Exam 3

Which of the following is the most common vector-borne disease is a result of travelers introducing the disease to the United States? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever

b Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. About 2000 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia. Dengue is rarely transmitted in the United States. Onchocerciasis and Yellow fever are not reported as common vector-borne diseases.

A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect? a. Common source b. Mixed c. Propagated d. Intermittent

a A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. A mixed outbreak is a common source outbreak followed by secondary exposures related to person-to-person contact. Intermittent source cases may be exposed over a period of days or weeks. A propagated outbreak does not have a common source but spreads gradually from person to person over more than a single incubation period.

Three female clients were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? a. Alcohol blood level b. Cardiac workup c. Pregnancy test d. STI tests

a Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. Because of the high rate of alcohol involvement in injuries seen in trauma centers, an alcohol blood level would be most important. A cardiac workup, pregnancy test, or STI test would not be the priority.

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. "Wait," said the new mother. "Why is my son getting two shots?" Which of the following statements would be the best response by the nurse? a. "One injection protects your son, while the other encourages his body to build up immunity." b. "One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him." c. "Since you've already been infected with the virus, your son needs twice as much protection." d. "The second shot is just to make sure the first one works."

a Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection. One of the shots provides passive immunity and the other provides active immunity. The active immunity continues to be built up by receiving two follow-up injections weeks later.

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia

a Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat. Botulism, smallpox, and tularemia do not have the ability to be transmitted through a resistant aerosol that is highly fatal.

A nurse noted that of 18 children in a daycare center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill? a. Some of the children were from very low socioeconomic families. b. Some of the children inhaled car exhaust while playing outside. c. The bacterial cause of the illness was easily removed by handwashing. d. The daycare center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

a Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness and exposure to pollutants are considered agent factors, and the difference in temperature in the room is an environmental factor.

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

b HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter. The other descriptions are not characteristic of lesions of the human papillomavirus (HPV).

A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. "I wouldn't sit next to someone with HIV." b. "Having unprotected sex with someone who is infected spreads HIV." c. "Sharing needles when shooting up drugs spreads HIV." d. "Transfusions of blood products that are contaminated can spread HIV."

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

A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers' needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a. The group became cohesive enough to share leadership tasks. b. Teenagers don't like feeling dependent on adults with power. c. Teenagers often rebel against adult authority. d. The nurse was overwhelmed and lost control of task process.

a In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group. As the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion, not necessarily a rebellion against adult authority. The group naturally progressed to leading itself based on normal group development. This did not occur because of the teenagers' attitudes, behaviors, or because of the feelings of the nurse.

Which population is best protected against pertussis by the DTaP vaccine? a. Young children b. The pre-teen c. The teen d. Adult

a More than 200,000 children previously got pertussis each year. Two vaccines protect again this disease: DTaP protects young children from diphtheria, tetanus, and pertussis; and Tdap protects preteens, teens, and adults.

Which of the following is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population

a Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is. The environmental changes around the world are causing new infectious agents to emerge, not evolve. The environmental changes that occur because of overcrowding is the issue, not the population itself.

A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

a Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict. If the nurse were to respond to conflict by avoiding (suggesting that they avoid further discussion), forcing with power (assuming adult authority), capitulating, or excluding some members (asking the deviant members to leave), the behavior would fail to satisfy the concerns of those involved.

A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

a Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is secondary prevention. Because the client has the condition, treatment is aimed at prevention of further injury.

Which of the following statements regarding the Health Belief Model is accurate? a. Cues to action are an important component of the model. b. Multiple methods of education should be used when implementing this model. c. The first stage experienced in this model is the pre-contemplation stage. d. To successfully implement this model, ongoing maintenance of the behavior must be considered.

a The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The Health Belief Model does not indicate the number of methods of education that should be used. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.

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

a The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility. Symptoms of syphilis may not appear for several years after contracting the disease. The first stage of syphilis is called primary syphilis when a chancre, a firm, round, small and painless lesion, develops. Signs and symptoms of HSV-2 infection range from no symptoms to painful lesions or blisters around the genitals, rectum, or mouth. Most people with HPV are asymptomatic.

n January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their primary care providers recently. The incidence of reports of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. b. No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses. c. Action should be taken because there must be some cause for this noted increase. d. Action should be taken because this increase may be the beginning of an epidemic and should be investigated.

a Typically, any unusual increase in incidence should be investigated. But in the majority of cases, the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. The nurse should recognize that depression can be seasonal and not attribute this problem to an error in the data that has been collected. Because this is being recognized as a seasonal problem, there is no need for the nurse to take action. However, the nurse should continue to monitor the data to make sure that this trend does not continue as the weather begins to warm and more hours of daylight occur.

