Exam 3

Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. The nurse should be aware that marijuana has which of the following characteristics? Select all that apply. Decreases appetite. May lead to tolerance. Is highly toxic. Has little quality control. Is a safe therapeutic agent.

B, D, E Compared with the other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. However, because of its illegal status, there is little quality control, and a user may consume contaminated marijuana that may cause problems. Tolerance can develop, as well as physical dependence; however, withdrawal is benign.

The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? Assessment level Design level Evaluation level Implementation level

Implementation level Although deinstitutionalization was noble in conception, it was bankrupt in implementation. Families and communities were not prepared to take on the treatment responsibilities they had to assume, and little education was available. Either care settings such as nursing homes, personal care settings, supervised apartments, rooming houses, single-occupancy hotels, and other similar settings were not available, or people were not educated or prepared to deal with this population.

A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population?

Migrant farmworkers A migrant farmworker is a person whose principal employment is in agriculture on a seasonal basis, who has been employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode. Seasonal farmworkers work cyclically in agriculture but do not migrate.

When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas? Large metropolitan areas Most rural and highly populated urban areas Most rural and suburban areas Small suburban and all urban areas

Most rural and highly populated urban areas Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults occur in the most rural counties. Residents of rural areas have the highest death rates resulting from unintentional injuries in general and motor vehicle injuries in particular.

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

housing for migrant workers. Housing conditions greatly vary among states and localities. When housing costs are high, 50 farmworkers may live in one house, or three families may share one trailer. Some may live in cars or tents if necessary. Housing may lack individual sanitation, bathing, or laundry facilities. Poor-quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis.

The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: A. fosters equal family and provider commitment to success. B. facilitates outcomes-oriented family nursing research. C. decreases the need for nurse contact and intervention. D. removes barriers to needed services to achieve success.

A. fosters equal family and provider commitment to success. Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between the parents, or the indirect interaction between the parents and the child). The systems approach to family always implies that when something happens to one family member, the other members of the family system are affected.

A family nurse is working with a married couple that has decided to remain child-free. The nurse recognizes this decision as a: A. biological necessity. B. contemporary family function. C. religious belief decision. D. threat to family survival.

B. contemporary family function. In contemporary times, the traditional functions of families have been modified and new functions added. One of the traditional family functions was to procreate to ensure the survival of the species. Many married couples are electing to be child-free rather than to reproduce.

A public health nurse employed by the Department of Health is working on a team developing local health policy. The nurse recognizes which of the following about policy development? It is based on Socratic method. It is important that the policy has been approved by the American Nurses Association. It is primarily up to politicians to plan for health care. It is very similar to the nursing process.

It is very similar to the nursing process. Statement of a health care problem Statement of policy options to address the health problem Adoption of a particular policy option Implementation of the policy product Evaluation of the policy's intended and unintended consequences in solving the original health problem

Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is another advantage to the use of Methadone? Methadone is a cure for heroin addiction. Methadone has few known side effects. Methadone produces a "high" similar to heroin. Methadone is short acting.

Methadone has few known side effects. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other opioids thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long acting and effective orally, does not produce a "high," is inexpensive, and has few known side effects. The oral use of methadone offers a solution to the danger of the spread of HIV infection and other blood-borne infections that commonly occur among needle-sharing addicts. Although not recognized as a cure for heroin (or other opiate) addiction, methadone maintenance is a harm reduction intervention because it reduces deviant behavior and introduces addicted persons to the health care system (Volkow et al, 2014).

The Patient Self-Determination Act of 1990 requires that providers receiving Medicare and Medicaid funds give clients written information regarding: legal options for treatment choices in the event the person becomes incapacitated. patient rights. the cost of services. patient privacy.

a. legal options for treatment choices in the event the person becomes incapacitated. The Patient Self-Determination Act of 1990 (PL 103-43) requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. A routine discussion of advance medical directives can help ease the difficult discussions faced by health care professionals, family, and clients. The nurse can assist an individual to complete a values history instrument. These instruments ask questions about specific wishes regarding different medical situations.

The ethical question, "Are persons assigned to develop community knowledge adequately prepared to collect data on groups and populations?", is based on an ethical tenet that supports the community-oriented core function of: assessment. assurance. policy development. compliance.

assessment. Assessment is systematic data collecting about the population, monitoring of the population's health status, and making information available about the health of the community. Competency related to knowledge development, analysis, and dissemination is important because the research, measurement, and analysis techniques used to gather information about groups and populations usually differ from techniques used to assess individuals. Policy development and assurance are core functions that use ethical decision making in community-oriented health services.

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: competition. unemployment. survivor guilt. work-related stress.

work-related stress. Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.

A parent with two school-age children has just finished a family health assessment questionnaire. The parent asks the nurse why one of the questions asks whether there is a neighborhood playground. The nurse's best response would be: "Don't worry about it. We are going to talk about all this anyway." "It's important to good health to have adequate recreation resources." "We want to be able to report any dangerous playground equipment to the city." "We want to know what kind of neighborhood you're in so we can assess income."

"It's important to good health to have adequate recreation resources." The importance of social risks to family health is gaining increased recognition. A family's health risk increases if they are living in high-crime neighborhoods, communities without adequate recreation or health resources, in communities with major noise pollution or chemical pollution, or in other high-stress environments.

During a family nursing assessment, a parent questions whether God is punishing the family, because one of the children has just been diagnosed with leukemia. The most facilitative response by the nurse would be: "God is loving and doesn't punish people." "Tell me more about your family's spiritual beliefs." "That is not part of my religious belief system, so I don't know." "Why do you think your family needed to be punished?"

