appear strong. Men believe that they are telling the truth, as they may be less willing to talk, may not recall health problems, and may lack a health vocabulary. There is nothing to suggest that the data is collected by women and that this causes a problem with inaccuracies.

Which of the following statements best describes how the United States compares with other countries on infant mortality rate? a. Best of all the industrialized nations b. About in the middle of the industrialized nations c. Near the bottom of the industrialized nations d. Gradually improving among the industrialized nations

C. Near the bottom of the industrialized nations The United States ranks a dismal 27th in infant mortality behind most other industrialized nations, including Japan, Sweden, Spain, Hong Kong, Italy, France, and Canada. Fifty years ago, the United States ranked 12th. The gap in infant mortality between the United States and other nations has occurred in spite of the United States' comparatively high per capita spending on health care and technological advancements.

Which of the following best explains why cancer rates increase as people get older? a. Better prevention programs are available for cardiac disease, so cardiac disease rates are decreasing, making cancer rates increase. b. It is harder to screen for cancer than for other fatal diseases, so the rates are increasing because of the inability to detect the cancer at an early stage. c. Poor lifestyle choices, environmental exposures, and increased life expectancy have all caused cancer rates to increase. d. Other causes of death are decreasing, so it appears that cancer rates are increasing.

C. Poor lifestyle choices, environmental exposures, and increased life expectancy have all caused cancer rates to increase. Cancer rates appear to be increasing for a number of reasons, including lifestyle choices (smoking, diet, sun exposure); increasing exposure to environmental carcinogens; and age. There has not been a significant decrease of cardiac disease or other causes of death. Screening programs exist to detect cancers early and more cancers are detected at earlier stages.

Using a public health perspective, which of the following has responsibility for a child's health? a. The child's family b. The businesses in the community c. The entire community d. The school system

C. The entire community Child health is affected by many factors; therefore, the responsibility for improving children's health rests with the entire community. This responsibility begins with parents and includes health care professionals, community groups, businesses, and the public sector. When a child gets older, he or she can be responsible for practicing healthy behaviors and obtaining proper health care.

Which of the following questions would be a good opening to address health concerns with a male client? a. "How do you know when you are ill?" b. "What sort of health problems or illnesses do you have?" c. "What are your usual physical activities?" d. "What would your wife say about your health?"

C. What are your usual physical activities? The text suggests to ask a man about how he spends his leisure time, what he is doing to take care of himself, and what his usual physical activities are. Thus, asking about his physical activities would be the most appropriate question. Asking how he knows when he is ill, the sorts of illnesses he experiences, or what his wife says about his health would not be a good opening to the conversation.

Which of the following statements best explain the difference in suicide rate according to gender? a. Men are less likely to attempt suicide and less likely to be successful. b. Men are more likely to attempt suicide but less likely to be successful. c. Women are more likely to attempt suicide but less likely to be successful. d. Women are less likely to attempt suicide but more likely to be successful.

C. Women are more likely to attempt suicide but less likely to be successful. Women are more likely to attempt suicide but less likely to be successful. On the other hand, men are less likely to attempt suicide, but are more likely to be successful.

Which of the following is the most useful way to discuss aging? a. By divisions—young-old, middle-old, old-old, and elite-old b. Chronological age c. Functional age d. Number of chronic comorbidities

C. functional age Functional age refers to functioning and the ability to perform activities of daily living, such as bathing and grooming, and instrumental activities of daily living, such as cooking and shopping. This definition of aging is a better measure of age than chronological age. After all, most older adults are more concerned with their functional ability than their chronological age. Assisting older adults to remain independent and functional is a major focus of nursing care.

A nurse is trying to determine who would be the most appropriate person to make a health care decision for an adolescent, the adolescent or the parent. Which of the following considerations will the nurse need to make? a. The need for cultural competence b. The need for access to care c. The need for client autonomy d. The need for client privacy and confidentiality

C. need for client autonomy This situation addressed the need for client autonomy. When considering client autonomy, the nurse must consider the following questions. In the specific case, who should make health care decisions for a young client, especially when opposing opinions arise? The client? The parents or guardian? The nurse or other health care professional? At what age does a child become mature enough to participate in such decision making? What laws does any given state have that affect adolescent client autonomy? What should the community health nurse do if he or she believes the client's or parent's decisions are not in the best interest of the client?