When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a. Educator b. Content c. Learners d. Objectives

a Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge. The educator determines how content can be tailored to the learner. The educator determines the objectives.

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

a Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease. Recurrence with HSV-2 is common. The treatment for HSV-2 may be episodic or suppressive for frequent recurrence, which is not expensive to treat. HSV-2 may be asymptomatic but does appear as vesicles, painful ulceration of penis, vagina, labia, perineum, and anus with lesions lasting 5 to 6 weeks.

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a. Areas where people share dressing or bathing facilities b. Daycare centers and schools c. Long-term care facilities d. Senior citizen centers

a Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas. Daycare centers, schools, long-term care facilities, and senior citizen centers are not places where the incidence of VRSA and MRSA is rising. These are not places where people are closely sharing dressing and bathing facilities.

Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

a Vectors include mosquitoes, which can transmit the infectious agent by biting the host. Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance.

A woman and man who have come to the health clinic begin to argue loudly. "You gave me an STI!" the man yells. The woman screams back, "Not me. I don't have an STI!" Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. "Actually, you're very fortunate to have been tested, so you and your partner can begin treatment before more serious damage is done." b. "Some STIs may not have any symptoms, so you need to be tested for other conditions and treated if necessary." c. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." d. "You may be able to get treatment from your pharmacist so you won't have to be embarrassed like this again." e. "Some STIs are spread in ways that are non-sexual in nature."

a, b, c Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STI test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person. The pharmacist must receive an order from the primary care provider in order to dispense a prescription.

A client tells a nurse, "I know all about this already. I read about it on the Internet" and then begins to summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a. Were you able to find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information? d. Did you enjoy reading the material on the website? e. Did the information sound correct to you?

a, b, c To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc. Assessing if the material was enjoyable to read or sounded correct does not help the nurse to assess the quality of information that was read by the client.

The nurse is scheduled to teach carbohydrate counting to middle-aged adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning. e. Reinforce learning with handouts.

a, c Because the nurse is working with middle-aged adults, the assumption can be made that they are members of Generation X. This generation tends to be self-directed, likes to work with teams, and may need to develop skills because they are not as likely to be as tech savvy. Members of this group can tolerate delayed gratification; they want clear information with practical value; and they are able to have fun and engage in games and activities when appropriate. Because of this, the best approach will be to use adult experiences and practical problems as learning motivators—for instance, appealing to adults' sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions. This generation tends to be self-directed so they most likely will not depend on the instructor to set goals for learning or need the instructor to emphasize how important it is to know this information. Reinforcement with handouts are generally helpful. Members of this generation are likely to have the intrinsic motivation to accomplish these things on their own.

Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. The necessary ability to perform the skill b. An open mind to learn the new skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill Desire to learn the skill

a, c, d Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor abilities, having a sensory image of how to carry out the skill, having opportunities to practice the new skill. Having an open mind to learn a new skill and wanting to learn the skill are important. However, it is not necessary in order to master psychomotor learning.

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

b An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination. If testing is anonymous, the client is given an identification code number that is attached to all records of the test results and is not linked to the person's name and address. Demographic data such as the person's sex, age, and race may be collected, but there is no record of the client's name and associated identifying information. Thus, the client is able to know the results of the test while staying anonymous. It would be a violation of HIPAA for the providers to share the results of this test or any other medical information with family members. The follow-up related to payment is not a main concern for the population who is requesting anonymous testing.

A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. "Don't you know HIV children are immunosuppressed?" she exclaimed. Which of the following would be the nurse's best response? a. "All children have to have these immunizations before they can attend school." b. "Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized." c. "I'm so sorry; I forgot for a moment your child was HIV positive." d. "The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them."

b Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Although this child is HIV positive, there is no medical reason why the child should not be immunized. Many states do have a "no shots, no school" law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Ask the students why they are being so rude. b. Explain why the information is crucial to their current clinical practice. c. Nothing; let the instructor of the course handle the problem. d. Tell a joke to get the students' attention.

b Before learning can take place, you need to gain the learner's attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally. Asking the students why they are being so rude would not be a professional response by the nurse. The nurse should take responsibility for gaining the attention of the audience and not expect the instructor to do so. Gaining the students can best be accomplished by telling the students why it is important rather than telling a joke.

Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) d. Mixed alcoholic beverages

b Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications. Beer, cigarettes, and mixed alcoholic beverages are not as culturally acceptable as caffeine, as there are regulations that limit the age that these products can be used.

A student reports to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? a. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b. "Your daughter may have pinworms; let me teach you how to check for this." c. "Perhaps your child is not developmentally ready for group play." d. "Try to arrange more one-on-one time with your 3-year-old."

b Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver. The nurse should suspect that the underlying problem is pinworms, not dry skin. These symptoms do not demonstrate a developmental delay or the need for additional one-on-one time.