"Tell me more about your family's spiritual beliefs." The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change.

The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: 6 months for white mothers. 10 months for white mothers. 3 months for African American and Hispanic/Latino mothers. 12 months for African American and Hispanic/Latino mothers.

3 months for African American and Hispanic/Latino mothers. Violence that begins in pregnancy may continue for several years after, with increasing severity. Variations by ethnicity have also been observed during this postpartum period: intimate partner violence may peak at 3 months postpartum among African American and Hispanic/Latino new mothers and at 18 months for white mothers. The nurse should look for physical signs of abuse, as well as for controlling or intrusive partner behavior.

Which of the following are factors that may contribute to vulnerability? Select all that apply: Exercise habits Crime Peeling lead paint Social Isolation Literacy

A, B, C, D Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problems

What terms are used to describe healthy families? a. Families with strengths b. Dysfunctional c. Functional families d. Resilient families e. Resistant families

A, C, D Families with strengths, functional families, and resilient families are terms often used to refer to healthy families. Research has been conducted about healthy families, but it is clear that the issues examined all relate to those of relational needs. This means that in healthy families, the basic survival needs are met. The traits ascribed to healthy families are based on attachment and are affectionate in nature.

Which of the following factors have had an impact on the complex relationship among nursing practice, health policy, and politics? Select all that apply. Categorical funding Death penalty Head Start Health fairs Statutory authority for the profession

A, C, E Categorical funding, designating funding for specific needs, has led to the special and more narrowly shaped nursing roles and tasks in community-oriented nursing (e.g., home health care, school nursing, and family planning). Government funds assigned to specific programs or purposes cannot be used to support other services. This factor has restricted the broader development of a public and community-oriented nursing role to meet unanticipated needs since funding drives programming, which drives services, which drives roles. School health legislation establishes a minimum of services that must be provided to children in public and private schools. Examples of such federally legislated programs that affect nursing practice in the schools and with families are Head Start, early diagnostic screening programs, nutritional programs, services for the handicapped, and special education. Despite the broad nature and varied roles of nurses in practice, two legal arenas are most applicable to nurse practice situations. The first is the statutory authority for the profession and its scope of practice, and the second is professional negligence or malpractice. The issue of scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers. The issue is of particular importance to community-oriented nurses who traditionally practiced with much autonomy.

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? Select all that apply. Bed-wetting episodes Desire to return to school Fantasies of denial Increased playfulness with peers Thumb sucking

A, C, E The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to parents or have nightmares and fantasies that the disaster never occurred. School-related problems may also develop, and the child may not be able to concentrate or may even refuse to attend school.

The nurse in community health uses information about family structure, household composition, marriage, divorce, birth, death, adoption, and other family life events to forecast and predict stresses and developmental changes experienced by families and identify possible solutions to family challenges. This best describes the study of: family demographics. family functions. family health. family resilience

A. Family demographics. Family demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing. Nurses must be knowledgeable about family structures, functions, processes, and roles. In addition, nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures.

In applying the developmental theory, a family nurse determines the developmental stage of the family based on: A. age of the eldest child. B. family strengths. C. individual growth patterns. D. overall tasks of the family.

A. age of the eldest child. Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development.

The community health nurse performs an assessment of violence by observing which of the following community characteristics? Select all that apply. Presence of social support networks Crime rates Levels of unemployment Presence of physical disabilities in individuals Presence of family violence

B, C Identification of risk factors is an important part of primary prevention used by nurses who work with clients in a variety of settings: crime rates, unemployment levels, lack of neighborhood resource and support systems, and a lack of community cohesiveness. Individual factors include the presence of physical disability and familial factors are those related to violence and other family factors.

The problem of the working poor and uninsured places a major burden on the current health care system that affects those families and the community in general. Nurses in community health see this as a major: Select all that apply. behavioral issue. policy issue. health risk issue. social issue. nursing issue.

B, C, D Economic risk is one of the foremost predictors of health. It is useful to know whether families' resources are adequate to meet their needs. The standard of living they are comfortable with is not the measure of risk. If the main wage earner is employed but receives no medical benefits, and the salary is not sufficient for health promotion or illness-related care, the family may qualify for available government-sponsored programs. This is a major policy issue of concern to nurses.

Which of the following statements are true regarding the health-related vulnerabilities of men? Select all that apply. More males die at birth. Fewer health services are emphasized for men. Men are less likely to be honest about their symptoms. More males die from suicide. Men do not participate in health care at the same level as women.

B, C, E Although health policies, campaigns, and community health organizations offer services for men, women's health is more often emphasized. Several barriers to men reaching their full health potential have been identified. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Giorgianni et al, 2013). A study from researchers at Rutgers University found that men who held traditional beliefs about masculinity, such as toughness, bravery, self-reliant, and emotionally restrained, were less likely than women to seek medical help, more likely to choose a male provider, and less likely to be honest about their symptoms (in particular, minimizing their symptoms) (Himmelstein and Sanchez, 2016).

Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response? Select all that apply. Disillusionment and reconstruction is most associated with response efforts. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Disillusionment is the longest phase in the stress reaction process. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

B, C, E The first two phases, the Heroic and Honeymoon phases, are most often associated with response efforts. The latter two phases, Disillusionment and Reconstruction, are most often linked with recovery. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Survivors will gather to share experiences and stories. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. The last phase, Reconstruction, is the longest. Homes, schools, churches, and other community elements need to be rebuilt and reestablished.

A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? Select all that apply. Autonomy of the professional Confidentiality when possible Funding Promoting advocacy for disenfranchised persons Respecting only community rights

B, D The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; trustworthiness; and promoting advocacy for disenfranchised persons within the community.