Which of the following best explains why a community health nurse would choose to emphasize women's health? (Select all that apply.) a. Different nurses prefer different specialties. b. It is currently politically correct to verbalize support for female issues. c. Many women's groups are lobbying for more programs. d. Many factors resulting in illness and death in women are preventable. e. Knowledge deficits prevent women from assuming responsibility for their own health. f. Women face barriers in accessing health care.

D, E, F Many factors that lead to death and illness among women are preventable or avoidable. Knowledge deficits related to health promotion and disease prevention activities prevent women of all educational and socioeconomic levels from assuming responsibility for their own health and well-being. A significant number of women and their families face tremendous barriers in gaining access to health care. Although different nurses select different specialties, this does not explain why a nurse would choose women's health. Because women face tremendous barriers in addressing female issues, it is important that nurses provide political support for these issues because of their professional commitment, not because it is the politically correct action to take.

Which of the following actions should be taken by a typical community preparing for the expected demographic changes in the United States? a. Build more elementary schools b. Build more high schools c. Build more colleges d. Build more adult condominiums

D. built more adult condominiums The number of children will increase, but the proportion of children as compared with adults has been decreasing since the mid-1960s. Consequently, more housing for adults is needed.

A parent at a school says to the school nurse, "I can't keep that plate thing straight. What is the bottom line about nutritious eating today?" Which of the following is the most appropriate response by the nurse? a. "Avoid processed foods, and eat fresh fruits and vegetables." b. "Eat lots of protein, fruits, and vegetables, and don't worry about the other rules." c. "Let me get you a copy of the Department of Agriculture plate that you can keep on your refrigerator for easy reference." d. "Balance your plate with half of a plate of fruits and vegetables, and a quarter of a plate of both proteins and grains."

D. "Balance your plate with half of a plate of fruits and vegetables, and a quarter of a plate of both proteins and grains." The "My Plate" approach encourages persons to be mindful of the foods they eat in terms of both portion size and proportion to other foods. One half of the plate should consist of fruits and vegetables, one quarter each for meats/proteins and grains, preferably whole grains. Recommendations also include decreased sodium and sugary foods. Thus, there are additional considerations to keep in mind in addition to avoiding processed foods and eating fresh fruits and vegetables. Giving the parent a copy of the plate does not help educate the parent about the "My Plate" approach.

A woman confides in the nurse that she and her husband want to become parents as soon as possible. Which of the following statements would be the best reply from the nurse? a. "Ask some young parents if you can babysit for a while to get in practice." b. "Can you afford to become parents with all the items a baby will need?" c. "Consider whether you are really ready to become parents." d. "Start living as healthy a lifestyle as possible right now."

D. "Start living as health a lifestyle as possible right now." Adopting a healthy lifestyle and obtaining regular medical care before becoming pregnant can help to ensure a healthy pregnancy. Questioning the woman's statement would not be a therapeutic response from the nurse, rather the nurse should reply by providing support and education for the woman.

"I want to get pregnant as soon as possible now that I'm married," a 43-year-old female says to the nurse. Which of the following would be the most appropriate response by the nurse? a. "Having a child will certainly cement your new marriage and give it a focus." b. "It's understandable that your 'biological clock is ticking' and time is running out." c. "You're right, once you hit menopause you won't be able to have a child." d. "We will help you, but you need to know that there are more risks for you at your age."

D. "We will help you, but you need to know that there are more risks for you at your age." An additional risk factor, regardless of race, is advancing age. Women aged 40 years and older have over three times the risk of dying of a pregnancy-related cause as women aged 30 to 39 years. Intrinsic maternal factors, such as increasing frequency of hypertension and a greater likelihood of uterine hemorrhage, help explain this increase in the mortality rate. The other responses are not therapeutic responses by the nurse. It is important for the nurse to educate the woman that there can be more risks associated with becoming pregnant after age 40

What proportion of U.S. citizens are children? a. 12% b. 16% c. 20% d. 24%

D. 24% In 2011, there were 73.9 million U.S. children under the age of 18 years. Children represent about 24% of the country's population, down from a peak of 36% at the end of the mid-1960's baby boom.

How do the policies on children's health in the United States differ from the policies on children's health in other industrialized nations? a. Most industrialized nations, including the United States, have similar policies. b. U.S. policies are more market based and less social justice based. c. U.S. policies are voluntary, whereas in most countries they are required by law. d. Although industrialized nations have policies on children's health, the United States does not.