Which of the following types of surveillance systems is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? a. Active b. Passive c. Sentinel d. Special

b In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.

Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

b Infectious diseases, however, are still the number one cause of death worldwide. In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Injuries and terrorism are not the number one cause of death worldwide.

A client diagnosed with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a. "Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered." b. "This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs." c. "This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember." d. "Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs."

b It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment. The risk to client and the community if the client does not follow the treatment regimen is that the TB will become resistant to these medications. It does not have to do with the possibility of noncompliance by the patient, that the patient will not remember, or related to the cost of the medications.

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

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

Which of the following is an accurate concern about the marijuana? a. Strength of most available marijuana is weaker than in the past. b. Paranoia is a known side effect of marijuana use. c. Marijuana has no effect on a fetus. d. Psychological and physiological dependence are seldom experience with marijuana use.

b Marijuana's diverse reactions include anxiety, disorientation, and paranoia. The risks of marijuana are not being discussed as much as in the past. Today's marijuana is stronger than ever before, and people can become addicted. The Substance Abuse and Mental Health Services Administration (SAMHSA) says "approximately 1 in 10 people who use marijuana will become addicted." The rate increases to 1 in 6 if the youth is under age 18. Marijuana usehas known effects on fetal development.

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? a. Inform all students, staff, and faculty of a possible rubella epidemic. b. Inform all students, staff, and faculty of a possible measles epidemic. c. Reassure the student that it is just a bad cold and will soon pass. d. Tell the student to take two acetaminophen and drink lots of fluids.

b Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the United States in adolescents and young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), and a red, blotchy rash beginning several days after the respiratory signs. Measles is serious. Around 10% of measles cases require hospital admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who may have been exposed should be informed that anyone under 18 who has not received both immunization doses should receive measles vaccine. The student is displaying symptoms of measles, not rubella. Symptoms of rubella include a low-grade fever, runny nose, headache, and a rash that starts on the face and spreads to the rest of the body. The white spots (Koplik spots) should make the nurse suspect that the client has measles, not just a bad cold in which case the nurse would recommend the acetominophen and fluids.

Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment.

b Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long acting and effective when taken orally, it does not produce a "high," it is inexpensive, and it has few known side effects. The main effect of this medication is that it decreases the craving for heroin; it is not a drug that clients come to prefer nor does it prevent further dependence on drugs.

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlines. d. The nurse gave them too much information too fast for them to want to cope with it all.

b Most health information is printed at a tenth-grade reading level, which is too difficult for almost half of the adult readers in the United States. If people cannot read or understand the material, they discard it. Although visual images are certainly helpful, it does not explain why the handouts were discarded. Audience's expectations of the use of PowerPoint or video presentations or receiving too much information too fast do not explain why the handouts were thrown away. If the nurse covered information too fast, it is likely that the participants may have been more inclined to keep the handout.

A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic? a. Because nurses are employed in public health agencies b. Because nurses are often the first to recognize and respond to a problem c. Because nurses are responsible for ensuring that action is taken when necessary d. Because nurses are typically the ones to interact with the public and the media

b Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. Nurses may work in a variety of community agencies, including public health agencies. Nurses will collaborate with others to take action as necessary; it would not be the sole responsibility of the nurse. A wide variety of public health professionals interact with the public and the media, not only nurses.

Which of the following statements by the client indicates the client is experiencing a learner-related barrier to new information about type 2 diabetes management? a. "I know about diabetes; my sister has it." b. "I Don't like to read' just tell me what I need to know." c. "It won't change my life; it's type 2 diabetes." d. "It can't be that hard to learn; I don't have to take shots."

b One of the most important learner-related barriers is low literacy. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels. These individuals may be embarrassed to admit their reading deficit to health care providers, and educators and may try to appear to understand when they really do not. Denying the impact or the importance of learning about a new diagnosis is problematic but not considered a primary barrier.

A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth.

b Research demonstrates that genes are responsible for about half of the risk for abuse of alcohol. Multiple genes play a role in a person's risk for the development of alcoholism. Research has not shown that the family environment is the main risk factor for alcoholism. Alcoholism is more common among men than women. Persons who are born with fetal alcohol syndrome are not alcoholics from birth and are likely to have metabolic or other disturbances.

A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother's arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home.

b Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Fetal alcohol syndrome is a cause of newborn congenital dysfunctions. There is not known tolerance to tobacco smoke. While chewing tobacco doesn't produce smoke, the parents would still be at a considerable health risk from the nicotine.