Rural residents appear to have a more persistent, endemic level of depression. The factors that may contribute to this level of depression may be related to which of the following? Select all that apply. Crisis intervention Gaps in continuum of mental health services Sufficient number of mental health services Tolerance for destructive coping behaviors Trust in the health care professionals

B, D There appears to be a more persistent, endemic level of depression among rural residents. Factors that relate to this level of depression are high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.

Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? A. Assessment of the individual's health does not determine the overall family system's health. B. Family functioning affects the health of individuals C. Family system assessment specifically addresses the individual's health. D. The individual's health affects family functioning. E. Simultaneous assessment of individual family members and the family system as a whole is important to family health.

B, D, E The bio/psycho/socio/spiritual approach to family health refers to individual members as well as the family unit as a whole. An individual's health (wellness-illness continuum) affects the entire family's functioning and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.

The community health nurse is aware that lesbian, gay, bisexual, and transgender (LGBT) adults are more likely to experience which of the following conditions? Cardiovascular disease Poor mental health Obesity Poverty

B. Poor mental health Lesbian, gay, bisexual, and transgender (LGBT) adults represent a sometimes hidden special population, in part because of the social stigma associated with homosexuality coupled with the fear of discrimination. Several studies have documented health disparities by sexual orientation in population-based data and have revealed differences in health between LGBT adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, higher risk of disability, and excessive drinking.

Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? Life-cycle theory Family developmental theory Family systems theory Bioecological systems theory

Bioecological systems theory The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. Nurses use family systems theory to understand how a family is an organized whole as well as composed of individuals.

A nurse in community health is working with a single parent of three children, ages 4, 6, and 8. The 6-year-old has cerebral palsy. The 4-year-old has asthma. The maternal grandmother lives with the family and has diabetes. The nurse understands the importance of working within the context of the existing family structure and community resources because families are: a. resistive to outside intervention or involvement. b. responsible for providing/managing the care of their members. c. unable to manage the stress of complex health needs. d. restricted in their ability to identify interventions.

B. responsible for providing/managing the care of their members. Health care decisions are made within the family, the basic social unit of society. Families are responsible for providing and managing the care of family members. Families are significant members of health care teams because they are an ever-present force over the lifetime of care. Families are more responsible than ever for assisting in the health care of ill family members.

It is estimated that one in 11 males becomes a father during his teen years. The nurse should be aware that many young men facing paternity have specific challenges such as: Select all that apply. acting as though they are interested when they are disinterested. avoiding prenatal care involvement. desiring and needing to be involved with their children. being rejected by the young woman's family. rejecting their role as a father.

C, D Nurses can acknowledge and support the young man as he develops in the role of father. Young men react differently when they learn that their partner is pregnant, and it often depends on the nature of the relationship before pregnancy. Many young men will accompany the young woman to a health care center for pregnancy diagnosis and counseling. A large percentage of young men will continue to accompany the young woman to some prenatal visits and may even attend the delivery. These young men may also want to and need to be involved with their children regardless of changes in the relationship with the teen mother. It is not unusual for a young man to be excluded or even rejected by the young woman's family. He may then begin to act as if he is disinterested when he may really feel that he cannot provide resources for his child or know how to take care of the child.

The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? a. Families are defined by genetic ties. b. Family names are needed to confer status. c. Members of a family are self-defined. d. Traditional family functions have been redefined.

C. Members of a family are self-defined.The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill? Assessment Case management Geriatrics Tertiary prevention

Case management Nurses working in rural areas, including those working with migrant farmworkers, have opportunities to use many skills of nursing in community health. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models to address some of those deficits and resolve rural health disparities.

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district health status related to that problem. When gathering information at a national level, they would begin with the: Centers for Disease Control and Prevention (CDC). Centers for Medicare and Medicaid Services (CMS). Health Resources and Services Administration (HRSA). National Institute of Nursing Research (NINR).

Centers for Disease Control and Prevention (CDC). The Centers for Disease Control and Prevention (CDC) serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. The Centers for Medicare and Medicaid Services (CMS) administer Medicare and Medicaid accounts and guide payment policy and delivery rules for services for the poor, elderly, disabled, and unemployed. HRSA has been a long-standing contributor to the improved health status of Americans through the programs of services and health professions education that it funds. The NINR is the focal point of the nation's nursing research activities.

When final health care-related regulations are published, they often lead to changes in practice. After a period of draft review, public comment/hearing, further study if necessary, and then final redrafting, the regulations at both federal and state levels carry the weight of law and are published in the: ANA Code of Conduct. Code of Regulations. Patient Safety Act of 1997. Interstate Nurse Licensure Compact.

Code of Regulations. Revisions made to proposed regulations are based on public comment and public hearing. Depending on the amount and content of the public reaction, final regulations are prepared, or the area and issues are studied further. Final regulations are published in the Code of Regulations at the state and federal level and carry the force of law. When regulations become effective, health care practice is changed to conform to the new regulations. Monitoring administrative regulations is essential for the professional nurse, who can influence regulations by attending the hearings, providing comments, testifying, and engaging in lobbying aimed at individuals involved in the writing of the regulations. Concrete written suggestions for revision submitted to these individuals are frequently persuasive and must be acknowledged by government in publishing the final rules.

A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? Cultural Environmental Political Social

Cultural Cultural attitudes are the beliefs and perspectives that a society values. Perspectives about individual responsibility for health and well-being are influenced by the prevailing cultural attitudes. The media communicate thoughts and attitudes through literature, film, art, television, and newspapers.

