Community Exam #3

b.) a baccalaureate degree in nursing (BSN). According to ANA, the BSN provides the theory and skills required for practice as a generalist in home health. The home health nurse must be skilled in providing nursing care to individuals, families, and caregivers and have skill in community health assessment, client assessment, client education, managing resources, collaborating with other disciplines, and coordinate care.

According to the American Nurses Association's (ANA) Scope and Standards of Home Health Nursing Practice, basic preparation for the generalist home health nurse is a.) an associate degree in nursing. b.) a baccalaureate degree in nursing (BSN). c.) a diploma in nursing. d.) a master of science degree in nursing.

a.) use of violence to handle disputes. Adolescents and children increasingly use violence to settle disputes. Children are often not taught peaceful ways of resolving differences and learn by what they observe at home, on television, in video games, and in movies. Consequently, schools have become a common site for violence. The reasons for violence are complicated and multilayered, but the most common reason cited is use of violence to handle disputes.

As a school nurse, you know the leading reason cited as the cause of school violence is a.) use of violence to handle disputes. b.) an unhappy home life. c.) overly protective parental situations. d.) poor communication with authority figures.

a.) African Americans The HIV/AIDS epidemic represents a growing and persistent health threat to women in the United States, especially young women and African American women. Sixty-one percent of women diagnosed with HIV/AIDS are black.

HIV primarily affects women in which ethnic population? a.) African Americans b.) Hispanics c.) Asians d.) Caucasians

Examples: -Drug testing -Risk identification -Ensure accommodations -Workmen's comp claims

Name one intervention an occupational health nurse would perform. (List not inclusive)?

Agent Mode of Transmission Portal of Entry Susceptible Host

Put the listed elements of the infection transmission chain in order. Hint- 2 elements are not listed. Agent Susceptible Host Mode of Transmission Portal of Entry

a.) Lack of access to adequate nutrition

What are the contributing factors to diseases being transferred in developing countries? a.) Lack of access to adequate nutrition b.) Annual physical examinations c.) Up to date childhood vaccinations d.) Appropriate health insurance coverage

Males more likely than females to be assaulted

What is Assault?

Often unreported -Females are more likely than males to be raped -Higher rates in urban areas, between 8p-2a, on weekends and in summer

What is Rape?

Females more likely to attempt, males more likely to complete Risk factors- depression, comorbid mental health condition, substance abuse, access to lethal means, partner violence

What is Suicide related to violence?

Use of violence or fear to coerce government or society Usually politically or religiously motivated Include- violence, fear and intimidation

What is Terrorism?

Most committed by someone known to the victim -Often related to substance abuse -Violence often precedes homicide

What is a Homicide?

d.) Providing emotional support

What is the priority action when performing a sexual assault examination? a.) Performing a pregnancy test b.) Swabbing for sexually transmitted diseases c.) Administering prophylatic antibiotics d.) Providing emotional support

c.) Federal Emergency Management Agency (FEMA) FEMA's mission is to support citizens and first responders to ensure that as a nation everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all. The other agencies may be peripherally involved in national disasters, but it is not their primary focus.

Which agency has a mission to support citizens and first responders to ensure that as a nation everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all? a.) American Red Cross (ARC) b.) National Institute for Health (NIH) c.) Federal Emergency Management Agency (FEMA) d.) Centers for Disease Control and Prevention (CDC)

d.) many factors cause the problem. Information from studies to date is insufficient to establish a definitive biological cause for mental illness. Scholars have concluded that mental disorders are multifactorial, complex physiological phenomena.

You are working in a mental health facility as a nurse. You are involved with patients who have varied diagnoses. One of your patient's family members asks what biological problem causes all of these people to have mental illness. You respond that most experts believe a.) brain structure is the problem. b.) neurotransmitters are the problem. c.) genetics are the problem. d.) many factors cause the problem.

a.) Primary Primary prevention occurs in the nondisaster and predisaster stages. Actions during these stages includes developing local, state, and federal disaster plans; conducting drill tests; training volunteers and health care providers; and providing educational programs. Secondary measures are those taken after the disaster has occurred and tertiary measures are aimed at rehabilitation. Disaster prevention is a broad term covering all types.

You teach a community disaster preparedness class on how to find shelter during and after a disaster situation. This is an example of what kind of prevention? a.) Primary b.) Secondary c.) Tertiary d.) Disaster

c.) family history of depression. A family history of depression is a major risk factor for childhood depression. Other associated factors that may increase the risk of depression in children and adolescents include a history of verbal, physical, or sexual abuse; frequent separation from or loss of a loved one; poverty; mental retardation; attention-deficit/hyperactivity disorder; hyperactivity; and chronic illness.

You work in a community clinic that specializes in pediatric mental health. Joy, age 12 years, has been diagnosed with depression. You know a major risk factor for depression in childhood is a.) family history of diabetes. b.) family history of abuse. c.) family history of depression. d.) family history of poverty.

Prior history of violence, Substance use, Poor family functioning, Community poverty -Look at video games they play, tv they watch, if parents hit them or other children -Overall homicides are down, but youth homicides are UP!

Youth-Related Violence- (Table 28.3, page 582)?

c.) the nurse may be an expert witness in court. The nurse will not be diagnosing or identifying illnesses, that is a physician's role. Although the nurse may be working in a psychiatric facility, the best reason for being knowledgeable about these illnesses is because the forensic psychiatric nurse may be called to be an expert witness in court.

It is vital that the forensic psychiatric nurse be knowledgeable about mental illnesses and personality disorders because a.) the nurse will be diagnosing many of the illnesses. b.) the nurse will work in psychiatric facilities. c.) the nurse may be an expert witness in court. d.) the nurse will be identifying new cases.

a.) risk-taking behaviors. b.) infrequent use of the health care system. c.) gaps in preventative health behaviors. Although there are many male health care providers, there are not many health care providers that specialize in men's health. Little effort has been made to create a male-specific health care climate. Risk-taking behaviors, infrequent use of the health care system, gaps in preventative health behaviors, and differences in illness and health orientations and reporting of health behavior all contribute to a diminished health status for men.

Public health nurses should be aware that factors that impede men's health include (Select all that apply.) a.) risk-taking behaviors. b.) infrequent use of the health care system. c.) gaps in preventative health behaviors. d.) lack of male health care providers. e.) financial ability.

B.) Determine the client's financial situation

A nurse case manager is preparing to meet with a client who recently lost their health insurance. Which is first action the nurse should take to address the client's healthcare needs related to their lack of insurance? A.) Coordinating services to meet the client's needs B.) Determine the client's financial situation C.) Compare client healthcare outcomes to their goals D.) Clarifying the roles of the care team members

c.) youths and young adults. e.) international markets. The tobacco industry has now started targeting youths and dramatically increased international exports. Tobacco sales among American adults is down.

After the implementation of various policies to reduce tobacco use, the tobacco industry has begun targeting (Select all that apply.) a.) elderly people. b.) Hispanics. c.) youths and young adults. d.) African Americans. e.) international markets.

d.) Difficulty remembering new names With aging, the human body experiences physiological changes in all systems. Included are changes in taste, including diminished taste sensation, decreased saliva production, and decreased sensitivity to sweetness and salt. Pain threshold is increased, perhaps associated with physical changes in brain weight, reductions in functioning neurons, and increases in neurofibrillary tangles. Sleep changes include decrease in stage 3 and 4 sleep, as well as a reduction in total sleep time. Multiple cognitive changes occur as part of normal aging, including better long-term versus short-term memory retrieval. Remembering new names is an aspect of short-term memory.

An elderly client expresses the following concerns to the community health nurse. Which of these concerns is a physiological change associated with the aging process? a.) Increased saliva b.) Decreased pain threshold c.) Increased nightly sleep time d.) Difficulty remembering new names

c.) Patient-centered case management Case management is patient centered and system centered. Patient-centered case management assists the client through a complex, often fragmented and confusing health care delivery system and achieves specific client-centered goals. System-centered processes recognize that health care resources are finite. Some case management programs are disease based; for example, case management is focused on clients with heart failure. Case management has its origins in public health.

Assisting the family of a special needs child through the complex health care system is an example of what type of case management? a.) Disease-specific case management b.) System-centered case management c.) Patient-centered case management d.) Public health case management

a.) reach almost 10 billion. The world's population soared to 4 billion between 1960 and 1974 and then to 5 billion between 1974 and 1987. In 1999, the world population was 6 billion; in 2016, it was 7.4 billion. The population is projected to reach 8 billion by 2025 and 9.8 billion by midcentury.

By the middle of the 21st century, the world population is expected to a.) reach almost 10 billion. b.) reach 8 billion. c.) be largely unchanged from the 20th century. d.) show a slight decline.

Build trust and confidence with client Focus on client rather than situation -Don't make them feel like the victim Assess for immediate danger -What is your safety plan? -Who do you call? Bag packed? Provide emergency care if needed -Collection of evidence Assist client to develop safety plan Refer to community services and legal options Complete mandatory reporting- agency and state guidelines -Abuse against children,elderly, developmental delays we have to report these -Would report a physical assault where you have to get the law enforcement involved only; if you suspect but no proof do not report

Care for Clients Who Experience Violence?

a.) weapons of mass destruction. Weapons of mass destruction refer to any weapon that is designed or intended to cause death or serious bodily injury through release, dissemination, or impact of toxic or poisonous chemicals or their precursors. Chemical warfare agents are classified as nerve agents, vesicants, pulmonary agents, and cyanides.

Chemical warfare agents such as pulmonary agents and cyanides are classified as a.) weapons of mass destruction. b.) computer-based attack weapons. c.) recovery agents. d.) prevention medications.

Schizophrenia -Most debilitating Depression -Most common illness Bipolar Disorders Anxiety Disorders Eating Disorders Attention-Deficit Hyperactivity Disorder Suicide

Common mental illnesses in community setting?

Threats of physical violence, physical assault, muggings, bullying High risk occupations: -Healthcare: ER, Prison systems, Inpatient psych, Geriatric units -Law enforcements -Delivery services -Waiters, bartenders where alcohol is served

Community Violence: Workplace?

Legalization- fully legalizing illicit substances or changing controlled substance classification -No consequences at all; let everyone run free Decriminalization- stays illegal but criminal prosecution does not occur when caught with the substance -Still illegal but just not arresting and incarcerating people for it -Larger amounts still prosecute like for drug dealers Supporters- Reduction in crime and decrease stigma, taxes on sales -If legal can make money off of taxes Opposition- criminal penalties deter use, less access results in fewer new users

Debate: Legalization vs decriminalization?

d.) Granger Westberg Reverend Granger Westberg was a Lutheran minister who worked with nurses in hospitals, medical schools, and church communities. He proposed a parish nurse program to Lutheran General Hospital in Chicago, Illinois, in 1984. John Wesley was the founder of the Methodist Church. Florence Nightingale is famous for improving the care of soldiers during the Crimean War. Jimmy Carter was a founding member of Strong Partners Interfaith Health Program.

Who is considered the founder of the modern parish nurse movement? a.) John Wesley b.) Florence Nightingale c.) Jimmy Carter d.) Granger Westberg

d.) a link among the health care system, the investigative process, and courts of law. Although the other options are somewhat correct, the correct choice includes all three areas in which forensic nursing is involved: (1) health care, (2) investigation, and (3) the court system.

Forensic nursing is best defined as a.) a field of legal nursing in which the nurse works with or for lawyers. b.) a field of correctional nursing in which the nurse works with inmates. c.) investigational nursing in which the nurse works with law enforcement. d.) a link among the health care system, the investigative process, and courts of law.

d.) give the immunizations. A low-grade fever is not a contraindication to immunizations. The nurse should give the immunizations. It is not necessary to contact the child's pediatrician. Vaccination should be postponed in cases of moderate or severe febrile illness to avoid any confusion between a vaccine side effect and an unknown underlying cause.

Four-month-old Lucy is in for immunizations at the local health department. The Vaccine Information Sheet is given to Lucy's mother, and informed consent is obtained. However, the mother then states, "Lucy did have a temperature around 99.1 degrees the night of her last immunizations." After this statement, the nurse should a.) consult the child's pediatrician. b.) delay the immunizations. c.) do not give the immunizations because of the contraindication. d.) give the immunizations.

History of abuse Poor self-control Recognizing Abuse: -Unexplained injury -Fractures/bruises in multiple stages of healing -Malnourishment/dehydration -Withdrawal and passivity Social and Community: -Work stress -Unemployment -Media exposure to violence -Poverty -Social Isolation -Lack of community resources -Crowded living conditions

Factors Influencing Violence?

b.) an elder with urinary incontinence. Individuals who are most at risk for elder abuse include female widows age 75 years and older, elders dependent on a caregiver for food and shelter, those with incontinence, and individuals who are frail or have illness or mental disability. Studies have described the typical abuser as a family member (typically a son or daughter) who is middle age or older with low self-esteem and low impulse control. The caregiver's perception of his or her own stress is strongly related to the risk for abuse. Elder abuse occurs at all cultural and socioeconomic levels.

The nurse is aware that a risk factor for elder abuse is a.) a caregiver with low income. b.) an elder with urinary incontinence. c.) an elder who is irritable and demanding. d.) a caregiver with a strong need for control.

Response stage

Pin the phase of disaster management when the nurse would use START triage.

a.) Judgement

According to the CIRCLE model, what should the nurse avoid when administering care? a.) Judgement b.) Emotion c.) Respect d.) Caring

d.) Federally funded breakfast and lunch program. The school nurse has several federal resources available to assist children in need. The nurse must be able to recognize children and families that may be eligible for assistance. Options A, B, and C are not appropriate referrals for a child in the specified situation. NET focuses on healthy nutritional choices and health promotion and disease prevention topics in school and child care settings. The Youth Risk Behavior Surveillance System identifies and trends youth risk behavior. Adult and Child Protective Services assess and protect children from abuse.

A 10-year-old boy visits the nurse complaining of a headache and nausea. The nurse recognizes the boy from an earlier conference with a teacher about the boy's declining school performance. The nurse has been concerned because the boy's father and mother are recently divorced, and his mother works nights. An appropriate nursing intervention would be to investigate the boy's eligibility for a.) The Nutritional Education and Training Program (NET). b.) Youth Risk Behavior Surveillance System. c.) Adult and Child Protective Services. d.) Federally funded breakfast and lunch program.

b.) A SANE (sexual assault nurse examiner) Although all of the health care providers listed are able to complete a physical examination on this patient, the SANE would be most appropriate because of the clues that a date rape may have occurred. The SANE is trained specifically to collect evidence in such a case, which is why the emergency nurse would not be most appropriate. The stem includes a statement that the patient is medically stable; therefore, the SANE should be chosen over the physician.