Which client may be able to safely detoxify and manage their withdrawal symptoms with only minimal medical supervision? a. A 50-year-old who uses diazepam to "manage my anxiety" b. The 30-year-old reporting a "weekend cocaine habit" c. A 60-year-old who takes a secobarbital "most nights to help me sleep" d. A 70-year-old who usually drinks "3-4 beers in the evening"

b Stimulants, e.g., cocaine or opiates, may produce withdrawal symptoms that are uncomfortable but not life threatening. Detoxification from these drugs does not require direct medical supervision, but medical management of the withdrawal symptoms increases the comfort level. On the other hand, drugs such as alcohol, benzodiazepines, e.g., diazepam, and barbiturates, e.g., secobarbital, can produce life-threatening withdrawal symptoms. These clients should be under close medical supervision during detoxification and should receive medical management of the withdrawal symptoms to ensure a safe withdrawal.

A nurse is concerned about the prevalence of tuberculosis among migrant farm workers. Which of the following activities would be best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

b Tertiary prevention is carried out among persons already infected with the disease. In this instance, DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems. Administering purified protein derivative (PPD) to contacts of those with tuberculosis is secondary prevention as this is an at-risk population. Providing education about the prevention of tuberculosis to members of the migrant community is a primary prevention strategy as it is aiming to prevent the disease from occurring. Using skin tests to screen migrant health workers for tuberculosis infection is secondary prevention as it is a screening aimed at early detection of the disease.

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

b The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection. The agent is the factor that is causing the disease or illness. The host is the human or animal that becomes infected.

Which of the following best describes the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases

b The goal of prevention and control programs is to reduce the prevalence of a disease to a level at which it no longer poses a major public health problem. In some cases, diseases may even be eliminated or eradicated. The goal of elimination is to remove a disease from a large geographical area (e.g., a country or region of the world), such as has been done with polio in the Americas. Eradication is the irreversible termination of all transmission of infection by extermination of the infectious agents worldwide, as has been done with smallpox. Because of the large amount of international travel, it is impossible to prevent the spread of diseases from occurring worldwide. The expansion of health care facilities would not improve the treatment of infectious diseases, rather improved sanitation could assist in this. The goal for the spread of communicable diseases is eradication, not control of new cases.

Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education

b The harm reduction model is a public health approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. Substance abuse education is only one part of the harm reduction model. Using an approach of punishment and the criminal justice system has not been found to be effective based on research.

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

b The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information. There is no evidence that the presence of an STD in women with cervical cancer will lead to congenital defects in offspring. The presence of an STD increases the risk for another STD. There is no evidence of relapse of cervical cancer when there is presence of an STD.

Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital? a. So that the children's families know the public health department cared about them b. So that action could be taken to avoid any such future episodes c. Because the children's parents need to know whom to sue for their medical expenses d. To confirm that the symptoms were due to an infectious disease

b The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case, the nurse wanted to make sure children did not become ill again when it could be avoided. The further investigation of the illness is not to demonstrate caring on the part of the public health department, rather it assists with learning about what factors contributed to the occurrence. It is unlikely that the parents would sue for a hospitalization for severe vomiting and diarrhea. Also, there is no indication that there would be an individual or agency to sue for the symptoms that the child is experiencing. There is no indication as to what caused these symptoms, thus, the nurse would need to do further investigation to determine if they were related to infectious disease or some other contributing factor.

Which of the following describes the purpose of surveillance systems today? (Select all that apply.) a. To obtain data used to fight for increased budgets from taxpayers b. To evaluate the effectiveness of public health programs c. To monitor the incidence of chronic diseases among the local population d. To note and help prevent occupational exposure and diseases help e. To formulate interventions to reduce the incidence of chronic diseases

b, c, d, e Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. With limited budgets, surveillance systems are important. The taxpayer money should be used in the most effective and efficient ways possible. This involves monitoring the effectiveness of health programming, not asking for increased budgets from taxpayers.

A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a. Each participant will state why TSE is important and explain how to do it. b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c. 90% of the men will correctly demonstrate testicular self-examination. d. 100% of the men will do a testicular examination correctly on a model.

c If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, "I'm sorry to bother you when you're not feeling well, but I need to ask you a few questions." Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. "Do you know how you got this infection?" b. "Who lives with you?" c. "Where are you employed?" d. "Where do you usually eat?" e. "Are you sexually active?"

b, c, e The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the client's place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others. Hepatitis A can be spread through food contaminated by an infected food-handler, contaminated produce, or contaminated water. However, this mode of transmission is not very common in the United States.

Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Emphasize how to build learning from previous experiences. b. Use simple words to enhance understanding. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences. e. Use concrete examples to reinforce learning

b, c, e When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills. When working with adults, emphasis should be placed on previous experience. This is not as important when working with children as they have had more limited experiences. Children are not concerned with long-term consequences, rather they focus on consequences and activities that will occur in the near future (short-term).