D. Although industrialized nations have policies on children's health, the United States does not. In the United States, the government's role in promoting or ensuring children's health is more limited than in many other countries. Other countries often have defined policies on children's health; the United States does not. Not only do such policies indicate that children are a priority of the citizenry, but they also help shape the operation of programs and their funding.

Which of the following best explains how the Civil Rights Act amendments have been helpful to adult women who are employed? a. If both a man and a woman apply for a position, preference must be given to the woman. b. Everyone has permission to apply for any employment position regardless of gender. c. Employers are prohibited from paying different salaries to men and to women for the same position responsibilities. d. Discrimination against pregnant women or conditions involving childbirth or pregnancy is prohibited.

D. Discrimination against pregnant women or conditions involving childbirth or pregnancy is prohibited. There is no affirmative action for gender, and pay scales remain different for men and women. Anyone has always been able to apply for any position; the issue is whether or not you would be chosen. The Civil Rights Act was amended to prohibit discrimination against pregnant women or conditions involving childbirth or pregnancy. This landmark legislation makes it unlawful for employers to refuse to hire, employ, or promote a woman because she is pregnant. In addition, employee benefit plans that continue health insurance, income maintenance during disability or illness, or any other income support program for disabled workers must include disabilities resulting from pregnancy, childbirth, and other related conditions. If employers allow disabled employees to assume lighter or medically restricted assignments, the same considerations must extend to pregnant women.

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

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

A male client reports that he is unable to change his health behaviors and adopt a healthier lifestyle. Which of the following is the most likely reason for his difficulty? a. Lack of financial resources b. Lack of transportation c. Lack of programs d. Lack of motivation

D. Lack of motivation Two nurse researchers (Dallas & Neville, 2012), conducted a study to describe the health education and health screening practices of older men living in an area of New Zealand and the perceived barriers and benefits of healthy lifestyle choices. Of those men who did report barriers, the most common reason was lack of motivation (12%), followed by lack of knowledge related to availability of programs and screenings (8%). Reported external barriers included: lack of programs, associated costs, and transportation challenges.

Which of the following statements is correct? a. Males are more likely to have colorectal testing than females. b. Males are more likely to receive dental care than females. c. Males are more likely to have routine physicals than females. d. Males are more likely to be eligible for primary care services than females

D. Males are more likely to be eligible for primary care services than females Men do not engage in these health protective behaviors at the same frequency as females (Brown and Bond, 2008). Most men do not have routine checkups. National health surveys indicate that women overall are more likely than men to have visits to various healthcare providers (NCHS, 2011). Men are twice as likely to report no usual source of care although eligibility for primary care in males exceeds that for females (Lynch, 2008). Men tend to have fewer dental health care visits (56.2) versus women (58.9) (NCHS, 2011, p. 319). Additionally, men have lower rates of use of colorectal testing and procedures (men, 54.7, women, 55.1).

Which of the following outcomes for the infant and mother have occurred because of fetal monitoring? a. Improved outcomes for both infant and mother b. No difference for the infant but improved outcomes for the mother c. No difference for the mother but improved outcomes for the infant d. No difference in outcomes for the infant but increased risk for the mother

D. No difference in outcomes for the infant but increased risk for the mother The technology of fetal monitoring has been shown to increase the C-section rate without improving neonatal outcomes. C-sections are risky for the mother as they involve the risks of any major surgery such as hemorrhage, infection, damage to adjacent structures, as well as risks associated with anesthesia. Long-term sequelae for women include pelvic pain, along with formation of adhesions and placental abnormalities that lead to complications in subsequent pregnancies. Improved outcomes both for the mother and infant have not been demonstrated.

Which of the following factors is the single largest threat to child health? a. Child abuse b. Obesity c. Poor nutrition d. Poverty

D. Poverty Poverty is the greatest threat to child health. Children in poverty have less access to nutritious food, shelter, and health care. They are often deprived of advantages such as good schools and may live in substandard housing, have stressful home lives, live surrounded by drugs and crime, and lack positive and nurturing adult role models.

"Stand up straight, mom," a young woman said to an older woman in the grocery store checkout line. Which of the following would be the most appropriate action by the nurse who is standing next to them in line? a. Do nothing; the nurse is not expected to act as a nurse when not at work. b. Say to the older woman, "You need to start treating that osteoporosis." c. Say, "Older women who don't get much calcium, vitamin D, or exercise can often have trouble standing up straight. Keep reminding yourselves." d. Say, "You both may have some problems. Have you both ever been checked for osteoporosis?"