A 16-year-old young woman arrives at the local emergency department (ED) early Sunday morning and states, "I was on a date last night, and the last thing I remember was eating dinner with my boyfriend." She comments that she woke up in her bed with her clothes "messed up" and states, "I just don't feel right down there" as she points to her genital area. She appears medically stable. Which health care provider would be most appropriate to conduct the physical examination? a.) An experienced obstetrical nurse because the patient could be pregnant b.) A SANE (sexual assault nurse examiner) c.) The physician on call in the ED department d.) An emergency nurse

a.) Personal or family history of breast cancer b.) Early age of menarche c.) Late age at menopause Personal or family history of breast cancer, early age of menarche, late age at menopause, never having children, having first child after the age of 30 years, and aging are all risk factors for breast cancer. Fibrocystic breast disease is not a risk factor for breast cancer.

A 35-year-old woman came to her appointment for her yearly mammogram and Pap smear. Her physician discussed with her the risk factors for developing breast cancer. The following are risk factors for breast cancer: (Select all that apply.) a.) Personal or family history of breast cancer b.) Early age of menarche c.) Late age at menopause d.) Fibrocystic breast disease e.) Multiparous

b.) Lack of prenatal care and advanced maternal age Major risk factors for maternal death include lack of antepartal care and family planning services, inadequate health education, and poor nutrition. An additional risk factor, regardless of race, is advancing age. Women age 40 years and older have over three times the risk of dying from a pregnancy-related cause as women age 30 to 39 years. Sexually transmitted infections and disorders and socioeconomic status and urban dwelling may contribute to maternal morbidity.

A 41-year-old pregnant black client, who is at 35 weeks of gestation, has not seen a physician throughout her pregnancy. Which factor places her most at risk for maternal mortality? a.) Sexually transmitted infections and disorders b.) Lack of prenatal care and advanced maternal age c.) Cultural and ethnic influences d.) Socioeconomic status and urban dwelling

a.) Asbestos exposure b.) Chronic lung disease c.) Genetic predisposition Widely accepted risk factors for lung cancer include exposure to environmental tobacco smoke, certain occupational exposures (especially asbestos), genetic predisposition, sex, gender, diet, chronic lung disease, and a history of tobacco-related cancer.

A 50-year-old female who has been a smoker since age 22 visits the health care provider because of having a chronic cough for the past three weeks. The health care provider educates the patient about lung cancer. Which are risk factors for lung cancer in women? (Select all that apply.) a.) Asbestos exposure b.) Chronic lung disease c.) Genetic predisposition d.) Socioeconomic status e.) High carbohydrate diet

a.) Blood pressure check every 2 years b.) Dental examination every year c.) Eye examination every 3 to 5 years d.) Colorectal screening every 3 to 5 years One-time abdominal aortic aneurysm is recommended for all men older than age 65 years who have smoked. Blood pressure check every 2 years, dental examination every year, eye examination every 3 to 5 years, and colorectal screening every 3 to 5 years are recommended preventive health screenings for men older than the age of 50 years.

A 50-year-old male client should be counseled to receive the following preventive health screenings: (Select all that apply.) a.) Blood pressure check every 2 years b.) Dental examination every year c.) Eye examination every 3 to 5 years d.) Colorectal screening every 3 to 5 years e.) Abdominal aortic aneurysm screening every 2 to 3 years

b.) refer the child to an eye specialist. The role of the nurse in a school-based health center includes vision, hearing, and scoliosis screening and first-aid and medication administration, but the nurse should refer the individual to an appropriate specialist for diagnosis and treatment.

A 6-year-old child fails a routine vision screening on a Snellen chart at a school-based health center. The appropriate action by the nurse is to a.) rescreen the child in the following year. b.) refer the child to an eye specialist. c.) use a Rosenbaum chart instead of a Snellen chart. d.) do an internal ophthalmologic examination.

d.) Talk with the patient alone and question the possibility of elder abuse. Elder abuse is underdiagnosed and underreported. The nurse must assess the possibility of elder abuse occurring. The other interventions are not indicated based on the information provided.

A 71-year-old man is brought to the emergency department by his daughter and states that he has fallen and appears to have a broken arm. He is alert and oriented and walks alone without difficulty. Which nursing intervention is most appropriate after he is seen and treated by the physician? a.) Talk with the daughter about nursing home placement for the patient. b.) Discuss the dietary needs and regimen with patient and family. c.) Review the patient's current medications. d.) Talk with the patient alone and question the possibility of elder abuse.

D.) Identify referrals that the client needs

A case management nurse is preparing to initiate referrals for a client as part of discharge planning. Which of the following actions should the nurse take first? A.) Monitor the client's satisfaction with the referral B.) Provide client information to referral agencies C.) Review available resources with the client D.) Identify referrals that the client needs

c.) 19 According to federal statistics, individuals who survive to age 65 years can expect to live an average of 19.3 more years.

A client who regularly participates in activities at the local senior center is celebrating his 65th birthday today. Without regard to gender, according to the U.S. average, how many additional birthdays can he anticipate celebrating? a.) 10 b.) 14 c.) 19 d.) 22

B.) Tolerance to nicotine develops quickly

A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following information should the nurse include when discussing nicotine and smoking? A.) Nicotine Is a central nervous system depressant B.) Tolerance to nicotine develops quickly C. Withdrawal effects from smoking are minimal D. Vaping is the preferred method to consume nicotine

c.) Teaching a client with schizophrenia about medication interactions

A community health nurse is developing. strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? a.) Providing a support group for new parents b.) Screening a client whose partner recently died from suicide c.) Teaching a client with schizophrenia about medication interactions d.) Discussing stress reduction techniaues with emnlovees at an industrial site

c.) Women, Infants, and Children (WIC) WIC is a federally funded program that provides highly nutritious foods, nutrition education and counseling, and referral to millions of low-income pregnant and postpartum mothers and their children up to 5 years of age. Medicaid is a health insurance program for poor and low-income people. School-based health centers typically provide a combination of screening and preventive services, primary care, mental health and substance abuse counseling, dental health, nutrition education, and other health promotion activities. The MCH Block Grant program allocates federal funds to the states, and the states must contribute their own funds for maternal and child health services.

A community health nurse may work in a collaborative role with which program that provides nutritious foods, nutrition education, and referral to millions of American pregnant and nursing women and infants and small children? a.) Medicaid b.) School-based health services c.) Women, Infants, and Children (WIC) d.) Maternal and Child Health (MCH) Block

c.) physical examinations and comprehensive health history. The eight components of a comprehensive school health program are health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff and family, and community involvement. Physical examinations and comprehensive health history are not included.

A comprehensive school health program should include all except a.) health promotion for staff and health education. b.) health services and health education. c.) physical examinations and comprehensive health history. d.) nutrition services and counseling.

a.) arranging for a mobile mammography unit to come to the church to provide low-cost mammograms. Mammography is an example of secondary prevention. Whereas organizing a support group for those who have recently lost a spouse would be tertiary prevention, providing vaccinations and setting up a referral system would be examples of primary prevention.

A congregational health nurse is trying to establish a health program that is balanced across all levels of prevention (primary, secondary, and tertiary). An example of a secondary health intervention the nurse might consider would be a.) arranging for a mobile mammography unit to come to the church to provide low-cost mammograms. b.) organizing a support group for widows and widowers. c.) providing vaccinations against influenza to interested parishioners. d.) setting up a system that would facilitate referrals to community providers for primary care.

b.) displaced persons. Displaced persons are those who have to evacuate their home, school, or business as a result of a disaster. An indirect victim may be a family member or friend of the victim or a first responder. A mass casualty event is one in which 100 or more individuals are involved. Poverty is not considered a disaster classification.

A family of five people presented to a hospital after the flooding of their urban home. These family members are classified as a.) poverty victims. b.) displaced persons. c.) indirect victims. d.) mass casualties.

a.) lack of physical activity. b.) poor nutrition. c.) alcohol and drug use. e.) injury and violence. An objective of Healthy People 2020 sets a goal that middle, junior, and senior high schools provide health education courses in priority areas. Centers for Disease Control and Prevention (CDC) (2012a) identified six high-risk behaviors that need to be targeted in health education courses. The six behaviors identified by the CDC include (1) alcohol and drug use, (2) injury and violence (including suicide), (3) tobacco use, (4) poor nutrition, (5) lack of physical activity, and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies.

A goal set by Healthy People 2020 includes education to middle, junior, and senior high school students in priority areas. These areas include (Select all that apply.) a.) lack of physical activity. b.) poor nutrition. c.) alcohol and drug use. d.) poor organizational skills. e.) injury and violence.

b.) The student accepts a referral to a substance abuse counselor. Having a substance abuse problem does not mean that problems are always attributable to the addiction. An evaluation for other problems such as mental illness and depression should be conducted, with specialized attention involving a case management approach. Research demonstrates that treatment for substance abuse can be more effective than no treatment. The other goals may be appropriate but not the most desirable.

A high school student is referred to the school nurse for suspected substance abuse. After the nurse's assessment and interventions, what would be the most desirable outcome? a.) The student discusses conflicts over drug use. b.) The student accepts a referral to a substance abuse counselor. c.) The student agrees to inform his parents of the problem. d.) The student reports increased comfort with making choices.

b.) reservoir, mode of transmission A pathogen lives and multiplies in the reservoir and transfers from one host to another by a mode of transmission.

A pathogen lives and multiplies in a __________ and transfers from one host to another by a __________. a.) host, susceptible portal of entry b.) reservoir, mode of transmission c.) infectious agent, portal of exit d.) mode of transmission, reservoir

a.) schoolyard safety. Schoolyard injury accounts for 200,000 injuries yearly and is one of the greatest health concerns for elementary children. Motor vehicle safety should be included in programs for adolescents who are beginning to drive. Sports safety is particularly important among adolescents as participation in sports continues to grow, especially among girls. Immunization schedules are an important topic of education for parents of younger children and babies.

A priority health education topic for school-age children is a.) schoolyard safety. b.) motor vehicle safety. c.) sports safety. d.) immunization schedules.

a.) A flyer advertising an ice cream and pizza party for the student awards program School nurses facilitate positive student responses to normal development; promote health and safety, including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning.

A school nurse evaluates the implementation of health promotion in a high school staff. Which indicates a need for more education? a.) A flyer advertising an ice cream and pizza party for the student awards program b.) Condoms being provided in all restrooms of the school c.) A decrease in missed days at school d.) The discontinuation of the availability of soft drinks and candy in vending machines during school instructional hours

B. Perform vision and hearing screening

A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? A. Consult with cafeteria staff on lunch menus B. Perform vision and hearing screening C. Evaluate the number of students that passed D. Provide education on safe sex practices

b.) in an emergency. School health records are confidential, and without permission, releasing them is unethical and improper unless in an emergency.

A school nurse knows that under the Family Educational Rights and Privacy Act, a student's health record can be released a.) if the student is not a minor. b.) in an emergency. c.) to educators not involved in the student's education. d.) without the student's or guardian's permission.

b.) Reviewing immunization records The only option above that represents primary prevention is reviewing immunization records. This is a teachable opportunity for the nurse to stress the importance of maintaining immunizations for the child. The other options are secondary or tertiary prevention activities.

A school nurse performs all activities. Which one demonstrates primary prevention? a.) Establishing an after-school group for latch-key children b.) Reviewing immunization records c.) Obtaining grant funding to test for serum lead levels d.) Vision and hearing screening

b.) Vicodin. As of 2015, 4.4% high school seniors reported past-year nonmedical use of the prescription pain reliever hydrocodone (Vicodin), 3.7% reported abusing oxycodone (OxyContin), 7.7% reported use of amphetamines, and 7.5% reported misuse of Adderall—making these medications among the drugs most commonly abused by adolescents.

A survey done by The National Institute on Drug Abuse (NIDA) found that the most commonly abused prescription drug among high-school seniors is a.) OxyContin. b.) Vicodin. c.) Xanax. d.) codeine.

c.) frequent requests for a visit to the school nurse. Problems eating or sleeping, use of alcohol or other substances, problems making decisions, persistent angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or ailments, and inconsistent school attendance are all warning signs of stress. The nurse should be aware that these symptoms can negatively affect an adolescent's mental and physical health, and the student should be screened for depression and suicide.

A week before finals, a school nurse assesses a 15-year-old girl complaining of vague symptoms. All symptoms or behaviors should result in an immediate request for parent or guardian conference and referral to a physician for further evaluation except a.) problems eating or sleeping. b.) problems making decisions. c.) frequent requests for a visit to the school nurse. d.) inability to concentrate.

a.) The first screening begins at 21 years of age. c.) Screenings occur until the woman is 65 years of age. d.) Screening includes using a liquid-based Pap smear test. Current guidelines recommend cervical cancer screening to begin at 21 years of age. Screening should then be performed every 3 years until age 65 using liquid-based Pap smear tests.

A young woman visits the health care provider for a follow-up appointment to assess woman's treatment regimen for human papilloma virus (HPV). The health care provider shares information about cervical cancer screening. Which factors reflect the current guidelines for cervical cancer screening? (Select all that apply.) a.) The first screening begins at 21 years of age. b.) After 21 years, the screening occurs every 12 months. c.) Screenings occur until the woman is 65 years of age. d.) Screening includes using a liquid-based Pap smear test. e.) Ultrasound is used as a screening tool in women over age 50.

Goal: Reduce drug and alcohol addiction Increase the proportion of people with a substance use disorder who got treatment in the past year — SU‑01 Reduce the proportion of people who had alcohol use disorder in the past year — SU‑13 Increase the number of admissions to substance use treatment for injection drug use — SU‑D01 Increase the proportion of people who get a referral for substance use treatment after an emergency department visit — SU‑D02 Increase the rate of people with an opioid use disorder getting medications for addiction treatment — SU‑D03

Addiction- Healthy People 2030 goal?

a.) a younger workforce. Escalating health care cost, increased women and minorities in the workforce, and a competitive international marketplace all contribute to the challenges of occupational health nursing practice. In addition, an aging workforce also presents a challenge.

All are challenges currently facing occupational health nursing practice except a.) a younger workforce. b.) escalating health care cost. c.) increased number of women and minorities in the workforce. d.) influence of a competitive international marketplace.

c.) decreased availability of fast food. The higher cost of healthy foods, food insecurity, and the lack of access to safe places to exercise contribute to obesity in lower income communities. Fast food tends to be cheap and readily available in lower income communities.

All contribute to obesity among lower income communities except a.) the high cost of healthy foods. b.) food insecurity. c.) decreased availability of fast food. d.) lack of access to safe places to exercise.

d.) the client is without a job. The diagnosis of substance abuse includes the continued use of a substance despite the consequences; putting oneself or others in danger because of substance use; or substance use interfering with one's major role obligations, such as family, work, and friends.