Five students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that apply.) a. The first student asks for a salad with chicken strips and dressing on the side. b. The second student asks for a hamburger, very rare. c. The third student orders a tuna salad sandwich with extra mayonnaise. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast. e. The fifth student asks for a vegetable platter and a side of hummus.

b, d, e Escherichia coli O157:H7 can produce a strong cytotoxin that can cause a potentially fatal hemorrhagic colitis. Hamburger is often involved in outbreaks, since the grinding process exposes pathogens on the surface of the whole meat to the interior of the ground meat, effectively mixing the once-exterior bacteria thoroughly throughout the hamburger so that searing the surface no longer suffices to kill all bacteria. Also, hamburger is often made of meat ground from several sources. The best protection against foodborne pathogens is to thoroughly cook food before eating it. Salmonella is also transmitted by undercooked foods such as eggs, poultry, dairy products, vegetables and seafood. Consequently, students eating very rare hamburger and undercooked eggs are at high risk. The food items requested by the first (salad with chicken strips and dressing) and third (tuna salad sandwich with extra mayonnaise) students are at the lowest risk for illness. These foods have been thoroughly cooked which helps to assure that potential bacteria have been destroyed.

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a. The child develops allergies with sneezing. b. The child is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school. e. The child persists in biting behavior.

b, d, e Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Thus, the nurse should not be fearful of providing care to this child.

A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.) a. Doctors are feeling rushed as they interact with each patient. b. Emergency departments are notably busier than usual. c. Nurses are calling in ill to the local hospital. d. Pharmacists are discussing the increase in medication purchases. e. Orders for diagnostic tests have increased over last year at this time.

b, d, e Syndromic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to primary care facilities or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. Doctors feeling rushed and nurses calling in ill are not unusual events.

In the United States, which group is most affected by a new HIV diagnosis? a. Women having heterosexual relationships b. White IV drug abusers c. Young Black gay and bisexual men d. Men who have sex with other men

c Although new HIV diagnosis in general has declined, young Black gay and bisexual men are the most affected, with an 94% increase in diagnosis. The largest number of new infections in 2018 was in men who had sex with other men, and this was followed by heterosexual transmission. HIV infections in women are primarily due to heterosexual contact or IV drug use. This information supports the incorrectness of the other options.

Which statement made by the nurse best describes the effect vaccines have had on tuberculosis (TB)? a. Tuberculosis is no longer a threat in most of the world. b. Tuberculosis has developed resistance to the all antibiotics. c. The treatment has helped greatly reduce the incidence of TB in the United States. d. The incidence of TB has remained constant since the 20th century.

c In 1900, communicable diseases were the leading causes of death in the United States. Since that time, improved sanitation and nutrition, the discovery of antibiotics, and the development of vaccines has ended some epidemics such as diphtheria and typhoid fever and greatly reduced the incidence of others such as tuberculosis (TB).

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? a. "Certain pets and farm animals may be Salmonella carriers." b. "It is possible to transmit Salmonella by person-to-person contact." c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d. "Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

c Anthrax (not Salmonella) forms spores when infected blood is exposed to air. Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings.

A nurse considered copying last month's surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? a. Because such data are legally required b. Because it is still part of the nurse's responsibilities, even if on minimal value c. To determine a local baseline rate and immediately notice any change d. To determine differences among communities in need for state assistance

c Disease surveillance generates knowledge of a disease or event outbreak patterns. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks. Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and improve health. Disease surveillance is not part of a legal requirement. There are many useful purposes for surveillance including monitoring for emerging infections and disease trends. The purpose of the monthly surveillance report is not for comparison among communities, rather it is a description of what is happening within the local community.

A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse

c Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful.

A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a. Evaluation b. Experience c. Participation d. Understanding

c Educators should include participation. Lack of participation is a barrier to learning. Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic. Evaluation occurs at the end of the education; evaluation is not necessarily missing when an educator uses lecture as the primary method of education. The nurse may be able to include experiences as part of the lecture when educating clients. It may be difficult to assess understanding if lecture is the primary method of education; however, the nurse should be able to use nonverbal clues to assess understanding. Also, the use of lecture does not mean that understanding is missing from the process.

A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." Which of the following would be the best action for the nurse to take? a. Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set up rewards, such as a nice snack after he gets back from walking.

c Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior. Group support often helps people make needed changes for health that they are unable to accomplish on their own or with the help of just one individual. The role of the employer is not to dictate employee health behaviors, so having a written contract would be inappropriate. The man may already recognize that walking is one of the best health promotion activities he can choose; however, he has expressed that he is lacking motivation. Setting up rewards for himself may be helpful; however, it may not be enough to get him motivated to take action. Group support may help him to get motivated.

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

c Hepatitis B infection can be prevented by immunization; vaccines for the remaining options are not yet available. There are not yet vaccines for chlamydia, gonorrhea, or genital herpes simplex.