D. Say, "You both may have some problems. Have you both ever been checked for osteoporosis?" It is assumed that students will know that symptoms of osteoporosis include loss of height, low back pain, neck pain, and stooped posture. These are late symptoms, and there is no cure for osteoporosis. But screening needs to be done so both of these women can be informed, especially of the risk of fractures with this condition.

Which of the following is the primary source of income for elderly Americans? a. Employment income b. Pensions c. Savings d. Social Security

D. Social security Aggregate income for the population aged 65 years and over comes largely from four sources: (1) Social Security provides 37%, (2) earnings account for 30%, (3) pensions provide 19%, and (4) asset income accounts for 11%.

If most students have no intention of ever leaving their local community, which of the following languages should be chosen as the required foreign language in high school? a. French, as it is a very romantic language b. German, because many of the students' names are German c. Latin, as it is the basis for many other languages d. Spanish, to improve employment opportunities

D. Spanish, to improve employment opportunities By 2050, Hispanic children as a percentage of the population are expected to grow to 39%, up from 24% in 2011. The percentage of children who are Hispanic has increased faster than that of any other racial or ethnic group. More immigrants speak Spanish, and care providers need to give culturally appropriate care. Speaking Spanish would be helpful. Because of these reasons, it would be most appropriate for Spanish to be selected as the required foreign language. Speaking French, German, or Latin would not be as practical as being able to speak Spanish.

Which of the following is most effective in helping males choose healthier lifestyle behaviors? a. Educational programs that include both threat and reward b. Involvement in team sports at school or at work c. Physician prescription for a specific behavior change d. Support from a female family member concerned about the man's well-being

D. Support from a female family member concerned about the man's well-being Cheatham reported that several studies showed males to be more likely to change health behaviors when these changes were suggested and supported by female family members whom they believed were concerned about the well-being of the man. Thus, female support is more important than educational programming, being part of a team, or a physician prescription.

A community health nurse suggested that a group of nursing students perform a diabetic screening at a location where groups of people meet. Which of the following sites would be best for the screening? a. The senior citizens center, which always welcomes students back b. The shopping mall where many young adults go to save money c. The YWCA/YMCA down the street d. The Weight Losers group meeting at the church

D. The Weight Losers group meeting at the church Adults who are obese and meeting at a group such as "Weight Losers" probably have not previously been screened for diabetes. If the senior citizen center always welcomes students back, they have clearly had screenings there before. Hence, even though older adults are at risk, it would be better to choose a different group. Young adults and those working out at a YMCA are not particularly at high risk.

Which of the following would be a source of care if families are employed at a salary above the poverty line, but at too low of an income for health insurance? a. Local health department clinics that provide care on a sliding scale b. Health care providers who donate time and pharmaceutical samples to free clinics c. School health clinics d. The state Children's Health Insurance Program (CHIP)

D. The state Children's Health Insurance Program (CHIP) Although families may be able to get some assistance from any of the listed resources, the CHIP is a publicly subsidized health insurance program for children. It was specifically created for children whose family income is above Medicaid limits but whose families do not receive health insurance through the parents' employment (i.e., the working poor).

Which of the following offers the best explanation as to why it is important for low-income women to seek prenatal care? a. To provide the extra support from a nurse who listens b. To begin the process of obtaining hospital care for delivery for a reduced cost c. To have time to begin healthy behaviors to ensure a healthy infant d. To obtain referrals for other helpful services

D. To obtain referrals for other helpful services. Comprehensive prenatal care is particularly important for low-income women. It can help them obtain other services such as the Special Supplemental Food Program for Women, Infants, and Children program, food stamps, smoking cessation, housing, child care, job training, substance abuse treatment, and domestic violence counseling. Ideally, healthy behaviors should begin before the woman becomes pregnant. Prenatal care would not assure obtaining reduced costs for hospital care at the time of delivery. Although nurses do provide support by listening, the most important resource that nurse can provide is referral for other community resources.

According to the U. S. Department of Commerce, which of the following rules must be followed by makers of toy guns? a. Darts from toy guns must be made of materials that will not penetrate skin. b. Toy guns cannot contain parts made of lead or lead-based paint. c. Reflective paint must be used on toy guns. d. Toy guns must be distinguishable from real guns.