All outcomes may contribute to the diagnosis of substance abuse except a.) the substance use has placed someone in danger. b.) the individual uses the substance despite negative consequences. c.) the substance use interferes with the ability to function at work or at home. d.) the client is without a job.

c.) women should be familiar with the look and feel of their breasts. d.) women should report breast changes to a health care provider. The current position of the U.S. Preventive Services Task Force is that there is insufficient evidence to recommend for or against the teaching of BSE (Thomas et al., 2002). The ACS (2016) also no longer supports the routine use of self breat exam (SBE) or clinical breast examination (CBE) for screening because of this lack of evidence. Instead, women are encouraged to be familiar with the normal look and feel of their breasts and to report changes to a health care provider.

American Cancer Society (ACS) (2016) recommendations for breast self-examination (BSE) include (Select all that apply.) a.) BSE should be taught to women beginning in their 40s. b.) BSE should be performed once monthly. c.) women should be familiar with the look and feel of their breasts. d.) women should report breast changes to a health care provider. e.) clinical breast examination now takes the place of BSE.

a.) recognize the need to work as a part of an interdisciplinary team. As workplaces have continued to change over the past few decades, the role of the occupational health nurse had become even more diversified and complex. It is essential that the occupational health nurse functions as a part of an interdisciplinary team collaborating with workers, employers, and other professionals to identify health needs, prioritize interventions, develop and implement programs, and evaluate services delivered.

An essential strategy to deal with the complexities of the workplace and workforce is for the occupational health nurse to a.) recognize the need to work as a part of an interdisciplinary team. b.) seek legal counsel to stay informed of the legislative mandates influencing the workforce. c.) engage in political action in order to have input into the revision of the Healthy People 2020 document. d.) participate in program planning to develop a model to ensure advanced education for all workers.

b.) health education programs.

An example of a primary prevention activity for a school nurse would be: a.) rehabilitation activities. b.) health education programs. c.) physical assessment. d.) screening for impairments.

d.) remain outside if you hear sounds of fighting in a home. When approaching a home, as a community health nurse, you should notice the environment, animals, fences, activities, possible indicators of crime, and places you could go for assistance if necessary. Walk with confidence and maintain a professional attitude. Listen for signs of fighting before knocking. If you hear sounds of fighting, leave. Do not enter a home if you suspect an unsafe situation.

As a visiting community health nurse, you must take precautions to avoid unsafe situations. To avoid putting yourself in danger, you would a.) enter a house where a violent act is occurring and call 911. b.) expect the client to control angry family members. c.) always carry a concealed weapon. d.) remain outside if you hear sounds of fighting in a home.

Protective Factors: • Effective clinical care for mental, physical, and substance abuse disorders • Easy access to a variety of clinical interventions and support for help seeking • Family and community support (connectedness) • Support from ongoing medical and mental health care relationships • Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes • Cultural and religious beliefs that discourage suicide and support instincts for self-preservation Risk Factors: • Family history of suicide • Family history of child maltreatment • Previous suicide attempt(s) • History of mental disorders, particularly clinical depression • History of alcohol and substance abuse • Feelings of hopelessness • Impulsive or aggressive tendencies • Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma) • Local epidemics of suicide • Isolation, a feeling of being cut off from other people • Barriers to accessing mental health treatment • Loss (relational, social, work, or financial) • Physical illness • Easy access to lethal methods • Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

BOX 25.3 Suicide: Protective Factors and Risk Factors?

Seek help as soon as possible by contacting a mental health professional or by calling the National Suicide Prevention Lifeline at 1-800-273-TALK if you or someone you know exhibits any of the following signs: • Threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself • Looking for ways to kill oneself by seeking access to firearms, available pills, or other means • Talking or writing about death, dying, or suicide when these actions are out of the ordinary for the person • Feeling hopeless • Feeling rage or uncontrolled anger or seeking revenge • Acting reckless or engaging in risky activities—seemingly without thinking • Feeling trapped—like there's no way out • Increasing alcohol or drug use • Withdrawing from friends, family, and society • Feeling anxious, agitated, or unable to sleep or sleeping all the time • Experiencing dramatic mood changes • Seeing no reason for living or having no sense of purpose in life

BOX 25.4 Warning Signs of Suicide?

• It occurs only in poor, uneducated, minority households. • It is a private family matter (vs. a societal problem). • It only occurs in heterosexual relationships. • Victims deserve the abuse. • Victims can change the abusers' behavior. • Abusers will stop the abuse on their own without professional intervention.

BOX 28.1 Common Myths Associated with Intimate Partner Violence?

Plan Ahead: Make sure you're safe, know where they're at, if don't feel safe don't go in • Know the area you are visiting. • Schedule the visit ahead of time and get 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 and wear a name tag. Avoid any provocative clothing. • Ensure that the vehicle you drive is in good repair, has a full gas tank, and has emergency equipment. Always carry two sets of car keys. Approaching the Home: • Notice the environment, animals, fences, activity, possible indicators of crime, and places you could go for assistance if necessary. • Walk with confidence and maintain a professional attitude. • Listen for signs of fighting before knocking. If you hear sounds of fighting, leave! • Do not enter a home if you suspect an unsafe situation. In the Home: • Be aware of who is in the home and what is going on. If angry people are in the home, use your professional and social skills. Do not expect the client to protect you. • Note the exits and sit between the client and an exit of the home. Be prepared to leave quickly if the situation changes suddenly. • If someone in the home is violent, leave and call 911. Handling a Tight Situation: • Do not show fear; control your breathing. • Speak calmly and in a soothing manner. Be assertive but not aggressive. • Repeat the reason for your visit and find a reason to leave. Leaving the Home: • Take all of your belongings and keep your car keys in your hand. • Watch for cars following you when you leave. Do not stop. If you feel that you are in danger, go to the nearest police station or well-lighted business and ask for help. • Trust your instincts. Never forget your own safety.

BOX 28.4: Safety Issues for the Community Health Nurse?

b.) American Nurses Credentialing Center d.) Case Management Society of America Although there is no standard for formal educational preparation for case managers, role-specific certification is available through the American Nurses Credentialing Center (ANCC) and the Case Management Society of America (CMSA). The other options do not offer certification for nurses in the field of case management.

Certification for registered nurses in the field of case management is provided through which professional organization? (Select all that apply.) a.) American Nurses Association b.) American Nurses Credentialing Center c.) American Hospital Association d.) Case Management Society of America e.) National Association for Healthcare Quality

d.) neglect. Neglect is the failure of the responsible person to provide basic needs such as shelter, food, clothing, education, and access to medical care; permitting the child to use drugs/alcohol; and inattention to the child's emotional needs. The other options are types of abuse.

Child maltreatment that allows the child to use drugs and alcohol is an example of a.) sexual abuse. b.) physical abuse. c.) psychological abuse. d.) neglect.

b.) 21% In 2017, approximately 21% (about 15 million) of American children lived below the poverty line. Many more children (about 43%) live in low-income families that are close to the poverty level and unable to meet basic living expenses.

Children living below the poverty threshold account for what percentage of the U.S. population? a.) 8% b.) 21% c.) 35% d.) 44%

d.) Suffering chronic fatigue and tension When subject to repeated abuse, the victim experiences a variety of responses, including shock, denial, confusion, withdrawal, psychological numbing, and fear. He or she lives in anticipatory terror and experiences chronic fatigue and tension, disturbed sleeping and eating patterns, and vague gastrointestinal and genitourinary complaints. The other options are not symptoms of chronic violence.

Chronic stress characterizes the lives of people living with domestic violence. As the community health nurse, you recognize which as a long-term effect of violence? a.) Spontaneous disclosure of abuse to health care provider b.) Not complaining of physical symptoms c.) Having disturbed eating patterns, but sleeping well d.) Suffering chronic fatigue and tension

National Alliance for the Mentally Ill (NAMI)- advocacy group -Lobby on capitol hill big driver for mental health initiatives -Support them Substance Abuse and Mental Health Services Administration (SAMHSA) -Gov organization -Administer programs and provide funding to mental health organizations Mental Health America (MHA) -Don't need to know National Institute of Mental Health (NIMH) -Research gov organization -Specific departments related to alcohol and drug abuse U.S. Department of Veterans Affairs National Center for PTSD -Can be a significant issue in regards to mental illness -Research, funding, for PTSD

Community-based Mental Health?

Initiation: First use of the substance Exposure frequently occurs through family or friends Continuation: Continued, more frequent use of substance Usually social use only, with no detrimental effects Transition: Beginning of change in total consumption, frequency, and occasions of use More than just social use, with beginning of loss of control Abuse: Adverse effects and consequences of substance use -Rationalizations for continued use and denial of adverse effects present in user and significant others -Unsuccessful attempts at control of use Dependency and addiction: Physical or psychological dependency, or both, on the substance; marked by behavioral and cognitive changes -Preoccupation with the substance and its procurement, despite negative consequences -Narrowing of interests, social activities, and relationships to only those related to the substance use

Course of Addictive Illness: Table 27.2 Substance Abuse?

a.) Racism b.) Poverty c.) Violence e.) Lack of access to health care Unfortunately, many women face barriers to good health throughout their lives, including racism, violence, poverty, and lack of access to health care. Those living in suburban areas and most outer urban areas experience superior access to health care services compared with those living in rural areas and inner cities, especially if they are poor.

Despite nursing activities and public awareness campaigns on this topic, many women face barriers to good health throughout their lives. The barriers to good health women face include the following: (Select all that apply.) a.) Racism b.) Poverty c.) Violence d.) Living in a suburban area e.) Lack of access to health care

a.) Establishing health care surrogates b.) Providing home visits to dying congregational members c.) Providing emotional support to grieving family members d.) Developing grief support groups Faith community nurse activities related to end-of-life care may include educational sessions on drawing up living wills, but it is not the faith community nurse's role to actually write up the will and notarize it. Other activities related to end-of-life care the faith community nurse may perform include establishing health care surrogates and understanding hospice and palliative care, providing home visits to dying congregational members and emotional support to family and survivors, and developing grief support groups.

Faith community nurse activities related to end-of-life care include the following: (Select all that apply.) a.) Establishing health care surrogates b.) Providing home visits to dying congregational members c.) Providing emotional support to grieving family members d.) Developing grief support groups e.) Drawing up and notarizing living wills

a.) Diagnosis To apply for nursing case management certification through the CMSA, the nurse must perform essential activities of case management, including assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy, achieved through collaboration with the client and others involved in the client's care (CMSA, 2016). Diagnosing is not an essential function of case management.

For an RN to apply for certification for case management through the Case Management Society of America (CMSA), the nurse must perform essential activities of case management. Which is not one of the required activities? a.) Diagnosis b.) Coordination c.) Evaluation d.) Outcomes e.) Assessment

c.) engaging in risk-taking behaviors. The major developmental goal of adolescence is establishing independence. When coupled with adolescents' view of themselves as invincible, this often leads to risk-taking behaviors. Although early and unprotected sexual activity is one example of risk-taking behavior, the best (more comprehensive) answer is engaging in risk-taking behaviors. Generally, adolescence is a time of emotional maturity that includes learning problem-solving and coping skills. Adolescents are generally healthy, and it is common that they rarely use preventive health services.

Health prevention activities targeting the 13- to 18-year-old population must be based on the knowledge that a priority health threat faced by adolescents is a.) inadequate problem solving and coping skills. b.) avoidance of preventive health services. c.) engaging in risk-taking behaviors. d.) sexual activity.

d.) cardiovascular accidents, stroke, and diabetes. Healthy People 2020 does not address cardiovascular accidents, stroke, or diabetes in its objectives for children and adolescents. The other options are addressed.

Healthy People 2020 addresses all goals for children and adolescents except a.) physical activity. b.) sex education and HIV prevention. c.) smoking prevention. d.) cardiovascular accidents, stroke, and diabetes.

c.) male infants have a higher rate for infectious diseases. Males' experience of higher mortality rates for perinatal conditions is attributed to biological disadvantages such as males' greater risk of premature birth, higher rates of respiratory distress syndrome, and higher rates of infectious disease in infancy resulting from the influence of male hormones on the developing lungs, brain, and possibly the immune system of the male fetus.

Higher mortality rates for male infants may be explained by a.) male infants have a lower risk for prematurity. b.) male infants have a lower rate of respiratory distress syndrome. c.) male infants have a higher rate for infectious diseases. d.) male infants have a higher rate for musculoskeletal disorders.

Influences on alcohol use- drinking increased during World Wars, decreased during Great Depression and Prohibition, legal drinking age went from 21 to 18(60-70s) back to 21 (late 80s), criminal activity- driving under the influence, federal agencies- National Institute on Alcohol Abuse and Alcoholism, Bureau of Alcohol, Tobacco, Firearms and Explosives -Criminal alcohol use- drinking and driving --Blood alcohol level to operate certain machinery; federal government implemented and threatened to withhold funding for road improvement if all states didn't put a BAC % in each state Influences on illicit drug use- 70s counterculture- avoided alcohol used hallucinogens, marijuana and heroin instead, Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and eradication efforts (AKA War of Drugs), current funding for research and enforcement to multiple federal agencies- SAMHSA, National Institute on Drug Abuse, Drug Enforcement Agency -War on drugs disparity: much larger portion of african american males who are caught with marijuana and institutionalized for it SAMHSA also helps drug abuse with mental health

History Lesson on Alcohol/Illicit Drug use?

b.) Betty Moulder was employed by a group of companies to care for coal miners and their families. c.) Ada Mayo Stewart was hired by the Vermont Marble Company to care for the company's workers. d.) A nursing service was established for employees of the Frederick Loeser department store in Brooklyn, New York. e.) Anna B. Duncan was employed by the John Wanamaker Company to visit sick employees at home. Occupational health nursing dates to the late 1800s with the employment of Betty Moulder by a coal mining company and Ada Mayo Stewart by a marble company. After that, the Fredrick Loeser department store hired a nursing service for employees and Anna B. Duncan was employed by the John Wanamaker Company to visit sick employees at home. Lillian Wald was instrumental in the development of public health nursing.

Important historical events leading to the development of occupational health nursing as a specialty practice include: (Select all that apply.) a.) Lillian Wald, the first public health nurse, established the Visiting Nurse Service of New York. b.) Betty Moulder was employed by a group of companies to care for coal miners and their families. c.) Ada Mayo Stewart was hired by the Vermont Marble Company to care for the company's workers. d.) A nursing service was established for employees of the Frederick Loeser department store in Brooklyn, New York. e.) Anna B. Duncan was employed by the John Wanamaker Company to visit sick employees at home.

c.) old-old (ages 85 years and older). The greatest growth will occur in the population aged 85 years and older, whose numbers are projected to grow from 6 million in 2014 to nearly 20 million by 2060.

In long-range planning for community needs, the community health nurse considers that the fastest-growing segment of the senior population is the a.) young-old (ages 65 to 74 years). b.) middle-old (ages 75 to 84 years). c.) old-old (ages 85 years and older). d.) elite-old (more than 100 years old).

b.) falls. Falls are the number one cause of fractures, hospital admissions for trauma, loss of independence, and injury deaths. Fall reduction is a Healthy People 2020 objective for older adults. Fire, heat or cold stress, and motor vehicle accidents are also serious safety concerns for older adults.