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? a. "Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b. "It's just the right thing to do." c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d. "We're a religious God-fearing community, and we take care of each other."

c Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease. The purpose of immunization laws is to promote herd immunity. Receiving immunizations helps to block the further spread of the disease as more members of the community become resistant to the infection.

In which of the following situations would the nurse most likely use an active surveillance system? a. A newspaper wants to know the incidence of asthma in the community. b. A real-time ongoing communication channel is established to monitor a particular symptom. c. Several children become ill with gastrointestinal (GI) upset at one local school. d. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

c In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. Special surveillance is developed when a particular type of data is sought.

Which of the following is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever

c Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States. Babesiosis, Ehrlichiosis, and Rocky Mountain spotted fever are all diseases borne by ticks as the vectors. These are not the most common vector-borne diseases.

The leader of an Alzheimer's support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a. Group norms b. Task norms c. Maintenance norms d. Reality norms

c Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible andcomfortable space. Group norms set the standards for the group members' behaviors, attitudes, and perceptions. Task norms are the commitment to return to the central goals of the group. Reality norms occur when members reinforce or challenge and correct their ideas of what is real.

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

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

A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge

c Steps in the affective domain have the learner doing the following in this sequence: knowledge, comprehension, application, analysis, synthesis, and evaluation. During evaluation, the learner adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior, and this has resulted in the ability to maintain the value of a healthy weight. Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation. None of the other options are considered in the sequence.

Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered

c Syndromic surveillance systems use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks. These systems incorporate factors such as the previously mentioned temporal and geographic clustering and unusual age distributions with groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs, skin rashes, gastrointestinal symptoms) with the goal of detecting early signs of diseases that could result from a bioterrorism-related attack. Syndromic surveillance systems may include tracking emergency department visits sorted by syndrome symptoms as well as other indicators of illness including school absenteeism and sales of selected over-the-counter medications. In recent years, the tracking of cold medicines used to make crystal methamphetamine has received considerable attention. Syndromic surveillance systems use existing health data—the number of air travelers is not existing health data. It is the intention of syndromic surveillance systems to detect early signs of diseases that could result from a bioterrorism-related attack; thus, the system is not measuring the incidence of bioterrorism attacks. Administration of influenza vaccines should decrease the prevalence of this disease. Therefore it is unlikely that the administration of vaccines would be data that is collected; the incidence of the influenza would be more likely to be examined.

In which of the following scenarios is a family member enabling an individual to continue to abuse alcohol? a. The husband asks the nurse to explain why his wife's continued drinking is dangerous. b. The son threatens to leave home because he finds the father's behavior embarrassing. c. The teenage daughter of an alcoholic turns to a favorite teacher for emotional support. d. The wife tells her husband's boss that her husband is sick when he is actually inebriated.

d Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. When someone lies for the abuser, the individual is enabling the abusing behavior to continue. The other options do not demonstrate the behavior of enabling, since none are shielding the abuser from experiencing the consequences of the addiction.

A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, the nurse distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material

c The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned. Because breast self-examination is a psychomotor skill, the emphasis should be placed on the learner having the ability to perform the skill after the conference. The most important aspect should be the time for practice in this situation, and not on the time for questions. The nurse would not need to explain to the audience why culturally appropriate images are acceptable, rather these should have been incorporated into the session. Having printed materials is important so that the learner has a reference after leaving the conference.

A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse while demonstrating empathy? a. "I'm so sorry to hear that. Is your mother able to be with you?" b. "It's good that you and the baby are safe from him." c. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" d. "You must hate him for leaving you alone with a new baby!"

c The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. It is inappropriate to assume that the woman wants assistance from her mother. There is no evidence to suggest that the woman or her baby were in danger before he went to prison. Saying "you must hate him" is not appropriate, as it is not the nurse's role to tell the client how she should be feeling.

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States? a. Answering parents' questions about the safety and importance of vaccines today b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. "No shots, no school" legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge

c Vaccines are one of the most effective methods of preventing and controlling communicable diseases. One of the most effective programs has been the "no shots, no school" legislation, which has resulted in the immunization of most children by the time they enter school. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. These interventions have not been particularly instrumental in reducing childhood infections.

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

c When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV. Thus, it is not worthwhile to be tested during this stage of the illness. This information supports the incorrectness of the other options.

A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when and one is unable to continue drinking? a. If their alcohol consumption is the same size, they'll both pass out about the same time. b. Whoever has food in their stomach will probably vomit and be unable to continue drinking. c. The man will likely win because of an inborn tendency to greater alcohol tolerance. d. The woman will likely win due to the tendency to have more adipose tissue.

c Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men; thus men have an increased tolerance for alcohol. It is also unlikely that they will both "win" at the same time because the alcohol will likely affect the woman factor than the man. The adipose tissue ratio is not a factor in alcohol tolerance. While vomiting may occur, it will not necessarily affect the ability to continue to consume alcohol.

Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox? (Select all that apply.) a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever. e. Vesicles do not collapse when punctured.

c, d, e Symptoms of smallpox include rash lesions on face and extremities ("centripetal"), rash that occurs 2 to 4 days after onset of fever, and vesicles that are deep seated and do not collapse on puncture. Symptoms of chickenpox include a sudden onset with slight fever and mild constitutional symptoms, rash that is present at onset, rash progression is maclopapular for a few hours, vesicular for 3 to 4 days, followed by granular scabs, rash is "centifugal" with lesions most abundant on the trunk or areas of the body usually covered by clothing, lesions appear in "crops" and can be at various stages in the same area of the body, and vesicles are superficial and collapse on puncture.

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

d Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. A chancre at the site of entry is a symptom of primary syphilis. Difficulty coordinating movements is a sign of tertiary syphilis. Jaundice is a sign of congenital syphilis.

The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.) a. Analyze educational health programs offered to the public last year. b. Congratulate the public health staff on the success of their asthma awareness program. c. Determine whether there are any other data sources that might confirm the apparent increase in asthma. d. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases. e. Determine whether there are any other data sources that might dispute the apparent increase in asthma.

c, d, e Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? Confirming the data by comparing it to other sources would be the priority. After this has been completed, the next steps would be for the nurse to look at the health programming and community awareness education that has taken place. It would be premature to look at the programming if the initial data obtained is not accurate.

A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, "My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag." Which of the following best describes the group purpose that is being served by the teenager's statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking about food c. Task function of resolving problems about what to nibble during movies d. Task function of sharing information and resources

d A task function is anything a member does that deliberately contributes to the group's purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenager's statement shared information about a good resource for the group. Maintenance functions help members affirm, accept, and support one another, resolve conflicts, and create social and environmental comfort. The teenagers' comment does not support a maintenance function of the group, rather it focuses on a task function by contributing to the group's purpose.

A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. "A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test." b. "A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure." c. "A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood." d. "A diagnosis of AIDS is made when CD4 T-lymphocytes drop to less than 22 cells/mm."

d AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 22 cells/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, "I don't know if I want to share all the problems I'm having with strangers." Which of the following is the best nurse response? a. "Don't share anything with anyone until you're comfortable doing so." b. "I can understand what you are saying." c. "No one will require you to do anything you don't want to do." d. "The purpose of the group is to have a safe place to share problems with others who may be having similar problems."

d During the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. The response explaining that "the purpose is to have a safe place" both recognizes what was said and clarifies the purpose of the group. The statements of "Don't share anything until you're comfortable" and "No one will require you to do anything..." are supportive, but they do not recognize the phase of development of the group. The statement "I understand..." offers the client empathy but does not reinforce the purpose of the group.

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

d For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10-mm induration would be a positive finding in an immigrant from a region with high TB infection. Erythema alone does not indicate a positive finding. A 5-mm induration is not large enough to indicate a positive finding. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

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

d HIV-infected persons, who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB. Hepatitis B and hepatitis C are both transmitted through blood and body fluids which are not as highly contagious as tuberculosis which is transmitted through airborne droplets. Herpes zoster (shingles) is spread by direct contact with fluid from the rash blisters. None of the other options are as directly related to HIV as an opportunistic disease.

A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity? a. To ensure that local causes of death are consistent with national causes of death b. To confirm that no local health problems are beginning c. To evaluate effectiveness of health promotion programs d. To obtain mortality data for the local area

d Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports, such as death certificates, are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. It is not necessary that the local causes of death are consistent with national causes, rather it is important that the nurse be aware of the major causes of mortality in the community so that the needs of the community can be addressed. Mortality data can occasionally be used to evaluate the effectiveness of health promotion programs, but this would not be the primary purpose of reviewing death certificates. Other data can be used to detect the start of local health problems. Analyzing death certificates as the only means of examining local health problems would provide the nurse with data that is not current.

A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a. At the beginning of the program b. At the program midpoint c. Immediately following program completion d. Throughout the program

d Not only should learners receive feedback but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified. Obtaining feedback only at one point in time during the program does not give the nurse enough feedback as to what is happening throughout the presentation. In order for the educator to modify the teaching process and better meet the learner's needs, evaluation data should be obtained at multiple points in time.

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a. Active immunity b. Acquired immunity c. Natural immunity d. Passive immunity

d Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual, such as the transfer of antibody by the administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination. Active immunity occurs as antibodies develop due to exposure to the antigen. Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent. Natural immunity refers to a species-determined, innate resistance to an infectious agent.