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? Anxiety Effects of stress on individuals Sense of urgency Scapegoating and blaming

Effects of stress on individuals The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings. Key actions by the nurse can assist others with dealing with the stress, help people cope, allay concerns and fears, identify feelings that they may be experiencing, assist others to think positively and move to the future, and prepare nursing personnel to be effective in a crisis/emergency situation.

A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? Emotional abuse Emotional neglect Physical abuse Physical neglect

Emotional neglect Neglect is more difficult to assess than is abuse. Emotional neglect is the omission of basic nurturing, acceptance, and caring essential for healthy personal development. These children are largely ignored or in many cases treated as a nonperson. It is difficult for a neglected child to feel a great deal of self-worth because the parents have not demonstrated that they value the child. Astute observations of children, their homes, and the way they relate to their caregivers can provide clues of neglect.

The historical figure whose work in providing care to poor people, primary prevention, and environmental health established that individual as nursing's first moral leader and community-oriented nurse was: Sister Mary Augustine. Florence Nightingale. William Rathbone. Lillian Wald.

Florence Nightingale. Modern nursing has a rich heritage of ethics and morality, beginning with Florence Nightingale (1820-1910). The morals and values she gave to nursing have endured. She was passionate about the need to provide care to poor people and also about the importance of a sanitary environment, as seen in her work with soldiers in the Crimean War (1854-1856). Because of her commitment to poor individuals in communities, her championing of primary prevention, and her work to show that healthy environments saved soldiers' lives, she is seen as nursing's first moral leader and community-oriented nurse. Sister Mary Augustine, William Rathbone, and Lillian Wald are not known as nursing's first moral leader.

The family systems theory encourages nurses to view both the individual clients as participating members of a whole family. What is the major weakness of the systems framework? Views families from both a subsystem and a suprasystem approach. Defines the direction of interactions. Views the family as an agent of change. Focuses on the interaction of the family with other systems.

Focuses on the interaction of the family with other systems. The major strength of the systems framework is that it views families from both a subsystem and a suprasystem approach. That is, it views the interactions within and between family subsystems as well as the interaction between families and the larger supersystems, such as the community and the world. The major weakness of the systems framework is that the focus is on the interaction of the family with other systems rather than on the individual, which is sometimes more important.

A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family's children may qualify for enrollment in the State Children's Health Insurance Program (SCHIP). The nurse's intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides: direct financial subsidies for children. funds to insure currently uninsured children. outreach efforts to enroll eligible children in Medicaid. prospective payments for child services.

Funds to insure currently uninsured children. Title XXI of the Social Security Act provides for the State Children's Health Insurance Program (SCHIP) to provide funds to insure currently uninsured children. The SCHIP program is jointly funded by the Federal and State governments and administered by the states. Using broad Federal guidelines, each state designs its own program, determines who is eligible for benefits, sets the payment levels, and decides upon the administrative and operating procedures. The program is subject to change when states undergo budget reductions.

A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for: disenfranchisement. health disparities. loss of independence. resilience.

Health disparities. Vulnerable populations often have worse health outcomes than other people in terms of morbidity and mortality. These groups have a high prevalence of chronic illnesses, such as hypertension, and high levels of communicable diseases, including tuberculosis (TB), hepatitis B, and sexually transmitted diseases (STDs), as well as upper respiratory tract infections, including influenza. They also have higher mortality rates than the general population because of factors such as poor living conditions, diet, and health status, as well as crime and violence, including domestic violence. Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or with the larger society.

In the event of a disaster, shelters are generally the responsibility of which of the following entities? Centers for Disease Control and Prevention (CDC) Federal Emergency Management Agency (FEMA) Public Health Service (PHS) Red Cross chapter

Red Cross chapter Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress.

A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of: poverty. resilience. risk. vulnerability.

Vulnerability. Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources.

Many families have financial resources that allow them to maintain themselves but limit the quality of their purchasing power. Food high in fat and calories may be affordable, whereas fresh fruits and vegetables may not be affordable. A federal program that attempts to promote healthier diets for vulnerable populations is: Medicaid. Medicare. Supplemental Security Income (SSI). Women, Infants, and Children (WIC).

Women, Infants, and Children (WIC). Nutritious diets are important in preventing illness and promoting health. A US Department of Agriculture (USDA) study examined the effects of its Women, Infants, and Children (WIC) nutrition program. The study found that children who participated in WIC were more linked to the health care system than children who were not. Children in WIC were more likely to receive both preventive and curative care more often than children not participating in WIC.

A nurse in community health is conducting an assessment on a family of four. During the course of the assessment, the nurse collects information about previous generations of the family and siblings. The results are used to create a diagram for the family that displays the family unit across generations. Further discussions occur regarding the patterns of health and illness that relate to biological health risks. The diagram is called: an ecomap. a family plan. a genogram. a risk plot.

a genogram. A genogram is a drawing that shows the family unit of immediate interest and includes several generations, using a series of circles, squares, and connecting lines. Basic information about the family, relationships in the family, and patterns of health and illness can be obtained by completing the genogram with the family.

Provision 1 of the Code of Ethics for Nurses addresses practicing with compassion and respect for the person being cared for regardless of the person's status, attributes, or the nature of the health problem. In applying this provision to practice, the public health nurse understands that: a. there are times when individual rights may be limited because of public health concerns. b. the profession's integrity is at stake. c. the nurse's primary commitment is to the individual being cared for. d. this applies only to nursing in community health.

a. there are times when individual rights may be limited because of public health concerns. Provision 1 and its interpretive statement primarily address the individual when discussing how the nurse practices with compassion and respect for the person being cared for regardless of the person's status, attributes, or the nature of the health problem. However, it is also recognized under provision 1 that there are times when individual rights may be limited because of public health concerns. Provision 2 states "the nurses primary commitment is to the patient whether an individual, family, group, community, or population." All nurses have a responsibility to meet the obligations highlighting professional standards, active involvement in nursing, and the integrity of the profession as outlined in the Code.