In preparing a presentation for seniors and supportive family members, the nurse includes safety information. This is in response to the knowledge that the leading cause of death because of injuries for seniors is a.) fire. b.) falls. c.) heat or cold stress. d.) motor vehicle accidents.

b.) provision of direct clinical skilled care (e.g., dressing changes, medication administration). Case management services focus primarily on care coordination, assessment, monitoring, planning, and evaluation. The case manager will coordinate and monitor care; however, in most cases, the interventions are provided by other health professionals, including other nurses.

In providing care for a client who recently had a liver transplant, a nurse case manager would focus attention on all except a.) medication monitoring and management. b.) provision of direct clinical skilled care (e.g., dressing changes, medication administration). c.) identification of potential problems and notification of the physician. d.) evaluation of progress to meeting projected outcomes or goals.

d.) Stochastic theories explain aging as the accumulation of random events over time; nonstochastic explain aging as a predetermined process and therefore not modifiable through individual actions. Whereas stochastic theories explain aging as events that occur randomly and accumulate over time, nonstochastic theories view aging as predetermined. Thus, each individual will have a unique accumulation of the cellular processes resulting in aging. Nonstochastic theories describe life as a finite process, with defined cellular life processes, such as cellular division, defining the life span for a given species. Options A and B are examples of nonstochastic theories.

In reviewing research related to client actions that may retard the aging process, the nurse is aware that such research is based on stochastic theories of aging. Why? a.) Stochastic theories state that normal cells divide a specific number of times and the number of cell divisions is proportional to the life span of the species. b.) Stochastic theories state that aging is a programmed decline in the functioning of the nervous, endocrine, and immune systems. c.) Nonstochastic theories propose that aging is a result of a loss of self-regulation between the body and cells, resulting in an immune response that is not reversible or decelerating. d.) Stochastic theories explain aging as the accumulation of random events over time; nonstochastic explain aging as a predetermined process and therefore not modifiable through individual actions.

c.) listening. Listening is a skill that is highly developed in most experienced nurses. It allows an understanding of spoken and unspoken words and feelings, encourages open communication, and supports and empowers patients to communicate needs and desires.

In the CIRCLE Model of Spiritual Care, the L represents a.) love. b.) language. c.) listening. d.) life.

b.) widowhood. Elderly women are two to three times more likely to be widowed compared with men of the same age. Relatively small proportions of older men and women are divorced each year. Social isolation and criminal victimization are equal risks for older men and women.

In the role of advocate, the community health nurse recognizes that compared with men in the same age range, women age 65 years and older are most at risk for a.) divorce. b.) widowhood. c.) social isolation. d.) criminal victimization (e.g., robbery, burglary, assault).

b.) teach signs and symptoms of hypertension and stroke to the congregation. As a personal health counselor, the parish nurse discusses health problems with individuals and families within the church. The parish nurse would teach signs and symptoms of hypertension and stroke to the congregation in the health educator role. The parish nurse would train volunteers in the role of coordinator of volunteers. The parish nurse would arrange for health screenings in the facilitator role.

In the role of personal health counselor, the faith community nurse would a.) explain how to take a prescribed medication. b.) teach signs and symptoms of hypertension and stroke to the congregation. c.) train volunteers to work with the parish nurse program. d.) arrange for health screenings through the local health department.

b.) Occupational health setting More employers are providing health screening and education to their employees to keep their workforce healthy. Community health nurses who work in occupational health settings are in a position to provide primary prevention designed for the needs of the employees. The case manager in the high-risk clinic setting provides services to high-risk clients in settings such as HIV clinics, dialysis settings, and infusion centers. In the home health and hospice setting, the case manager would provide services to clients in their homes. In the public health setting, the case manager would provide services to clients in the community at large.

In which case management setting is the nurse responsible for providing primary prevention to employees to keep the work force healthy? a.) High-risk clinic setting b.) Occupational health setting c.) Home health and hospice setting d.) Public health clinic setting

Prevention: -What community factors promote starting substance use -Resources available to put primary prevention strategies in place -Fiscal resources to law enforcement, crop eradication, punitive laws for drug users and manufacturers Treatment- Harm Reduction- approaches to treatment of substance abuse that are not aimed at abstinence -Incremental changes -Elimination of harmful effects- infection, unwanted pregnancy, overdose, death -Examples- methadone for heroin, needle exchanges, dispensing naloxone, breathalyzer to activate care, special license plates for DUI --Safe consumption spaces, party plates- license plates for DUI can let police pull them over at any time with no probable cause

Interventions for Substance Abuse?

b.) Secondary prevention Secondary prevention includes the investigation of contacts to sexually transmitted disease cases. Secondary prevention includes activities to ensure early detection of infection and effective treatment of persons who are infected. Not only does this prevent progression of the infectious disease, but it also prevents transmission of the pathogen to others. Primary prevention of communicable diseases involves measures to prevent transmission of an infectious agent and to prevent pathology in the person exposed to an infection. Tertiary prevention includes activities involved in caring for persons with an infectious disease to ensure that they are cured or that their quality of life is maintained.

Investigating all contacts of a person infected with a sexually transmitted disease is an example of what? a.) Primary prevention b.) Secondary prevention c.) Tertiary prevention d.) Initial prevention

a.) The Family and Medical Leave Act (FMLA) FMLA allows an employee a minimum provision of 12 weeks of unpaid leave each year for family and medical reasons such as pregnancy. The FMLA guarantees the employee the same job with the same pay and benefits upon the employee's return to work. The ACA, in part, protects women from being denied coverage by insurance companies and being charged more for health care services because of their gender. The Social Security Act provides monthly retirement and disability benefits to workers and survivor benefits to families of workers covered by Social Security. The Public Health Service provides biomedical and health services research, information dissemination, resource development, technical assistance, and service delivery.

Jane, who is 12 weeks' pregnant, has been having preterm complications with her pregnancy, and her physician has placed her on bed rest. As a result, she will be unable to return to work. Which law will protect her future employment? a.) The Family and Medical Leave Act (FMLA) b.) Affordable Health Care Act (ACA) c.) Social Security Act d.) Public Health Service Act

b.) other factors may be influencing Joanne's hesitancy in seeking medical attention. Other factors, such as having experienced trauma or victimization, may cause female inmates to delay or never seek medical attention regarding female services. The other statements are incorrect.

Joanne, a 37-year-old incarcerated woman, is reluctant to seek medical attention for a routine Pap smear. The correctional nurse knows a.) this is usual; women do not seek health services as much as men in this setting. b.) other factors may be influencing Joanne's hesitancy in seeking medical attention. c.) Joanne is delaying the visit because she probably has a sexually transmitted disease or HIV. d.) because she is not sexually active, Joanne is not in need of a Pap smear at this time.

c.) indirect. The stem of the question indicates that the children played with the same toys. This would indicate the indirect mode of transmission. The other modes of transmission do occur through the sharing of toys.

Katie, a 2-year-old child, is brought to the doctor's office after 2 days of vomiting and diarrhea. Upon completion of the medical history, the mother tells the nurse that several of the other children at the daycare who played with the same toys as Katie have the same symptoms. The mode of transmission for the pathogen more likely was a.) vector. b.) direct. c.) indirect. d.) airborne.

a.) unintentional injuries. After the first year of life, unintentional injury is the leading cause of death in children. The leading cause of injury death for children younger than 1 year of age is accidental suffocation caused by choking or strangulation. For children younger than 5 years of age, drowning is the leading cause of death. From age 5 to 14 years, motor vehicle-related injuries are the cause of most deaths.

Keeping in mind the Healthy People 2020 objectives, the community health nurse is aware that education and actions focused on one specific risk factor may result in a significant reduction in childhood deaths. This is because the leading cause of death for all children older than the age of 1 year is a.) unintentional injuries. b.) drowning. c.) choking. d.) motor vehicle-related injuries.

Community health nurses will encounter many clients that have mental illness. 50% of the U.S. population will have a mental illness during their lifetime. -Big issue!! Access to mental health treatment is important to the health of a community. -Access is key to the health of the community The community health nurse must be familiar with common mental disorders to ensure they can assess the community and plan for needed services. -Have to know different disorders, symptoms, treatment -To make sure have right services in place -Clinic: weekly injections? Need to know if they need transportation Community health nurses may provide a variety of prevention strategies to prevent or mitigate mental disorders in various aggregates. -Primary, secondary, tertiary Community health nurses must be aware of organizations and resources to assist community members in managing mental illness.

Key Points for Mental Health Chapter?

Substance use disorder is recognized as a disease process and not a behavioral issue Substance abuse has a ripple effect on a community and presence of the disorder can poorly impact health outcomes Harm reduction is a trending treatment option Substance abuse clients may be difficult to care for at times but nurses must provider unbiased care. Many people use substances as a coping mechanism. Teaching life skills early in life is a primary prevention strategy. Many communities have resources and help groups to assist clients with substance abuse rehabilitation and recovery.

Key Points for Substance Abuse?

Violence is major public health issue and effects people across the lifespan Contributing factors include being exposed to violence in the home, access to firearms, media coverage of violence, and mental illness Community health nurses must possess good therapeutic communication skills to help identify and support survivors or violence and the offenders There are three levels of prevention related to violence and the community health nurse should try to implement them effectively and efficiently

Key Points for Violence?

b.) Occupational Safety and Health Act. The Occupational Safety and Health Act was enacted in 1970. The general clause of the Act states that employers must "furnish a place of employment free from recognized hazards that are causing or likely to cause death or serious physical harm to employees." The Act also identified the role of various government agencies such as the Occupational Safety and Health Administration under the jurisdiction of the Department of Labor.

Legislation passed in 1970 that requires employers to provide a place of employment free from recognized hazards to the employees is correctly referred to as the a.) Americans with Disabilities Act. b.) Occupational Safety and Health Act. c.) Workers' Compensation Act. d.) Occupational Health and Safety Administration.

c.) Proprietary agency Proprietary agencies can be individual-owned agencies, profit partnerships, or profit corporations. Providing the agencies make a profit, investors in corporate proprietary partnerships receive financial returns on their investments in the agencies. Official agencies are operated, organized, and funded by the government. Nonprofit home health agencies include all home health agencies that are not required to pay federal taxes because of their exempt tax status. Nonprofit groups reinvest any profits into the agency. Certified agencies meet federal standards in order to receive funding from Medicare.

Louisiana Health Care is a multistate home health organization consisting of 60 home health agencies. The company is a public company with stocks available on the open market. This is an example of what type of home health agency? a.) Official agency b.) Nonprofit agency c.) Proprietary agency d.) Certified agency

a.) men may be aware of being ill, but they make a conscious decision not to seek health care to avoid being labeled as "sick." Illness orientation is the ability to note symptoms and take appropriate action. However, the stereotypical view of men as strong and invulnerable is incongruent health promotion. Option B is a barrier health protection behavior. Option C is a barrier to reporting health behavior. Option D is a factor related to medical care access that impedes men's health.

Many barriers exist that prohibit positive male health behavior. One barrier that may exist for men is illness orientation. This is because a.) men may be aware of being ill, but they make a conscious decision not to seek health care to avoid being labeled as "sick." b.) men do not have routine reproductive health checkups that include screening. c.) men may be less willing to talk, may not recall health problems, and may lack a health vocabulary. d.) male health concerns are addressed by specialists and generalists who have not received gender-specific training that would enable them to focus on men's health needs.

1960s- Community Mental Health Centers Act- deinstitutionalization 1980s- States develop plans to care for serious mental illness -More funding, crisis centers become available 1999- Mental illness acknowledged as disease 2008- Insurance coverage for mental health and substance use conditions -People might have medical insurance but might not get mental help with it -Supposed to have same coverage for 2010- ACA- provides protection for preexisting conditions Proposed legislation- H.R.7666 - Restoring Hope for Mental Health and Well-Being Act of 2022 Passed house 6/22/22

Mental Health Care History?

Goal: Improve mental health Increase the proportion of people with substance use and mental health disorders who get treatment for both — MHMD‑07 -Screened for depression Increase the proportion of primary care visits where adolescents and adults are screened for depression — MHMD‑08 -Once we have identified the illness, need to provide support Increase the proportion of adolescents with depression who get treatment — MHMD‑06 Increase the proportion of children with mental health problems who get treatment — MHMD‑03 Increase the proportion of children and adolescents who get preventive mental health care in school — EMC‑D06 -Teaching coping mechanisms, life skills, stress reduction

Mental Health- Healthy People 2030?

c.) Most mental illnesses are caused by genetic factors; therefore, problems associated with them persist across generations and among certain racial and ethnic groups. Although genetic factors most likely contribute to some mental illnesses and in some individuals there is little information linking a specific gene to a specific disorder. Rather, the major psychiatric disorders are complex, and mental illnesses appear to result from a very complex interaction among neurochemical and metabolic changes and environmental and situational factors. The other statements are all true.

Mental illnesses adversely affect achievement of social justice. Which statement related to marginalization of some populations because of mental illness is false? a.) About half of all inmates in jails and prisons have mental health problems. b.) Mental illnesses can lead to employment difficulties, which adversely affects access to health insurance, thereby limiting treatment options. c.) Most mental illnesses are caused by genetic factors; therefore, problems associated with them persist across generations and among certain racial and ethnic groups. d.) Both natural and human-made disasters can adversely affect mental health; those with limited resources appear to be more directly impacted, and the effects persist longer.

b.) "Mental illness is a disease with biopsychosocial causes that are not the patient's fault." Mental illness is a medical condition that is caused by biopsychosocial attributions that are not the patient's fault nor caused by the patient's behavior.

Mr. B has been diagnosed with a severe mental illness. He tells the nurse that his family says his disorder is his own fault and is because of his laziness. Which reply by the nurse is accurate? a.) "Lazy people are more prone to mental illness." b.) "Mental illness is a disease with biopsychosocial causes that are not the patient's fault." c.) "Most people are unsupportive of family members with mental illness." d.) "It would really help your situation if you got over the stigma associated with mental illness."

c.) go back to work in an altered capacity. Men should be encouraged to return to work in an altered capacity rather than remaining off work, retiring, or starting a new job. Occupational accommodation for treatment regimen will help ensure compliance.

Mr. C, age 40 years, has recently sustained an injury at work. The occupational health nurse knows that based on gender-specific socialization processes, Mr. C would more than likely comply with his medical regimen if he were to a.) remain off work for several weeks. b.) retire from his job. c.) go back to work in an altered capacity. d.) start a new job.

c.) Behavioral therapy 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 rewards and satisfaction. Individual therapy focuses on the client's current life and relationships within the family, social, and work environments. Couple therapy is used to develop the relationship and minimize problems through understanding how individual conflicts are expressed in the couple's interactions. Family therapy involves problem-solving sessions with members of a family.