There is great concern in the nurse's community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? a. Ask the state department of health for assistance. b. Demand that everyone over age 65 become immunized immediately. c. Encourage immunization of all children under 12. d. Have an educational campaign to remove any containers of standing water.

d Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather—especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites. Currently, there is not a vaccine available for humans; an equine vaccine does exist, and work is under way to develop a vaccine for both birds and humans. The state health department would most likely not become involved in this local health problem, rather this may be the role of a local health department.

The nurse is trying to determine if a disease occurrence needs to be reported to the state health department. Which of the following resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Nationally notifiable infectious diseases on the CDC website d. State health department website

d Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The CDC updates these conditions annually, and the list can be found under the heading of Nationally notifiable infectious diseases on the CDC website. The weekly reports may provide information about the current incidence or prevalence of certain diseases, but it will not provide the nurse with information about what is required to be reported.

A school nurse stops a student in the hall and expresses concern that, "Your eyes look rather red and dry." The student yawns and denies eye problems but does mention having gained 15 pounds since smoking "special cigarettes." Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana

d Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. Side effects of crack cocaine and ice methamphetamine are similar and include increased breathing, rapid heart rate, high blood pressure, and increased body temperature. Tobacco use is associated with many chronic diseases but a person smoking tobacco would not necessarily display the student's symptoms.

An IV drug abuser admits to the nurse he has no desire to stop using drugs, so rather than lecture the individual on the dangers of drug addiction, the nurse provides information how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases

d Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. This client is already using IV drugs, thus, the nurse will be intervening at the tertiary level of prevention. Secondary and primary prevention strategies would not be appropriate when working with this client who already has a known problem.

A high school student is planning to volunteer at the hospital after school, so he or she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a. "I will be using tiny tines to administer the TB antigen to the skin on your arm." b. "Notify the clinic immediately if you experience any redness or itching at the test site." c. "The areas should be kept dry until you return; cover it with plastic wrap when bathing." d. "You will need to return in 2 to 3 days to have any reaction interpreted."

d The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters. The Mantoux test involves a 0.1-ml injection not tines as in the TB tine test. Slight redness or itching at the test site may occur, but that should resolve on its own and does not require the client to notify the clinic. The client can engage in normal activities; the site does not need to be kept dry.

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

d The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks; thus, this test could be negative now, but positive in 3 months. All persons who have an STD test should be counseled about risk reduction activities before and after the test is done. This information supports the incorrectness of the other options.

Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to "just say no" when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d. The fact that tobacco smoking causes more premature deaths than any other behavior

d The most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. Because the students are engaging in tobacco use, this is the most important topic to address with them at this time. If the students were not engaging in this behavior, the other topics of commonly used drugs on campus, just "saying no", and overcoming peer pressure may have been just as appropriate.

Which of the following infectious disease interventions best represents the use of secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual partners. b. Clients with HIV infection are given medications to improve immunological response. c. Health care workers are encouraged to receive annual vaccinations for influenza. d. Health care workers are required to have a tuberculosis skin test or chest X-ray.

d Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest X-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection.

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B (HBV) than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

d Unlike HIV, there is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease. There are multiple populations that have a high prevalence of HBV including injection drug users, persons with STDs or multiple sex partners, immigrants, and refugees and their descendants who came from areas where there is a high endemic rate of HBV, health care workers, clients on hemodialysis, and inmates of long-term correctional institutions. Those who are infected with HBV are still able to work in health care. There is no evidence that the fatality rate is higher or sooner with HBV than with HIV.

Research as shown that vaping increases an individual's risk of contracting what disease five-fold? a. Gingivitis b. Mouth cancer c. Oral herpes d. COVID-19

d Vaping increases the risk of contracting COVID-19. This is due to the fact that e-cigarettes affect the lungs and immune system, and that makes the user more susceptible to the virus. The seriousness is increased when teens or other uses share the e-cigarettes. Research has found that people who vaped and smoked were five times more likely to develop COVID-19. The other options are potential risks but have not been shown to be so directly associated with vaping.

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions

d Virulence is the ability to produce a severe pathological reaction. Bypassing the normal immunological response mechanisms, invading major organ systems, and producing toxins and poisons that weaken the body are not correct definitions of virulence.

Which aspect of a biological agent is probably the most frightening to those exposed? a. Infectivity b. Invasiveness c. Pathogenicity d. Virulence

d Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease.

A client who is very upset says to the nurse, "But we always used a condom! How could I have genital warts?" Which of the following would be the best response by the nurse? a. "Are you positive you always used a condom?" b. "Condoms don't always work." c. "The condom might have had a tear in the latex." d. "Contact may have occurred outside the area that the condom covers."

d Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur. The challenge of HPV prevention is that condoms do not necessarily prevent infection. Thus, even with correct usage and the use of undamaged condoms, transmission may still occur.