In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: absolutely honest about what will be reported and what the family can expect. authoritarian in approaching the problem. cautious in reporting unconfirmed reports of violence. sincere in concern for the victims.

absolutely honest about what will be reported and what the family can expect. The principles of giving care to families who have experienced violence include the following: intolerance of the violence, respect and caring for all family members, safety as the first priority, absolute honesty, and empowerment. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach.

The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges: adapting and coping responses. intellectual capacity. socioeconomic status. spiritual awareness.

adapting and coping responses. Eighty-five percent of all elderly people live in homes alone, with spouses or other family or friends. For many families, the caregiving experience is a positive, rewarding, and fulfilling one. Nursing intervention can facilitate good health for older persons and their caregivers and contribute to meaningful family relationships during this period.

A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: advocacy. culturally competent care. partnership. social justice.

advocacy. Advocacy refers to those actions one undertakes on behalf of another. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that lead to improved public health services for these populations.

For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize drug addiction can be successfully treated, anyone may develop drug dependence, and: any psychoactive drug can be abused. illegal drugs are the category of abused drugs. prescription drugs rarely cause dependence. over-the-counter (OTC) drugs are "good drugs."

any psychoactive drug can be abused. A health care approach to ATOD problems is the harm reduction model. This is a new public health model that nurses can use to treat individuals, families, and communities. To develop a therapeutic attitude, the nurse must realize that any psychoactive drug can be abused, anyone may develop drug dependence, and drug addiction can be successfully treated.

A nurse doing a family assessment asks the client, "Have any of your blood relatives had mental illness?" The nurse is asking this question to: determine whether the family is stable. assess for biological risk factors. decide whether this family member needs medication. demonstrate open-mindedness about mental illness.

assess for biological risk factors. Healthy People 2020 (US Department of Health and Human Services, 2010) identified the following major categories as being: inherited biological risk, including age-related risks, social and physical environmental risks and behavioral risks as well as health care risks. Although single risk factors can influence outcomes, the combined effect of several risks has greater influence.

A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: a. advocate for government programs to treat survivors. b. demonstrate the provider's commitment to address the need for services. c. increase awareness of community resources to address violence and abuse. d. increase the number of individuals identified as perpetrators.

c. increase awareness of community resources to address violence and abuse. Referral is an important component of tertiary prevention. Nurses should know about available community resources for abuse victims and perpetrators. If attitudes and resources are inadequate, it is often helpful to work with local radio and television stations and newspapers to provide information about the nature and extent of human abuse as a community health problem. People often do not seek services early in an abusive situation because they simply do not know what is available to them.

A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: carrying heavy book bags. changing to home education. decreasing fluid intake to avoid nausea. keeping up her grades.

carrying heavy book bags. If teens return to school, it is important for the nurse to discuss these needs: (1) using the bathroom frequently, (2) carrying and drinking more fluids or snacks to relieve nausea, (3) climbing stairs and carrying heavy book bags, and (4) fitting comfortably behind stationary desks.

Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to: character development. consequentialism. distributive justice. egalitarianism.

character development. The goal of virtue ethics, one of the oldest ethical theories, is to enable persons to flourish as human beings. According to Aristotle, virtues are acquired excellent traits of character that dispose humans to act in accord with their natural good. Examples of virtue ethics include benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. Consequentialism is the action that produces the greatest amount of good or the least amount of harm in a given situation. Distributive or social justice refers to the allocation of benefits and burdens to members of society. Egalitarianism is the view that everyone is entitled to equal rights and equal treatment in society.

A particular chronic health problem that is a serious public health challenge and results in health complications that double medical costs is: stroke. hypertension. diabetes. cardiovascular disease.

diabetes. Diabetes is a serious public health challenge for the United States. According to the National Diabetes Statistics Report 2014, one out of every 11 people of the United States population have diabetes (CDC, 2014). People with diabetes are at a higher risk for serious health complication, such as: blindness, kidney failure, heart disease, stroke, and loss of toes, feet, or legs. Due to these health complications, medical costs are twice a high for people with diabetes as those without diabetes. At least 18 of the goals of Healthy People 2020 are related to diabetes.

A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: child abuse. depression. intimate partner abuse. parent's resentment of the preteen.

child abuse. To help abusive families, nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence. As children, abusers were often beaten or saw siblings or parents beaten. They learned that violence is a way to manage conflict. Both men and women who witnessed abuse as children were more likely to abuse their children. Financial solvency and support tended to decrease the incidence of child abuse.

A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for: asthma. attention deficit disorder (ADD). childhood obesity. poisoning.

childhood obesity. Obesity among the youth of the nation has reached epidemic proportions. Many factors contribute to the likelihood that a child will become overweight or obese. Factors include genetics, family eating, and physical activity patterns and time spent inactive while viewing television, playing computer games, or using other electronic devices. The environment in which children live influences obesity.