Mr. H is a patient in the primary care center where you work as a staff nurse. He tells you that he is currently participating in a type of therapy that helps patients change behaviors. You know that Mr. H is describing which type of therapy? a.) Individual therapy b.) Couple therapy c.) Behavioral therapy d.) Family therapy

a.) Suicide Men are three to four times more likely than women to commit suicide. Men older than age 85 years are 11 to 12 times more likely to die as a result of suicide than women the same age. Males continue to be at risk for death because of unintentional injury with a rate of 54.7 compared with 27.3 for females per 100,000. Among men age 15 to 24 years, African American men are seven times more likely to die of homicide. In 2014, death caused by HIV in males was 3.0 per 100,000, and for females it was 1.1 per 100,000

Mr. H, an 85-year-old-man, has recently lost his wife. He comes to the local health department to have his blood pressure checked quite often. The nurse should recognize that Mr. H is at greater risk for what? a.) Suicide b.) Homicide c.) Accidental injury d.) HIV infection

a.) Seat belt usage Men remain three times less likely to use a seat belt as women of the same age despite aggressive legislative action for seatbelt usage. The other options are not gender specific.

Mr. K, age 35 years, is in the nursing clinic for a follow-up health visit. Additional gender-specific educational information should be offered about which subject? a.) Seat belt usage b.) Falls c.) Digital rectal examinations d.) Immunizations

b.) depression. Depression is often a complication of serious physical disorders such as heart attack, stroke, diabetes, and cancer. The other options are usually not complications of other physical disorders.

Mr. S was recently hospitalized for a stroke. While in the hospital, he was also diagnosed with diabetes. As his nurse, you know he is at risk for a.) panic disorder. b.) depression. c.) schizophrenia. d.) bipolar disorder.

a.) Schizophrenia Diagnostic criteria for schizophrenia are two or more of (each present for a significant portion of a 1-month period): delusions, hallucinations, disorganized speech (e.g., frequent derailment or incoherence), grossly disorganized or catatonic behavior, or negative symptoms (e.g., affective flattening, alogia, avolition).

Mr. T has been admitted to the mental health floor for evaluation. You, the nurse, note that he has displayed hallucinations, disorganized thinking and speech, and bizarre behavior. He has a flat affect, lack of energy, and poor attention. You know that these are symptoms of what disorder? a.) Schizophrenia b.) Depression c.) Anxiety d.) Panic disorder

a.) "My medication will cure me of my depression." Psychotherapeutic medications do not cure mental illness; rather, they act by controlling symptoms. The other statements are correct.

Ms. L is being treated for depression. Which statement by her indicates a need for further education? a.) "My medication will cure me of my depression." b.) "A side effect of my medication (Prozac) may be gastrointestinal upset." c.) "I need to keep my follow-up appointment for medication management." d.) "I should not stop taking my medication without checking with my doctor first."

b.) attention-deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD). The reported symptoms best fit ADD/ADHD, although the young woman should also be screened for depression and substance abuse, which can accompany ADD/ADHD.

Ms. W, 18 years old, presents at a community clinic describing vague symptoms. She explains that she recently dropped out of high school and is having trouble keeping a job. She notes that she has difficulty concentrating and has used drugs (i.e., marijuana and alcohol) when riding motorcycles with friends. When conducting the initial assessment, the RN should include questions and tools that would screen for a.) depression. b.) attention-deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD). c.) posttraumatic stress disorder. d.) obsessive-compulsive disorder.

a.) working in pairs. Risk factors for violence in the workplace include increasing number of acute and chronically mentally ill patients, working alone, availability of drugs at worksite, low staffing levels, poorly lit parking areas and corridors, long waits for service, inadequate security, increasing number of substance abusers, and access to firearms.

Nurses, including public health nurses, are at increased risk for workplace violence. Risk factors for violence in the workplace include all except a.) working in pairs. b.) access to medications. c.) increased number of mentally ill patients. d.) inadequate security.

Self-assessment is important to prevent providing biased care -Knowing how you feel about substance use is important Non-judgmental approach Routinely assess substance use patterns during client history Home visits paint a picture- empty pill or liquor bottles Increase awareness when the client is in denial Involve the client's social network Know community resources- treatment programs, help groups and transportation Every client will have an individualized treatment plan

Nursing Perspectives for Substance Abuse?

b.) promoting, preventing, and restoring health within the context of a safe and healthy environment. Occupational health nursing is a specialty practice that focuses on promoting, preventing, and restoring health within the context of a safe and healthy environment. The other options limit the scope of the practice role.

Occupational health nursing is best described as a specialty practice that focuses on a.) providing comprehensive health care service to workers and their families. b.) promoting, preventing, and restoring health within the context of a safe and healthy environment. c.) preventing adverse effects from occupational and environmental hazards at the workplace. d.) planning, implementing, and evaluating safety programs for workers at the workplace.

a.) avoid all products containing alcohol. Disulfiram, when combined with any alcohol, produces the classic disulfiram-ethanol reaction of flushing, tachycardia, nausea, headache, chest tightness, and chest pain. Adhering to concomitant vitamin B therapy and returning for monthly blood drug level monitoring are not necessary when taking Antabuse.

On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to a.) avoid all products containing alcohol. b.) adhere to concomitant vitamin B therapy. c.) return for monthly blood drug level monitoring. d.) limit alcohol consumption to a moderate level.

d.) lack of interest in health issues and health care. In developing countries, people are more likely to be exposed to communicable diseases as a result of a number of factors, including high population density, lack of accessible health care and treatment, and poor or limited sanitation. In addition, although tobacco use is decreasing in most developed countries, it is increasing in many underdeveloped ones. Although people in developed countries often lack resources and information, they are nonetheless interested in health promotion, disease prevention, and many aspects of health care delivery.

People who live in developing countries are at risk for a variety of health threats as a result of all factors except a.) limited sanitation facilities. b.) increased chance of exposure to communicable diseases, including AIDS, tuberculosis, and hepatitis B. c.) higher rates of tobacco use compared with most developed countries. d.) lack of interest in health issues and health care.

a.) impulsive. d.) disinhibited. Two broad personality dimensions are also associated with an increased risk for alcohol abuse. Impulsivity and ease of disinhibition add to the risks for substance abuse. Being prone to anxiety and depression is also a risk, and these comorbidities are not well understood. The other options are not associated with a risk for alcohol abuse.

Personality traits associated with an increased risk of alcohol abuse include (Select all that apply.) a.) impulsive. b.) shy. c.) withdrawn. d.) disinhibited. e.) aggressive.

a.) Male immune systems are weaker than women's c.) Men have fat stores in their abdomen e.) Men's brain cells die faster than women's Physiological gender differences that may account for increased mortality rates include the following: (1) Some evidence supports the hypothesis that men's higher testosterone levels contribute to lower high-density lipoprotein levels. (2) Body fat distribution may also contribute to sex differences in ischemic heart disease risk, specifically the tendency for men in Western countries to accumulate abdominal body fat versus the tendency for women to accumulate fat on the buttocks and thighs. (3) Men's higher levels of stored iron may also contribute to risk for ischemic heart disease. (4) Male immune systems are weaker than women's. (5) During the process of aging, men's brain cells die faster than women's brain cells. This may explain why men are more often hospitalized for serious mental disease.

Physiological gender differences that may account for increased mortality rates for men include: (Select all that apply.) a.) Male immune systems are weaker than women's b.) Men have lower levels of stored iron than women c.) Men have fat stores in their abdomen d.) Men's progesterone levels are cardiac protective e.) Men's brain cells die faster than women's

c.) increased incidence of disease. Overcrowding leads to pollution, stress, disease, and violence. Mortality rates are increased, and quality of life decreases.

Population overcrowding can result in a.) increased productivity. b.) improved education. c.) increased incidence of disease. d.) decreased mortality.

b.) chronic stress. c.) poverty. d.) minority status. Factors associated with preterm birth and low birth weight include minority status, chronic stress, maternal age of younger than 17 years and older than 35 years, chronic health problems, lack of prenatal care, multiple births, certain problems with the uterus or cervix, low socioeconomic status, unhealthy maternal habits, induced labor before 39 weeks of pregnancy without a medical indication, and elective cesarean birth.

Preterm birth and low birth weight are the most important predictors of infant health. Factors associated with preterm birth and low birth weight include (Select all that apply.) a.) age younger than 25 years. b.) chronic stress. c.) poverty. d.) minority status. e.) first pregnancy.

Primary Prevention: -Increase public awareness, especially youth -Encourage development of life skills -Assist in formation of awareness groups- MADD, DFCoA (MADE locally) --Mothers against drunk driving Secondary Prevention: -Screen individuals for substance use disorders -Identify at-risk individuals and assist to reduce stress (consider social services referral) --Increase stress: Unemployment, death, homelessness Tertiary Prevention: -Assist client to develop plan to avoid high-risk situations and enhance coping --Narcan available -Refer to community groups- AA, NA Monitor pharmacological management- nicotine replacement therapy and medication assisted therapy -Support to those in recovery and families

Prevention Strategies for Substance Abuse?

Primary Prevention: -Teaching anger management and conflict resolution techniques -Parenting classes- anticipatory guidance for age-appropriate behavior -Teach individuals they have a right to feel safe and how to report cases of abuse -Teach public about safeguarding funds and property Secondary Prevention: -Screen for abuse- especially vulnerable populations including pregnant women -Refer sexual assault or rape survivors to local emergency room for assessment -Support and educate the offender -Advocate for legislation to assist vulnerable populations through funding and laws Tertiary Prevention: -Establish parameters for long-term follow-up and supervision -Make resources available in the community- telephone numbers of crisis lines and shelters -Develop support groups -Provide grief counseling

Prevention of Violence?

Individual Risk Factors: -Involvement with drugs, alcohol, or tobacco -Antisocial beliefs and attitudes -Low IQ -History of violent victimization -History of early aggressive behavior -Attention deficits, hyperactivity, or learning disorders -Poor behavioral control -Deficits in social, cognitive, or information-processing abilities -Exposure to violence and conflict in the family -High emotional distress -History of treatment of emotional problems Community Risk Factors: -Diminished economic opportunities -High concentration of poor residents -High level of family disruption -Low levels of community participation -Socially disorganized neighborhoods -High level of transiency Family Risk Factors: -Poor family functioning -Low emotional attachment to parents or caregivers -Low parental education and income -Parental substance abuse or criminality -Poor monitoring and supervision of children -Harsh, lax, or inconsistent disciplinary practices -Authoritarian child-rearing attitudes Peer/Social Risk Factors: -Association with delinquent peers -Involvement in gangs -Social rejection by peers -Lack of involvement in conventional activities -Poor academic performance -Low commitment to school and school failure

Risk Factors for Youth-Related Violence Table?

Teach clients, families and community members to identify mental illness symptoms and suicide risk factors -People might not recognize the problem, especially the family members Assess- direct questions or observations -Are you having thoughts of killing yourself? Work settings- crisis housing program, supportive employment programs, Assertive Community Treatment (ACT) teams, Crisis Intervention Teams (CIT), medication management programs, community case management programs -Homeless shelter, Occupational health at a job facility, People who have difficulty managing medications Provision of services- access, cost and disparity -What providers? Can they have transportation? Do they have insurance? Recognize that individuals have more difficulty accessing care? (Homeless, minorities, children (don't know to ask for help or don't realize they're in a bad situation), Old people rely on other people) Navigating systems- healthcare, social service, legal -Applying for gov assistance, job training programs, childcare (job and family services) -Community health nurses need to know how to navigate the legal system because a lot of people in jail are crazy and have mental health issues --Need to know how to teach others

Role of Community Mental Health Nurse?

a.) The route of transmission for hepatitis A is fecal-oral. Hepatitis A is transmitted by fecal-oral route. Coughing or bleeding would not transmit hepatitis A. Option D does not have enough information to form a conclusion about hepatitis A transmission.

Seven cases of hepatitis A are diagnosed in a community over a period of 2 weeks. An investigation results in a determination that all of the infected individuals ate at a local restaurant. Which statement explains the possible connection between hepatitis A and a restaurant? a.) The route of transmission for hepatitis A is fecal-oral. b.) A food worker likely coughed on the customers. c.) A food worker may have a bleeding wound. d.) Hepatitis A is transmitted where people congregate.

Social consequences- role in crime (steals, assaults), need for money to buy substances, theft of drugs, irreversible health consequences from use Continued availability of the substance and social support system that enables use may maintain addiction -Infection, Hepatitis, HIV, physical changes with methadone (lose teeth), cirrhosis of the liver from chronic alcohol use -Enabling behavior: giving them money to go buy drugs, allowing to bring in and do drugs in the home, and lets them maintain the addiction People use multiple substances or have cross addictions more than in past -Some people use drug of convenience (smoking, drinking) Government typically takes a criminalization approach -Typically fined, put in jail -Concerns related to that: Jail overcrowding, spreading infection in crowded environments, paying for medical care as taxpayers for these people in jail, having to pay government facilities (police workforce) to arrest them, etc.

Sociocultural and Political Aspects of Substance Abuse?

Primary Prevention: Educate populations about mental health issues --AWARENESS; need to recognize illness and need to know when to seek help Teach stress reduction techniques -Good coping skills, suicide hotline, posting flyers everywhere, social media postings Promote protective factors and risk reduction factors Share suicide hotline information Secondary Prevention: Screen to detect mental health disorders -Screen for depression because most debilitating; should ask everyone at primary care doctors; public health: health fairs Conduct crisis intervention -Be available to respond to those issues -A house fire, car wreck (child has died and apart of a large school system) -Mass shooting -Hurricane/tornado -People that were apart of incidence and that had to care for them Tertiary Prevention: -Make referrals to mental health professionals and support groups -Educate client and family on medication adverse effects and possible interactions -Prevent relapse and frequent hospitalization

Strategies to Improve Mental Health: Primary, Secondary, and Tertiary Prevention?

Men die by suicide 3.5 times more than woman and white males account for 7/10 suicides (AFSP, 2017) Second leading cause of death among 10-14 and 25-34 year olds, third leading cause for 15-24 and fourth leading for 35-44. (NIMH, nd) -Schools are a great place to start suicide prevention; especially for young kids Previous suicide attempt leading risk factor, substance use and mental illness increase risk Suicide warning signs mnemonic- IS PATH WARM (Table 25.2, page 506) Protective factors- clinical care, access and support to clinical interventions, social support system, problem solving skills, cultural beliefs that discourage suicide

Suicide Statistics?