D. Toy guns must be distinguishable from real guns The U.S. Department of Commerce requires toy guns to be distinguished from real guns. In many cases, the toy industry has established voluntary safety standards to minimize risk of injury. There is not specific legislation from the U.S. Department of Commerce that outlines the materials that must be used in darts of toy guns or banning the use of reflective or lead-based paint or lead products.

A mother was debating whether or not to take her son to the clinic. His temperature was 104° F and rising so she gave him acetaminophen (Tylenol). Which of the following will most likely be the deciding factor in the mother's decision? a. Whether or not the child is crying b. Whether or not the fever goes down after the Tylenol c. Whether or not the child seems to be getting better d. Whether or not the child is covered under insurance

D. Whether or not the child is covered under insurance The ability to pay for health care greatly influences whether a parent takes a child to see a health care provider. Having health insurance would be the most important deciding factor in this situation, more important than if the child is crying, if the fever goes down, or if the child seems to be getting better.

A school nurse is developing a health education program for third grade students about how to play safely. Which of the following provides the best rationale for this nursing action? a. The kids were playing chicken in front of the school buses each day. b. The students are at the age when they begin to engage in risky behaviors. c. Toys can have unexpected hazards from lead paint to small swallowable parts. d. Without proper head protection, many sports can lead to traumatic brain injury (TBI).

D. Without proper head protection, many sports can lead to traumatic brain injury (TBI). Head injury from cycling and other wheeled sports, such as skateboarding, is a leading cause of child death and disability. Without proper head protection, a fall from as little as two feet can cause TBI. The use of helmets and proper protective equipment can substantially reduce the risk of injuries. Adolescents are the population who begin to engage in risky behaviors. As third graders, these children are not typically at risk for swallowing small parts from toys. Although the education may provide information about why it is not safe to play chicken in front of the school buses, this is a behavior that should be stopped by the rules and regulations that are in place at the school.

Which of the following best explains why lung cancer kills more women than breast cancer? a. Early detection and cure of breast cancer has lowered the death rate. b. Pap smears lead to early detection and often the cure of uterine cancers, hence avoiding breast metastasis. c. There is no accepted treatment for lung cancer. d. Women have begun smoking.

D. Women have begun smoking Lung cancer is responsible for more deaths yearly in U.S. women than breast, ovarian, and uterine cancers combined. The increase in the incidence of lung cancer in women is due primarily to an increase in their tobacco use. Eighty-five percent to 90% of all clients in whom lung cancer develops have a history of cigarette smoking. The incidence of breast cancer continues to increase, and is the most common cancer among women, but it is not responsible for as many deaths as lung cancer. Pap smears are used as a screening tool for early detection of cervical cancer. There is accepted medical treatment for lung cancer, and it is similar for both men and women with the disease

Which of the following provides the best explanation for the importance of the "Go Red" and "The Heart Truth" campaigns? a. Because heart disease is so prevalent, we all need to know the usual symptoms so we may seek help quickly. b. Few people are aware of how to prevent chronic diseases such as cancer. c. We need to increase awareness of the genetic component in chronic disease. d. Women have different symptoms and require different treatment than men.

D. Women have different symptoms and require different treatment than men. After the age of 65 years, women are twice as likely to die because of heart disease as men. Women have higher rates of complications after revascularization procedures and higher rates of death after myocardial infarction. This phenomenon exists because women display different symptoms of heart disease and are managed differently than men. In 2002, the American Heart Association launched the "Go Red" campaign for women and "The Heart Truth" program for health care providers. Both programs are designed to educate about the unique features of women and heart disease. These campaigns address heart disease and do not include information about other chronic diseases such as cancer. Heart disease is caused by both lifestyle choices and genetic factors, thus education needs to be provided related to both of these aspects

Which of the following events caused attention that has resulted in the current emphasis on women's health? a. Hillary Clinton and Sarah Palin's comments during the presidential race b. Political correctness, including addressing the rights of women c. New research studies that are focusing on women d. Women's movement from the 1970s

D. Women's movement from the 1970s Beginning in the 1970s, the women's movement called for the reform of systems affecting women's health. The current emphasis began before the presidential races that involved Hillary Clinton and Sarah Palin. The women's movement has caused there to be new research studies that focus on women. Additionally, political correctness addressing the rights of women has occurred because of the women's movement.