A nurse in community health is following an older woman who complains frequently of migraine headaches, backaches, and GI disturbances. During a recent visit, the woman states that her adult son now lives with her. He was recently let go from his job. He enjoys hanging out with his old buddies. When he feels better, he will look for a new job. Despite the added burden she really enjoys having her son around again. The nurse should explore this further to determine whether the family is: abusive. codependent. coping. estranged.

codependent. Drug addiction is often a family disease. People in close relationship with the addict often develop unhealthy coping mechanisms to continue the relationship. This is known as codependency, a stress-induced preoccupation with the addicted person's life, leading to extreme and excessive concern with the addict. Codependents try to meet the addict's needs at the expense of their own. Codependency may underlie medical complaints and emotional stress seen by health care providers such as ulcers, skin disorders, migraine headaches, chronic colds, and backaches.

Vulnerable populations may be exposed to more than one hazard at a time. This is known as: cumulative risk. disenfranchised populations. resilience. underserved populations.

cumulative risk. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Risks come from environmental hazards (e.g., lead exposure from lead-based paint from peeling walls or that which has been used in toy manufacturing or melamine added to milk supplies), social hazards (e.g., crime, violence), personal behavior (e.g., diet, exercise habits, smoking), or biological or genetic makeup (e.g., congenital addiction, compromised immune status).

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: anger. delayed stress reaction. inability to concentrate. insomnia.

delayed stress reaction. Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations. Also, they may feel frustration and conflict if their needs seem inconsistent with those of their family and coworkers or if they have left the disaster site thinking that so much more could have been done.

A client is back for his follow-up appointment and says to the nurse, "I know. I know. I drink too much, but the job is so stressful that I need to find a way to unwind at the end of the day. You would too!" The nurse should recognize that this is a primary symptom of addiction known as: denial. social drug use patterns. setting variable. coping.

denial. The role of the nurse in secondary prevention is to accurately assess the client to identify substance abuse and plan appropriate interventions. A progression in drug-use patterns and related problems warns about the possibility of addiction. Denial is a primary symptom of addiction and can be demonstrated by the following: lying about use; minimizing use patterns; blaming or rationalizing; intellectualizing; changing the subject; using anger or humor; and "going with the flow" (agreeing that a problem exists, stating behavior will change, but not demonstrating any behavior change).

The harm reduction approach to substance abuse focuses on health promotion and disease prevention. A primary prevention strategy that can be used by the nurse to address substance abuse under this approach is to: assess for recreational drug use. destroy the myth of good drugs versus bad drugs. encourage children to "just say no." refer to an addiction treatment program.

destroy the myth of good drugs versus bad drugs. Nurses are experts in medication administration and understand the potential dangers of indiscriminate drug use and the inherent inability of drugs to cure problems. Nurses can influence the health of clients by destroying the "good drugs versus bad drugs" myth. This means: (1) teaching clients that no drug is completely safe and that any drug can be abused and (2) helping persons learn how to make informed decisions about their drug use to minimize potential harm.

A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: developmental delays. ear infections. frequent colds and infections. irritability.

developmental delays. Young children are at highest risk for the effects of poverty, especially lack of adequate nutrition and brain development, exposure to environmental toxins, trauma, abuse, and lower quality daily care (Children's Defense Fund, 2014).

The nurse at the adult daycare center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: confront the daughter when she arrives to pick the father up. discuss the findings with the caregivers to determine the cause of the injuries. educate the staff about indications of elder abuse. make a referral to the primary-care provider for follow-up.

discuss the findings with the caregivers to determine the cause of the injuries. Rough handling by caregivers can lead to bruises and bleeding into body tissues because of the fragility of older adult clients' skin and vascular systems. It is often difficult to determine whether the injuries of older adults result from abuse, falls, or other natural causes. Careful assessment through both observation and discussion can help determine the cause of injuries.

The nurse is evaluating a new home health client for ongoing management at home following back surgery for a traumatic injury. The client has been receiving a morphine-based drug for long-term pain management over the past 6 months. The nurse's assessment should include a plan for addressing the client's: drug dependence. drug addiction. substance abuse. opiate addiction.

drug dependence. Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. This is a physiological change in the central nervous system; therefore, the drug must be continued to prevent withdrawal symptoms. The morphine should be gradually tapered rather than abruptly stopped to prevent withdrawal symptoms.

An eighth-grade athlete is brought to the clinic with complaints of palpitations and insomnia. The nurse should consider the possible use of: marijuana. energy drinks. MDMA (Ecstasy). PCP (phencyclidine).

energy drinks. There is a growing public health issue related to the use of energy drinks by children, adolescents, and young adults. Energy drinks are beverages that contain caffeine, taurine, vitamins, herbal supplements, and sugar or sweeteners and are marketed to improve energy, weight loss, stamina, athletic performance, and concentration. The main ingredient, caffeine, causes coronary and cerebral vasoconstriction, relaxes smooth muscle, stimulates skeletal muscle, has cardiac effects, and reduces insulin sensitivity.

A mother brings her child to the nurse's office a few days before the first day of class for the new school year. The mother wants the child to begin school but says, "I'm going to take care of the immunizations tomorrow." The most important action the nurse should take is to: conduct a physical examination to determine whether the child is healthy. explain to the parent that all required immunizations must be given before the child will be allowed to enter school. let the child begin school but ensure that the school keeps the child separated from the other children. make sure the child does have an appointment for tomorrow.

explain to the parent that all required immunizations must be given before the child will be allowed to enter school. Community-oriented nursing practice interacts with many legal aspects of nursing in community health. Nurses employed by health departments or boards of education may deliver school and family health nursing, a specialty area of practice with its own legal aspects. School health legislation establishes a minimum of services that must be provided to children in public and private schools. Children must have immunizations against certain communicable diseases before entering school.

Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as: neglect. incompetence. exploitation. self-determination.

exploitation. Neglect refers to a lack of services that are necessary for the physical and mental health of an individual by the individual or a caregiver. Older persons can make independent choices with which others may disagree. Their right to self-determination can be taken from them if they are declared incompetent. Exploitation is the illegal or improper use of a person or their resources for another's profit or advantage. During the assessment process, nurses need to be aware of conflicts between injuries and explanation of cause, dependency issues between client and caregiver, and substance abuse by the caregiver.

A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: child neglect. family secrets. father-daughter incest. impaired family functioning.

father-daughter incest. Incest occurs in all races, religious groups, and socioeconomic classes. A typical pattern is as follows: The daughter involved in the parental incest is usually 9 years of age at the onset and is often the oldest or only daughter. The father seldom uses force. He is more likely to use threats, bribes, intimidations, or misrepresentation of moral standards. These children may have difficulty in social situations and demonstrate avoidance behaviors. They may also attempt to cover or protect their bodies. Therefore the nurse must be aware of these indicators in order to conduct an appropriate assessment and plan appropriate interventions.

A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in: delinquent behavior. drug use. field work. Migrant Education Program.

field work. Children of migrant farmworkers may need to work for the family's economic survival. Federal law does not protect children from overworking or from the time of day they work outside of school. Therefore children may work until late in the evening or very early in the morning every day of the week. These children may experience constant fatigue and are set up for failure in school.

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

fragmented services. Although migrant workers move from job to job, their health care records typically do not go with them. This leads to fragmented services in such areas as TB treatment, chronic illness management, and immunization. When migrant farmworkers move, they must independently seek out new health services to continue their medications. Also, people with TB may forfeit treatment because they are afraid of immigration authorities.

Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: community deterioration. health care costs. juvenile delinquency. population density.

health care costs. Violence is a public health problem that has both emotional and physical effects. Violence is the major cause of premature mortality and lifelong disability, and violence-related morbidity is a significant factor in health care costs. Violent behavior is predictable, and therefore it is preventable, especially with community action.

Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by: dependency cycle. health literacy. income level. race and ethnicity.

health literacy. A new concern for public nurses and nurses in community health is whether the populations with whom they work have adequate health literacy to benefit from health education. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: fleeing to a shelter. homicide. possessive behavior. spontaneous abortion.

homicide. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the greater potential for homicide, the effects on the children in the household, and the more serious long-term emotional and physical consequences.

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: environmental hazards are minimal. individuals must ultimately recover on their own. the government provides economic support. religious organizations must bear the burden of the community.

individuals must ultimately recover on their own. Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster. During the recovery period, all involved agencies pull together to restore the institutions and properly rebuild. In the end, all of the nurses and organizations in the world can only provide partnerships with the victims of disaster. Ultimately, it is up to the individuals to recover on their own.

A nurse in community health working in an inner city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: at home. full term. identical twins or triplets. low-birthweight babies.

low-birthweight babies. Poor pregnant women are more likely than other women to receive late or no prenatal care and to deliver low-birthweight babies, premature babies, or babies with birth defects.

A community-oriented nurse is interested in studying the hospital discharge data for facilities that typically provide services to members of the community where the nurse practices. The nurse accesses the National Hospital Discharge Survey database of the Department of Health and Human Services (DHHS) to identify data at national, regional, and local levels for comparison purposes. The government health care function being used by the nurse is: direct services. financing. information. policy setting.

information. The federal, state, and local governments carry out four health care functions, which fall into the general categories of direct services, financing, information, and policy setting. Collecting vital statistics, including mortality and morbidity data, gathering census data, and conducting health care status surveys are government functions that relate to the role of the government to provide information. The National Hospital Discharge Survey is a national data source on the health status of the US population from the federal government, Department of Health and Human Services. Direct services may be provided to individuals or groups. Financing refers to government payment for health care services. Policy decisions about health care are made at all levels and within all branches of government.

The most common causes of preventable disease, disability, and death among children are: injuries and accidents. maintaining a healthful diet. physical activity. cardiovascular health.

injuries and accidents. Injuries and accidents are the most common causes of preventable disease, disability, and death among children. Unintentional injuries are any injuries sustained by accident such as falls, fires, drowning, suffocation, poisoning, sports, recreation, or motor vehicle accidents. Because of their size, growth and development, inexperience, and natural curiosity, children and teens are especially at risk for injury.

A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be: complicated to address. costly to serve. invisible to the community. resilient to the community.

invisible to the community. Disenfranchisement refers to a feeling of separation from mainstream society. Groups such as the poor, the homeless, and migrant workers are "invisible" to society as a whole and forgotten in health and social planning. Vulnerable populations are at risk for disenfranchisement because their social supports are generally weak, as are their links with formal community organizations.

In applying Ethical Principles for Effective Advocacy, the ethical principle that empowers the client (groups or communities) to make knowledgeable decisions is: act impartially and offer frank, independent advice. act in accordance with the client's wishes and instructions. act in the client's best interest. keep the client properly informed.

keep the client properly informed. 1. Act in the client's best interest. 2. Act in accordance with the client's wishes and instructions. 3. Keep the client properly informed. 4. Carry out instructions with diligence and competence. 5. Act impartially and offer frank, independent advice. 6. Maintain client confidentiality.

For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: limitations in following treatment protocols. limited number of transient treatment facilities. transition to persistent poverty. use and abuse of tobacco, alcohol, and illicit drugs.

limitations in following treatment protocols. Homeless people are exposed to the elements, crowded and unsanitary living conditions, malnutrition, lack of sleep and stress. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens.