Ideation: Does the person state that he or she is having thoughts of suicide? Substance abuse: Is the person demonstrating increased use of alcohol or drugs? Purposelessness: Does the person state that he or she feels as if there is no purpose in his or her life? Anxiety: Is the person demonstrating anxiety-related behaviors such as talking about being overly worried about things, ruminating, difficulty concentrating, or exhibiting increased psychomotor agitation? Trapped: Does the person state that he or she feels trapped, that there is no way out of the current situation except to die? Hopelessness: Does the person state that he or she feels hopeless? Is the person able to describe something to look forward to? Withdrawal: Is the person withdrawing from others such as family and friends? Is the person isolating? Anger: Is the person demonstrating uncontrolled anger? Is the person acting with rage or seeking revenge? Recklessness: Is the person engaged in risk-taking behaviors? Is the person acting as if he or she "doesn't care" or isn't thinking about the consequences of the risk-taking behavior? Mood changes: Is the person experiencing dramatic mood changes?

Suicide Warning Signs: "Is Path Warm"?

• 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

Symptoms of Depression (Box 25.2)?

b.) utilization review. Utilization review (UR) defined by CMSA consists of the evaluation of medical appropriateness or medical necessity of care. This review ensures that patients receive the "right care at the right time" to improve clinical outcomes and lower costs. Care coordination is defined as the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services. Continuum of care is defined as the long-term services required for discharged patients with chronic illness. Care management consists of programs that apply systems, science, incentives, and information to improve medical practice and to allow clients and their support systems to participate in a collaborative process with a goal of improving medical, social, and mental health conditions more effectively.

The case manager reviews the chart of a patient to determine appropriateness and timeliness of medical care while the patient is in the hospital. This function of case management is referred to as a.) care coordination. b.) utilization review. c.) continuum of care. d.) care management.

d.) sudden infant death syndrome (SIDS). The five leading causes of infant death are congenital defects, disorders related to short gestation or low birth weight, sudden infant death syndrome (SIDS), maternal complications of pregnancy, and accidents such as suffocation. These five factors account for close to 60% of all infant deaths. The order of the top five leading causes changed slightly from 2012 to 2013. In 2012, SIDS was the third leading cause, followed by maternal complications, whereas in 2013, maternal complications was third and SIDS was fourth

The community health nurse is aware that one of the five leading causes of infant death in the United States is a.) respiratory distress. b.) circulatory system disease. c.) neonatal infections. d.) sudden infant death syndrome (SIDS).

b.) increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities. Healthy People 2020 establishes national objectives for health promotion and disease prevention. Healthy People 2020 has incorporated specific objectives related to older adults that are designed to promote healthy outcomes for this population, including increasing the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities; increasing the proportion of older adults who receive Diabetes Self-Management Benefits; increasing the proportion of older adults who use the Welcome to Medicare benefit; and increasing the proportion of older adults with one or more chronic health conditions who report confidence in managing their conditions.

The community health nurse is reviewing the Healthy People 2020 objectives. She understands a primary goal for the elderly population is a.) decrease the proportion of older adults who have diabetes. b.) increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities. c.) increase the proportion of older adults who qualify for Medicare benefits. d.) increase the proportion of older adults who seek medical care for chronic conditions.

c.) "Admit you are powerless over alcohol and that you need help." As a nonprofessional ongoing source of assistance, Alcoholics Anonymous is viewed as an invaluable resource to the community. The first step of the 12-step program is the admission of defeat and surrender to a higher power. The other options are false.

The community health nurse is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond a.) "You must first stop drinking." b.) "Your physician must refer you to this program." c.) "Admit you are powerless over alcohol and that you need help." d.) "You must bring along a friend who will support you."

c.) Methamphetamine Short-term effects of methamphetamine are increased heart rate, insomnia, excessive talking, excitation, and aggressive behavior. PCP is known for its violent dissociative and anesthetic effect. Alcohol intoxication causes euphoria, disinhibition, and sedation. Inhalants cause euphoria.

The community health nurse is visiting the home of a known substance abuser. The client is talking excessively and is excited and aggressive. The nurse notes that the patient's heart rate is 158 beats/min. The nurse recognizes the client is most likely high on which substance? a.) PCP b.) Alcohol c.) Methamphetamine d.) Inhalants

a.) An 18-year-old client with a previous gunshot wound b.) A 50-year-old client who saw people die in the disaster c.) A 23-year-old client experiencing extreme fear e.) A 35-year-old client with a history of schizophrenia Risks for PTSD include living through dangerous events or traumas; having a history of mental illness; getting hurt; seeing people hurt or killed; feeling horror, helplessness, or extreme fear; having little or no social support after the event; and dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

The community health nurse is working in an emergency shelter with displaced families. Which clients have risk factors for posttraumatic stress disorder (PTSD)? (Select all that apply.) a.) An 18-year-old client with a previous gunshot wound b.) A 50-year-old client who saw people die in the disaster c.) A 23-year-old client experiencing extreme fear d.) A 60-year-old client who had little social support before the event e.) A 35-year-old client with a history of schizophrenia

a.) maternal and child care are the major focus of many public health departments. Not only is maternal and child health a major focus of many health departments, but neither a medical nor a nursing specialty within a health department routinely exists to specifically address men's health. Preventive reproductive health care (i.e., family planning, prenatal care, and cancer screening) and associated general screening are not routinely available for men. The hours of services offered by health departments usually do not provide convenient access for men. The community health nurse's commitment to health for all requires an increased awareness of men's health issues in their social and cultural context and individual and group action that will improve men's physical, psychological, and social well-being.

The community health nurse's commitment to health for all requires an increased awareness of men's health issues; however, men are less likely than women to be seen by a community health nurse. This is because a.) maternal and child care are the major focus of many public health departments. b.) preventative reproductive health care is the only service available for men. c.) community health nurses do not have the competencies to focus on men's health care needs. d.) health department hours are flexible.

a.) World Health Organization (WHO) The WHO introduced the goal of "health for all." The CDC strives to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. UNICEF focuses on child and women's health.

The concept of "health for all by the year 2000" was initially introduced by which international organization? a.) World Health Organization (WHO) b.) Centers for Disease Control (CDC) c.) United Nations International Children Emergency Fund (UNICEF) d.) National Institutes of Health (NIH) Healthy People 2000

d.) Volunteers in a church are held to the same degree of accountability as paid employees. Churches are not exempt from discrimination laws. Ministers may be required to disclose confidential information in court. Parish nurses are required to document care given.

The faith community nurse must recognize which to be correct concerning church law? a.) The doctrine of separation of church and state exempts churches from discrimination laws. b.) Ministers are required to disclose confidential information in court. c.) Parish nurses are not required to document care given. d.) Volunteers in a church are held to the same degree of accountability as paid employees.

d.) Florence Nightingale. Florence Nightingale's legacy serves as the foundation for community health nursing in the global health care arena. She channeled her energy into all aspects of health from the care of wounded soldiers at Scutari to the broad public policies that affected health in her time. The other three women were instrumental primarily for their contributions in the United States.

The first nurse to establish international links and networks was a.) Clara Barton. b.) Mary Breckenridge. c.) Dorothea Dix. d.) Florence Nightingale.

c.) United Nations International Children Emergency Fund (UNICEF). UNICEF works for children's survival, development, and protection by developing and implementing community-based programs. UNICEF achievements are well documented in child health, nutrition, education, water, sanitation, and progress for women. PAHO is an international public health agency that works to improve the health and living standards of the Americas. The WHO introduced the goal of "health for all." The CDC strives to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats.

The global health organization that works for children's survival, development, and protection is the a.) World Health Organization (WHO). b.) Centers for Disease Control (CDC). c.) United Nations International Children Emergency Fund (UNICEF). d.) Pan American Health Organization (PAHO).

d.) Initiating discussion and education Clients frequently are hesitant to discuss end-of-life issues. This hesitancy arises from a wide variety of psychosocial issues. The nurse-client therapeutic relationship includes proactive communication and education about end-of-life issues, including living will, durable power of attorney or medical surrogate, or do-not-resuscitate order. Discussion regarding end-of-life issues with family members should not be to the exclusion of the client.

The home care nurse is caring for a client recently diagnosed with inoperable cancer. Which best expresses the nurse's role related to end-of-life issues? a.) Monitoring for the client to express interest in talking about these issues b.) Asking the client whether an advance directive has been completed c.) Exploring end-of-life issues with the client's family d.) Initiating discussion and education

c.) Changes in reimbursement that resulted from the implementation of the prospective payment system (PPS) for home health care, particularly for Medicare patients Home health care has changed dramatically in the last 20 years in relation to changes in Medicare home health reimbursement. Under the PPS, HHAs receive a fixed amount of money based on reasonable cost given the client's diagnosis and plan of care. Home health services have continued to evolve to meet the needs of their clients. Many new technologies can be provided in the home by skilled nurses.

The home health care industry has changed significantly in the past 20 years. Which is a factor that is responsible for the change in the home health care industry? a.) Failure of traditional home health services to change to meet the needs of clients with new needs such as AIDS patients, terminally ill patients, and increasing numbers of elderly b.) Advanced technology that resulted in new procedures and equipment not possible for use in the home c.) Changes in reimbursement that resulted from the implementation of the prospective payment system (PPS) for home health care, particularly for Medicare patients d.) Nurses lack of knowledge regarding cost-containment strategies

a.) Client b.) Family d.) Health team Structural elements include the client, family, provider agency, health team, and professional nurse. The process elements include the type of care, coordination of care, and intervention. Outcome elements consist of patient and family satisfaction with care, quality of care, cost-effectiveness of care, health status, and self-care capability.

The home health care nurse is measuring the quality of the home health care patient's outcomes. Which elements are included when measuring structural outcomes? (Select all that apply.) a.) Client b.) Family c.) Health status d.) Health team e.) Intervention

c.) the patient is not homebound. This is an inappropriate home health referral because the person is not homebound. If a patient can receive daily care at another health care facility, he or she is not suitable for home care. This referral may also be more appropriate for hospice services. Based on the information provided, the patient's needs that are appropriate for home care and skilled needs include pain management and end-of-life care. Palliative care is an appropriate need for home care services.

The home health nurse receives a referral for an evaluation visit for a patient. The nurse notes that the patient's primary diagnosis is end-stage lung cancer and that the patient is currently receiving daily palliative radiation treatments for pain management. This is not an appropriate home health referral because a.) the patient is receiving palliative care. b.) the patient's needs are too complex. c.) the patient is not homebound. d.) the patient does not have a skilled need.

b.) malaria. Malaria is a life-threatening parasitic disease transmitted by mosquitoes. Malaria causes more than 212 million acute illnesses and 429,000 deaths annually. AIDS is a disease caused by the HIV virus. Tuberculosis is an infectious disease caused by the tubercle bacillus. Hepatitis is inflammation of the liver.

The life-threatening parasitic disease that causes nearly 500,000 deaths annually is a.) AIDS. b.) malaria. c.) tuberculosis. d.) hepatitis.

d.) Green Green is for the wounded or individuals with minor injuries who are able to walk and to wait several hours before receiving medical treatment. Red is for those with life-threatening injuries but have a high probability of survival, yellow is for those with systemic but non-life-threatening complications, and black is for the deceased or those with nonsurvivable injuries.

The nurse at the disaster site is using the SMART triage system. What color triage tag would be provided to an ambulatory individual with a superficial cut on the left elbow and bruise to the right hand? a.) Red b.) Yellow c.) Black d.) Green

a.) inform the local police of the potential problem. b.) keep current pictures of the client available. d.) place bells on doors. e.) use childproof doorknobs. If wandering is a problem, the local police should be informed of the potential problem; current pictures of the individual should be available; and safety measures such as locks, bells placed on doors, or other means to ensure safety should be installed. The client who wanders should always be supervised.

The nurse is facilitating a support group for caregivers of parents with dementias. She discusses strategies to ensure safety of the client who wanders. These strategies include (Select all that apply.) a.) inform the local police of the potential problem. b.) keep current pictures of the client available. c.) consider restraining the client when left alone. d.) place bells on doors. e.) use childproof doorknobs.

b.) improve the quality of life for the terminally ill patients. Hospice services aim to improve the end-of-life care for terminally ill clients by focusing nursing on palliative care measures to relieve suffering and supporting the patient and family. The other options are not the primary purpose of hospice care but may be a result of it.

The primary purpose of hospice care is to a.) provide anticipatory grief support to the patient and family. b.) improve the quality of life for the terminally ill patients. c.) decrease the cost of traditional home health services. d.) coordinate the services reimbursed by Medicare for terminally ill patients.

b.) sense of belonging. c.) peer pressure. e.) need for respect. Reasons that young people give for joining gangs include the belief that gangs will protect them, peer pressure, the need for respect, and a sense of belonging.

The school nurse is interviewing a student who has been assaulted by another student. Both students proclaim to be gang members. The nurse understands the reasons most youth give for joining a gang include the following: (Select all that apply.) a.) financial gain. b.) sense of belonging. c.) peer pressure. d.) relative is in a gang. e.) need for respect.

c.) Al-Anon Substance abuse has been called a family disease because it affects the entire family system and holds potential adverse psychological and physical consequences for the family members in addition to the abuser. Al-Anon and Alateen are support groups for family members of substance abusers. A psychiatrist's referral is not necessary. Alcoholics Anonymous is focused more on the substance abuser than their families.

The wife of an alcoholic client is considering joining a support group to help her respond to her husband's condition in a healthy way. Where should the nurse refer this client? a.) A psychiatrist for a referral to a suitable group b.) Spouses Anonymous c.) Al-Anon d.) Alcoholics Anonymous

a.) the U.S. Department of Health and Human Services mandated occupational health nurses be hired for industrial settings that employed more than 350 people. The focus of health care for employees changed as a result of the two world wars, which changed the demographics of the workforce and increased the need for health services for employees, and the birth of the first national association for this specialty. The federal government never required companies to employ occupational health nurses.

There was an increase in the number and voice of occupational health nurses during the years of 1938 to 1943. All occurrences explain the rationale for this change except a.) the U.S. Department of Health and Human Services mandated occupational health nurses be hired for industrial settings that employed more than 350 people. b.) a national association for the specialty of occupational health nursing was created. c.) more women entered the workforce, changing the demographics of the workplace. d.) the government demanded health services for defense contract workers.

a.) refer him immediately for evaluation. It should be noted that suicide is the third leading cause of death among persons 15 to 24 years of age. Thus, it is important that all community health nurses become familiar with assessing for suicide warning signs and accessing appropriate resources. Whenever individuals exhibit suicide warning signs, nurses should refer the person to a mental health clinic or provider as soon as possible.

Tony, age 16 years, comes to see you, the school nurse, with complaints of abdominal pain. You note that Tony exhibits signs and symptoms of depression, states he wishes he did not wake up today, and exhibits signs of anxiety. You would a.) refer him immediately for evaluation. b.) see him back in your office next week. c.) refer him next month for evaluation. d.) do nothing; this is normal in a 16-year-old boy.

c.) breaking only one link in the transmission chain. Breaking just one link of the chain can control transmission of an infectious agent. Destroying all reservoirs of infectious agents and maintaining high levels of herd immunity are two of several ways to break a link in the chain of transmission.

Transmission of an infectious disease can be efficiently controlled by a.) breaking all links in the transmission chain. b.) destroying all reservoirs of infectious agents. c.) breaking only one link in the transmission chain. d.) maintaining high levels of herd immunity.

Violence is public health epidemic Influences morbidity and mortality rates Uses healthcare resources Objectives: Identify causes of violence and abuse -Individualized in the community so need to do community assessment Improve funding for violence research and prevention - A lot of violence goes unreported so kind of difficult to get info Improve data collection

Violence and Public Health?

Goal: Prevent violence and related injuries and death Reduce emergency department visits for nonfatal intentional self-harm injuries — IVP‑19 Reduce the number of young adults who report 3 or more adverse childhood experiences — IVP‑D03 Reduce intimate partner violence — IVP‑D04 Reduce homicides — IVP‑09 Reduce physical fighting among adolescents — IVP‑11 Reduce the proportion of public schools with a serious violent incident — AH‑D03 Reduce nonfatal child abuse and neglect — IVP‑16 Reduce child abuse and neglect deaths — IVP‑15 Reduce firearm-related deaths — IVP‑13

Violence- Healthy People 2030?

Preadolescents/Adolecents- often used as coping mechanism, peer pressure, abuse/neglect, ADHD, depression, selling drugs for money Elderly- social isolation, increase prescriptions, decreased physiological tolerance -With more drugs = more chance for misuse -Polypharmacy -Confusion so moire likelihood for mistakes -Decreased tolerance for medications = can end up with overdose Women- absorb and metabolize alcohol differently, increase risk due to economic, social and cultural factors, history of abuse risk factor -Could use alcohol for history of abuse Ethnocultural considerations- numb "social pain" with substances, race, ethnicity, socioeconomic status -Due to disparities Dual diagnosis- comorbid SA and MI, high risk for STIs, may have difficulty maintain MI medication regimen -Substance use disorder and mental illness at the same time -Much higher risk for STIs, homelessness, maintaining medication regimen

Vulnerable Aggregates for Substance Abuse?

Street, motorcycle and prison -Use violence to control others and money

What are Gangs?

Crime motivated by person's identity- usually race, religion or sexual orientation -Significant emotional impact on survivor and family --Could be cause of race, religion, gender

What are Hate Crimes?

d.) Communication Communication is one of the biggest problems during a disaster. The reliance on telephone systems or cell phones should not be the only plan for communication during a disaster. Authority focuses on the people in charge, logistical includes focuses on storage of equipment and location of key responders, and search and rescue focuses on the search and rescue of victims.

What element of a community disaster plan investigates the citizen's reliance on telephone systems or cell phones during disasters? a.) Authority b.) Logistical c.) Rescue d.) Communication

Physical, sexual, and emotional -Neglect (failure to provide) -Financial mistreatment- controlling finances, theft

What is Abuse and Neglect?

Global issue, 2nd most profitable transnational crime -Drug trafficking is 1st Common health problems- anxiety, depression, cigarette burns, unsafe abortion, STIs, oral health problems, unwanted pregnancy, unhealthy weight loss Known as modern day slavery Going to suffer from mental illness, depression, fractures/ bruises at different stages, unhealthy weight loss,

What is Human Trafficking?

-Jails, prisons, community correctional facilities -Murder, forcible rape, theft and aggravated assault -How does the violence they are exposed to while in prison affect them after they get out??

What is Prison Violence?

b.) Routine vaccination

What is an example of a primary strategy in communicable disease prevention? a.) Antiretroviral use b.) Routine vaccination d.) Antibiotic use d.) STI culture

d.) Poverty Poverty is the greatest threat to child health. Child poverty in the United States is higher than in most other industrialized countries and the rate is rising. Low socioeconomic status contributes to most factors associated with childhood mortality.

What is the greatest threat to child health? a.) Accidents b.) Racism c.) Burns d.) Poverty

d.) The client will feel depressed, apathetic, and lethargic. Symptoms of withdrawal from CNS stimulants are depression, apathy, lethargy, and sleepiness. The client may experience signs of CNS stimulation while high on the CNS stimulant. The client withdrawing from opioids may experience anxiety and tremors. The client withdrawing from alcohol may experience hallucinations and seizures.

When a client regularly takes a drug that is a central nervous system (CNS) stimulant, such as cocaine, what symptoms would the nurse expect to see when the client abstains from this substance? a.) The client will have symptoms of CNS stimulation. b.) The client will experience anxiety, insomnia, and tremors. c.) Common symptoms include hallucinations and seizures. d.) The client will feel depressed, apathetic, and lethargic.

d.) assess the needs and work with the congregation to meet the health-related needs of the vulnerable population. When providing care to vulnerable populations, the nurse should not attempt to meet the population's needs alone. The nurse should assess the needs and teach the faith community about the people and their spiritual, emotional, and physical needs. The people of the congregation can then share their talents and desire to meet these needs. The parish nurse works as a member of a church community to meet the health and related needs of vulnerable populations.

When providing care to vulnerable populations, the faith community nurse should a.) avoid involving the congregation in order to avoid legal issues. b.) deal with the issues alone, if possible. c.) refer the person to another resource and avoid getting involved. d.) assess the needs and work with the congregation to meet the health-related needs of the vulnerable population.

d.) Interrupting when necessary to verbalize correct medical information The correctional nurse should never interrupt when testifying in court. The other actions are appropriate.

Which action is inappropriate for a correctional nurse when testifying in court? a.) Looking the jurors in the eye when answering questions b.) Asking the attorney to repeat a question when not understood c.) Practicing saying difficult medical terms before the court date d.) Interrupting when necessary to verbalize correct medical information

b.) Reporting accusations of sexual harassment to local police Maintaining confidentiality of medical records, reporting occupational injuries and illnesses, and providing personal protective equipment training are all mandated by law. Sexual harassment allegations are routinely reported to administrative officials.

Which action of the occupational health nurse is not mandated by state or federal regulations? a.) Maintaining confidentiality of medical records b.) Reporting accusations of sexual harassment to local police c.) Recording and reporting occupational injuries and illnesses d.) Providing personal protective equipment training

a.) Sanity and competency evaluations b.) Parole and probation considerations c.) Sexual predator screening Psychiatric forensic nurses perform the following tasks in regards to mentally ill patients: evaluate sanity or competency, assess violence potential, assess capacity to formulate intent, consider parole and probation, assess racial and cultural factors in crime, assist in jury selection, screen sexual predators, and provide expert witness testimony.

Which activites are performed by psychiatric forensic nurses? (Select all that apply.) a.) Sanity and competency evaluations b.) Parole and probation considerations c.) Sexual predator screening d.) Assessment of prison health clinics e.) Evaluation of prison nurses

b.) Negotiation with an employer for an onsite fitness program for all employees Promoting physical activity is an example of health promotion activities at the primary prevention level. Blood pressure, diabetes, and cholesterol screenings and mammograms are all secondary prevention strategies aimed at early diagnosis and early treatment. Weight loss programs for the severely obese would be considered tertiary prevention.

Which activity implemented by an occupational health nurse would be considered primary prevention? a.) Annual blood pressure, cholesterol, and diabetes screenings b.) Negotiation with an employer for an onsite fitness program for all employees c.) Scheduling a mobile mammography van to see employees older than age 40 and their wives d.) Overseeing a weight loss competition among workers who are considered to be morbidly obese

c.) Federal government

Which agency is responsible for establishing regulations and providing funds for health care? a.) Volunteer organizations b.) Local health departments c.) Federal government d.) State health departments

a.) Physician-led, team based care c.) Integration and coordination of care d.) Improved access to care e.) Quality and safety The seven principles of a patient-centered medical home include the patient's relationship with the primary care physician; the physician-led, team-based care; the patient as a "whole person" who requires comprehensive care at various stages of life; integration and coordination of care; quality and safety; improved access to care; and a payment system that accurately reflects the efforts and care provided by the team. A value-based purchasing program was established by Centers for Medicare and Medicaid as a part of the Patient Protection and Affordable Care Act of 2010.

Which are principles of a patient-centered medical home? (Select all that apply.) a.) Physician-led, team based care b.) Value-based purchasing c.) Integration and coordination of care d.) Improved access to care e.) Quality and safety

a.) The client has a laceration on her forehead that was sutured. c.) The client has bruises on her forearms in various stages of healing. e.) The client is not sexually active but has a diagnosis of Chlamydia. Signs of physical abuse include bruises, lacerations, fractures, dislocations, untreated injuries in various stages of healing, and STDs in sexually inactive clients. The other options are not indications of physical abuse.

Which assessment findings by the community health nurse would suggest that an elderly client may be the survivor of physical abuse by a caregiver? (Select all that apply.) a.) The client has a laceration on her forehead that was sutured. b.) The client has a flat affect. c.) The client has bruises on her forearms in various stages of healing. d.) The client withdraws from soft touch. e.) The client is not sexually active but has a diagnosis of Chlamydia.

b.) A 70-year-old client with dementia who is cared for at home The most likely victims of elder abuse are individuals who are in poor physical or mental health and dependent on others for physical or financial support; these clients are often confused and depressed.

Which client is at highest risk for elder abuse? a.) A 75-year-old nursing home client who is alert and has osteoporosis b.) A 70-year-old client with dementia who is cared for at home c.) A 65-year-old client who has just had a hip replacement d.) A 72-year-old client on a rehabilitation unit with bilateral above-the-knee amputations

a.) HIV b.) Hepatitis c.) Tuberculosis The most critical heath care issues among the incarcerated population are chronic and communicable diseases. Of continuous concern are HIV, hepatitis, and tuberculosis.

Which communicable diseases found in prison inmates is of ongoing concern? (Select all that apply.) a.) HIV b.) Hepatitis c.) Tuberculosis d.) Bronchitis e.) Chlamydia

c.) A tornado resulting in flood and destruction of electrical systems for a community A natech disaster is a natural disaster that creates or results in a widespread technological problem. A flood covering crops and recreational areas of a geographic area does not mention a technological problem, and a terrorism attack and a nuclear accident are not natural disasters.

Which describes a NA-TECH (natural technological) type of disaster? a.) A flood covering crops and recreational areas of a geographic area b.) A terrorism attack causing major interruption of communication technologies c.) A tornado resulting in flood and destruction of electrical systems for a community d.) A nuclear accident at a power plant causing evacuation of people in an urban community

a.) AIDS d.) Parasitic infection e.) Dengue fever Among the infectious diseases that contribute to higher mortality rates in developing countries are AIDS, tuberculosis (TB), malaria, hepatitis B, rheumatic heart disease, parasitic infection, and dengue fever. Although these diseases claim the lives of millions, it is estimated they could be reduced by up to 50% through effective public health interventions.

Which diseases contribute to higher mortality rates in developing countries? (Select all that apply.) a.) AIDS b.) Hepatitis C c.) Cancer d.) Parasitic infection e.) Dengue fever

b.) Home health care is provided to homebound or disabled people in any residence or medical facility. Modern home health care is defined by the USDHHS as "a system in which health care and social services are provided to homebound people in their homes rather than medical facilities, and requires a comprehensive and coordinated plan to promote, maintain, or restore health or maximize level of independence. Services appropriate to the needs of the individual patient and family are planned, coordinated, and made available by providers organized for the delivery of home care through the use of employed staff, contractual arrangements, or combination of the two patterns." Home health services focus on allowing the individual to remain at home while receiving services they would otherwise receive in a hospital or long-term care setting.

Which does not accurately describe home health nursing as "officially" defined by the U.S. Department of Health and Human Services (USDHHS)? a.) Home health care is a system of comprehensive health care for people in their homes. b.) Home health care is provided to homebound or disabled people in any residence or medical facility. c.) Home health care has as its purpose to promote, maintain, or restore a client's health. d.) Home health care requires a coordinated plan of care provided by professional health care providers.

b.) Air pollution Air pollution and lead poisoning directly assault human health. Noise and litter affect quality of life. Global warming affects the ecologic balance.

Which environmental stressor directly assaults human health? a.) Global warming b.) Air pollution c.) Noise d.) Litter

a.) Inefficient storage b.) An intramuscular vaccine injection given subcutaneously d.) Light-sensitive vaccines exposed to light e.) Seroconversion Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that renders the vaccines ineffective, an improper administration route, or light-sensitive vaccines exposed to light. Additionally, some immunized persons never seroconvert, either because of failure of their own immune system or for some other unknown reason. Secondary vaccine failure is the waning of immunity after an initial immune response.

Which factors cause primary vaccine failure? (Select all that apply.) a.) Inefficient storage b.) An intramuscular vaccine injection given subcutaneously c.) Waning immunity in immunocompromised patients d.) Light-sensitive vaccines exposed to light e.) Seroconversion

b.) Health advocate Lobbying is part of the health advocate role of faith community nursing. As a health educator, the parish nurse provides health education to church leaders and members. As an integrator of health and healing, the parish nurse integrates spirituality as the basis of his or her nursing practice. As a coordinator of volunteers, the parish nurse recruits, trains, and directs volunteers to work with the parish nurse program or health ministry.

Which faith community nurse role includes lobbying for beneficial health policy? a.) Health educator b.) Health advocate c.) Integrator of health and healing d.) Coordinator of volunteers

b.) Assessment and teaching about parenting Primary prevention includes assessment and teaching about parenting, health, and wellness. It also includes development of programs and social support systems to prevent social isolation and increase resources for successful parenting and healthy behaviors. Identifying individuals and families at risk is secondary prevention. Providing education programs is secondary prevention. Providing resources for rehabilitation is tertiary prevention.

Which intervention is an example of primary prevention in parish nurse practice? a.) Identifying individuals and families at risk b.) Assessment and teaching about parenting c.) Providing education programs d.) Providing resources for rehabilitation

a.) Providing high-quality care b.) Decreasing fragmentation of health services c.) Containing cost of health care e.) Enhancing quality of life for clients According to the American Nurses Credentialing Center (ANCC), nursing case management is a health care delivery process whose goals are to provide quality health care, decrease fragmentation, enhance the client's quality of life, and contain costs.

Which is a goal of case management? (Select all that apply.) a.) Providing high-quality care b.) Decreasing fragmentation of health services c.) Containing cost of health care d.) Integrating specialty care e.) Enhancing quality of life for clients

d.) Mosquitoes Vectors can be animals or arthropods and can transmit disease through biological and mechanical routes. The other options are not vectors.

Which is classified as a vector of disease? a.) Humans b.) Door handles c.) Water and food d.) Mosquitoes

d.) Ectopic pregnancy Ectopic pregnancies are the leading cause of maternal death in the first trimester because of hemorrhage. Spontaneous abortion, hydatidiform mole pregnancy, and hyperemesis gravidarum are not major causes of maternal mortality.

Which is the leading cause of maternal death in the first trimester of pregnancy? a.) Spontaneous abortion b.) Hydatidiform mole pregnancy c.) Hyperemesis gravidarum d.) Ectopic pregnancy

d.) To act as command station for disaster responders to report to and get assignments The staging area is the onsite command station. Dispatch responders should report to this area and check-in. This allows everyone to be accounted for and to gather assignments. The other options are not appropriate uses for the staging area in a disaster.

Which is the purpose of the staging area in a disaster plan? a.) A triage area outside the hospital, supplying first aid and transport to medical facilities b.) A stage for entertainment to cheer up disaster victims c.) To provide sheltered area for displaced victims to sleep, eat, and bathe d.) To act as command station for disaster responders to report to and get assignments

c.) They are more likely to commit suicide. Adolescents in an adult correctional facility are more likely to be sexually assaulted, attacked by other inmates, or to threaten suicide than adolescents in a juvenile facility.

Which is true of adolescents who have been convicted and incarcerated in adult facilities rather than in a juvenile facility? a.) They are less likely to be sexually assaulted. b.) They are usually not attacked by other inmates. c.) They are more likely to commit suicide. d.) They are less likely to be diagnosed with a mental illness.

d.) Specific nursing interventions should be used by the parish nurse in cases of elder abuse. The nurse must have skill in recognizing symptoms of abuse and assessment and screening questions to identify specific problems. There are specific nursing interventions to use. An estimated 10% of elders are victims of abuse each year. The parish nurse may be the first person to identify signs and symptoms of elder abuse. Elder abuse may include financial theft or misuse of the elder's money.

Which is true regarding elder abuse? a.) Elder abuse is rare in the United States among elders active in faith communities. b.) The parish nurse is not likely to be the first person to identify signs and symptoms of elder abuse in a congregation. c.) Misuse of an elder's money is not considered elder abuse. d.) Specific nursing interventions should be used by the parish nurse in cases of elder abuse.

d.) The Civil Rights Act The Civil Rights Act of 1964 prohibits discrimination based on sex, race, color, religion, or national origin in determining employment or eligibility or termination, wages, and fringe benefits, as well as discrimination against pregnant women or conditions involving childbirth or pregnancy. The ACA, in part, protects women from being denied coverage by insurance companies and being charged more for health care services because of their gender. FMLA allows an employee a minimum provision of 12 weeks unpaid leave each year for family and medical reasons. The Occupational Safety and Health Act helps ensure safe and healthful working conditions for workers.

Which legislative act prohibited discrimination against pregnant women or conditions involving childbirth or pregnancy? a.) The Affordable Care Act (ACA) b.) The Family and Medical Leave Act (FMLA) c.) The Occupational Safety and Health Act d.) The Civil Rights Act

a.) underweight e.) poor hygiene

Which manifestations would indicate neglect? a.) underweight b.) healing spiral fracture of the arm c.) genital irritation d.) burns on the palms of hands e.) poor hygiene

c.) Patient-centered medical home The patient-centered medical home (PCMH) is a recent model of care developed to provide collaborative, quality-driven, safe primary care. The PCMH uses care coordination and case management processes to provide comprehensive, patient-centered, cost-effective, high-quality care. In the community-case management model, case managers provide services exclusively in the community after discharge. Disease-specific case management and geriatric care management are specific types of case management services provided to specific populations.

Which model of care was developed to provide collaborative, quality-driven, safe, primary care? a.) Community case management model b.) Disease-specific case management model c.) Patient-centered medical home d.) Geriatric care management

c.) Complete the medical history and physical assessment. Although all of the interventions are important, the most appropriate initial intervention is to complete the history and assessment. The nursing process is followed by using assessment first, and it is also at this time when medical issues are found for the inmate.

Which nursing intervention is the most appropriate as an initial intervention for a prison inmate? a.) Manage a chronic illness through needed education. b.) Administer the routine medication ordered. c.) Complete the medical history and physical assessment. d.) Test for HIV and tuberculosis.

a.) Negotiation of workplace accommodation for a worker with a disability On a tertiary level, the occupational health nurse plays a key role in the rehabilitation of a worker to the optimal level of functioning and includes such strategies as negotiation of workplace accommodation and counseling and support for workers who will continue to be affected by chronic disease. The other options are primary level strategies.

Which occupational health nursing intervention is an appropriate tertiary level strategy? a.) Negotiation of workplace accommodation for a worker with a disability b.) Work with an employer to build an onsite fitness center c.) Providing health-screening programs to detect conditions that could aggravate the disability of worker d.) Get automated external defibrillators AEDs for the workplace and train workers on how to use them

d.) All of the above Secondary prevention strategies are aimed at early diagnosis, early treatment interventions, and attempts to prevent disability. All three choices focus on identification of health needs, health problems, and employees at risk.

Which occupational health nursing intervention would be appropriate secondary prevention strategies? a.) Arrange for the collection of baseline liver function tests if the employee will be working with a chemical known to cause liver toxicity b.) Provide vision, blood pressure, hearing, and cancer screenings on an annual basis c.) Coordinate periodic evaluations to ensure workers are placed in the safest worksite setting d.) All of the above

b.) Staff training for mass casualty response

Which of the following falls within the scope of a school health nurse? a.) Removing cookies from lunch trays b.) Staff training for mass casualty response c.) Administering Intravenous Peramivir d.) Screening children for multiple sclerosis

d.) Report this to the local health department

Which of the following is a legal responsibility of a nurse following a patient diagnosis of chlamydia? a.) Adminsiter an IM injection of Penicillin G b.) Obtain consent to notify sexual partners c.) obtain an RX for Azithromycin d.) Report this to the local health department

b.) Heroic phase The heroic phase of a community's reaction to a disaster involves people feeling the need to rush to help people survive the disaster. Medical personnel may volunteer to work long hours without sleep and in dangerous conditions to care for patients. During the honeymoon phase, people who have survived the disaster get together to talk about their experiences. People begin to look to the future during the reconstruction phase and during the disillusionment phase people recognize that many things are different, and much needs to be done to adjust to the current situation.

Which phase of the community response to disaster includes medical personnel contributing long hours of volunteer work helping unfamiliar people after a disaster? a.) Honeymoon phase b.) Heroic phase c.) Reconstruction phase d.) Disillusionment phase

a.) Advocate b.) Coordinator c.) Teacher d.) Educator

Which role does the case manager perform? (Select all that apply) a.) Advocate b.) Coordinator c.) Teacher d.) Educator

a.) Teen use of cigarettes and smokeless tobacco is increasing. Teen use of cigarettes and smokeless tobacco has declined. Youth (ages 12 to 20) binge and heavy drinking rates in 2015 (13.4% and 3.3%, respectively) were higher than rates in 2010 (7.8% and 1.7%, respectively). The percentage aged 12 to 17 years who perceived great risk in smoking marijuana once or twice a week decreased from 47.5% in 2010 to 40.6% in 2015. Teen substance abuse, overall, is increasing.

Which statement about adolescent substance abuse is false? a.) Teen use of cigarettes and smokeless tobacco is increasing. b.) Alcohol use among youth declined increased between 2010 and 2015. c.) Most of the movement in teen substance abuse has been in the downward direction. d.) Marijuana use among teens is decreasing.

a.) Most homicides are caused by stabbings. Most homicides are caused by firearms. The other statements are true.

Which statement about homicide in the United States is false? a.) Most homicides are caused by stabbings. b.) Homicide is the third leading cause of death for 1- to 4-year-old children. c.) Blacks are more likely to be the victims of homicide than whites. d.) Over 50% of homicide victims are killed by someone they knew.

d.) Professional intervention is needed to change the abusers' behavior. Abusers will stop the abuse only after receiving treatment. Abusers do not change behaviors on their own. The other statements are true.

Which statement about intimate partner violence (IPV) is true? a.) It occurs only in poor, uneducated, minority households. b.) It only occurs in heterosexual relationships. d.) Victims can change the abusers' behavior. d.) Professional intervention is needed to change the abusers' behavior.

b.) Men are at greater risk for higher morbidity and mortality rates for conditions that are the leading causes of death (e.g., heart disease, cancer, stroke) compared with women. Men have higher morbidity and mortality rates for conditions that are the leading causes of death. Women have a higher incidence of acute infective and parasitic diseases, digestive conditions, and respiratory conditions than men. Men are more likely to die from unintentional injuries and to be involved in criminal activities.

Which statement comparing health risks between men and women is true? a.) Men have a higher incidence rate for acute infective and parasitic diseases, digestive system conditions, and respiratory conditions than women. b.) Men are at greater risk for higher morbidity and mortality rates for conditions that are the leading causes of death (e.g., heart disease, cancer, stroke) compared with women. c.) Men are less likely than women to die from unintentional injuries. d.) Men are less likely than women to be involved in criminal activities.

c.) The type of hospice services are limited as in home health care to skilled nursing, social services, physical therapy, occupational therapy, and speech therapy. Hospice patients, unlike traditional home health care, need not be homebound but must be certified by a physician as terminally ill and requiring care. The type of services and location of services are broader in hospice and may include coordination with long-term care, hospitals, and other agencies. The services provided also include traditional home care providers and pastoral care, respite, and volunteers. Attention to the caregiver is also important in the hospice plan of care. Bereavement services are offered following the death of the hospice patient.

Which statement differentiating hospice and traditional home health is not true? a.) Hospice patients need not be homebound but must be certified as within the last months of life by a physician. b.) Hospice services may be provided in the home, hospital, nursing home, or other health care site as appropriate. c.) The type of hospice services are limited as in home health care to skilled nursing, social services, physical therapy, occupational therapy, and speech therapy. d.) The hospice plan of care includes caring for the caregiver during and after the death of the patient.

a.) "I can't get human papilloma virus (HPV) from my boyfriend because we're not having intercourse." Option A indicates the patient needs more teaching. HPV can be transmitted via sexual intercourse, as well as any other means of direct contact. The other statements are true.

Which statement indicates that further teaching is needed for a patient involved in family planning? a.) "I can't get human papilloma virus (HPV) from my boyfriend because we're not having intercourse." b.) "I need to use condoms to prevent transmission of sexually transmitted diseases." c.) "Even though I have no signs or symptoms, I still may have Chlamydia." d.) "I can give my unborn baby warts during childbirth."

c.) Home health nursing has as a purpose to provide nursing care to individuals and clients in their homes. The purpose of home health nursing is to provide nursing care to individuals and clients in their homes. Although the focus of a home health visit may be on a particular individual, the client includes the entire family system. Home health nursing has a long history dating back even before Florence Nightingale.

Which statement is true concerning home health nursing? a.) Home health nursing is a new nursing specialty originating with the inception of Medicare in the 1960s. b.) Florence Nightingale is credited with creating the idea of home health nursing. c.) Home health nursing has as a purpose to provide nursing care to individuals and clients in their homes. d.) Home health nursing has as a purpose to provide nursing care only for the referred individual patient.

c.) Many factors that lead to morbidity and mortality among women are preventable. Most factors that lead to morbidity and mortality among women are preventable. The other statements are incorrect: women are more likely than men to be disabled from chronic conditions, and women experience higher incidence of acute conditions than males. Finally, most women do actively try to control and manage their own health.

Which statement is true? a.) Women experience fewer disabilities resulting from chronic conditions than men do. b.) Most women do not actively seek information that will allow them to be in control of their own health. c.) Many factors that lead to morbidity and mortality among women are preventable. d.) Women report a lower incidence of acute conditions than do males.

c.) Half of the STD rate in the United States falls within the 15 to 24 age range. An estimated 20 million cases of STDs occur each year in the United States, almost half of them in persons aged 15 to 24 years. The other statements are not true.

Which statement regarding sexually transmitted diseases (STDs) is correct? a.) The rate of STDs is decreasing because of effective medication therapies. b.) Women are less likely to use protection methods against STDs. c.) Half of the STD rate in the United States falls within the 15 to 24 age range. d.) Treatment for STDs in women is usually ineffective.

c.) "I gave the pain medicine every 3 hours as we planned even when he (the patient) didn't complain of pain." Pain management is an important goal for hospice nurses and their patients. The premise of pain management is to educate the patient and family to administer the medication on a regular schedule instead of PRN ("as needed"), to prevent the majority of the pain. Patient and family education includes explaining how the traditional view of patients becoming "junkies" or "drug addicts" is not an issue with terminally ill patients.

Which statement would indicate that the hospice patient's caregiver understood the nurse's instructions related to pain management? a.) "I didn't wake him (the patient) up last night for the 2:00 AM dose because he was sleeping." Incorrect b.) "I gave him (the patient) the ordered medicine whenever he complained of pain." c.) "I gave the pain medicine every 3 hours as we planned even when he (the patient) didn't complain of pain." d.) "I'm worried he (the patient) will become hooked on the medicine, so I only gave one-half of the dose."

c.) Value-based purchasing programs for hospitals were established. The Patient Protection and Affordable Care Act, passed by Congress in March 2010, included provisions in Title III of the bill that requires improvement in the quality and efficiency of health care. The Centers for Medicare and Medicaid (CMS) established a value-based purchasing program for hospitals, postacute providers, and practitioners. The program links Medicare payments to quality performance, utilization of evidence-based practices, cost of care, and patient experience scores (CMS.gov). Under the prospective payment system introduced in 1983, health care providers receive a fixed amount of money based on the relative cost of resources they use to treat Medicare patients within each diagnosis-related group. Third-party payers used the prospective payment system to negotiate reimbursement. Social security benefits were not affected by the Patient Protection and Affordable Care Act.

Which was a result of the Patient Protection and Affordable Care Act of 2010? a.) Social Security benefits were denied to selected aggregates. b.) Third-party payers (e.g., preferred provider organizations and health maintenance organizations) use prospective payments systems to negotiate reimbursement. c.) Value-based purchasing programs for hospitals were established. d.) Health care providers received a fixed amount of money based on the relative cost of resources they use to treat Medicare patients within each diagnosis-related group.

c.) Choose healthy lifestyle behaviors to retain health

Which would be the least expensive approach to treating chronic diseases? a.) Media campaigns encouraging early detection and treatment b.) Suggest self-therapies that have demonstrated to work c.) Choose healthy lifestyle behaviors to retain health d.) Promote seeking care at a local neighborhood health clinic

c.) Contact the parents and educate them about the immunization requirements. All states require proof of current immunization status or evidence of immunity unless there is an exception (religious, moral belief, or medical contraindication). It is the nurse's responsibility to assess the situation and educate the family. The nurse's responsibility is not to expel the students or immunize them herself.

While verifying compliance with immunization requirements, a school nurse notices that three students from the same family have not completed their immunizations. How should the nurse address this problem? a.) Discuss with the principal the lack of immunizations. b.) Expel the children from school. c.) Contact the parents and educate them about the immunization requirements. d.) Pull the students from class and immunize them.