Nurses often participate in field assessment teams during a disaster response. These assessments are crucial to best help: encourage good intentions of those giving aid. match available resources to the population's emergency needs. separate casualties and allocate treatment. provide compassion and dignity.

match available resources to the population's emergency needs. Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features. Elements of a rapid needs assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions.

Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to: adult immunization rates. chronic respiratory illness rates. maternal/infant morbidity rates. obesity rates.

maternal/infant morbidity rates. HPSAs tend to have a high proportion of racial minorities and fewer specialists, such as pediatricians, obstetricians, and gynecologists, available to provide care to at-risk populations. There are extreme variations in pregnancy outcomes from one part of the country to another, and even within states.

A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: developmental disorders. mental health problems. parental neglect. violence potential.

mental health problems. Children are at risk for disruption of normal development by biological, environmental, and psychosocial factors that impair their mental health, interfere with their education and social interactions, and keep them from realizing their full potential as adults. Children can develop depression or behavior problems in response to an actual or potential loss.

Ethical decision making is conducted in a generic framework. One step of ethical decision making is to place an ethical issue or dilemma within a meaningful context. The rationale for this step is: multiple factors affect the formulation and justification of ethical issues and dilemmas. the nature of ethical issues and dilemmas determines the specific ethical approach used. people cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. professional persons cannot avoid choice and action in applied ethics.

multiple factors affect the formulation and justification of ethical issues and dilemmas. The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified. The nature of ethical issues and dilemmas determines the specific ethical approach used when appropriate approaches are considered. The identification process assists people with making sound decisions. Professionals use ethical decision making to make decisions and take action.

One member of an older couple has just retired. This is considered a: developmental stage that will help the family with stress reduction. nonnormative event that will have psychological impact on the family. normative event and can increase the family's risk for illness. normative event and will have little effect on the family' well-being.

normative event and can increase the family's risk for illness. Life events can increase the risk for illness. Normative events are those that are generally expected to occur at a particular stage of development or the life span. If the event is normative, families may be able to identify needed resources, make plans to cope with the change, learn new skills, and prepare for the event and its consequences. This kind of anticipatory preparation can increase the family's coping ability and decrease stress and negative outcomes. However, when the event is nonnormative, or unexpected, families have little or no time to prepare and the outcome can be increased stress, crisis, or even dysfunction.

Indiscriminate use of "good drugs" has caused more health problems from adverse reactions, drug interactions, dependence, addiction, and overdoses than has the use of "bad drugs." The high-risk population group that most experiences the negative consequences identified above is: adolescents. injection drug users. older adults. pregnant women.

older adults. Older adults consume more prescribed and OTC medications than does any other age group. Problems with alcohol consumption, including interactions with prescribed and OTC drugs, far outnumber any other substance-abuse problem among older adults. Factors such as slowed metabolic turnover of drugs, age-related organ changes, enhanced drug sensitivities, a tendency to use drugs over longer periods, and a more frequent use of multiple drugs contribute to greater negative consequences from drug use among older adults.

A nurse in community health is working in a rural setting. In planning for programs to address the population's needs, the nurse should be aware that, in general, rural populations: engage in physical activity during leisure time. engage in preventive behaviors. perceive their overall health as less favorable. use seat belts.

perceive their overall health as less favorable. In general, people in rural areas have a poorer perception of their overall health and functional status than do urban residents. Rural residents older than 18 years assess their health status less favorably than do urban residents. Studies show that rural adults are less likely to engage in preventive behavior, which increases their exposure to risk.

The most significant commonalities between the ANA's Scope and Standards of Public Health Nursing Practice and the Public Health Code of Ethics assert that advocacy is conducted in the: assertiveness arena. education arena. litigation arena. policy arena.

policy arena. The ANA's Code of Ethics for Nurses states, "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient," whereas the Public Health Code of Ethics states, "Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all." There are commonalities between the Code of Ethics for Nurses and the Code of Ethics for Public Health. Both codes provide general ethical principles and approaches that are enduring and dynamic.

An underlying current throughout the special population groups with health disparities is: poverty. aging. minority groups. children.

poverty. Health disparities present political implications and influence government actions. Certain groups have been recognized as experiencing health disparities and have become a priority for policy efforts. Poverty is a strong and underlying current throughout all of the special groups.

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: ARC disaster training. community preparedness. personal preparedness. professional preparedness.

professional preparedness. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.

Nursing interventions and approaches for helping individuals and families to assume an active role in their care should focus on empowerment rather than on enabling. The underlying principle to empowerment is: client dominance. decreased competence. professional dominance. professional-client partnership.

professional-client partnership. Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. For families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action.

A nurse in community health that speaks out in a public hearing in support of changes to existing requirements for reporting any long-term effects of structural or organizational changes within the community's health care organizations would be demonstrating: legislative action. health policy. regulatory action. regulatory monitoring.

regulatory action. The regulatory process, although it may not be as visible as the legislative process, can also be used to shape laws and dramatically affect health policy. Because regulations flow from legislation, they have the force of law. The legislative process begins with ideas (policy options) that are developed into bills. At each level of government, the executive branch can and, in most cases, must prepare regulations for implementing policy and new programs. These regulations are detailed, and they establish, fix, and control standards and criteria for carrying out certain laws.

When determining whether a geographic area is rural or urban, the nurse should recognize that: rural and urban areas, by relative nature, occur on a continuum. rural regions have fewer than six persons per square mile. rural residents feel isolated. rural areas are recreational, retirement, or resort communities.

rural and urban areas, by relative nature, occur on a continuum. Rural and urban residencies are not opposing lifestyles. Rather, they are a rural-urban continuum ranging from living on a remote farm, to a village or small town, to a larger town or city, and to a large metropolitan area with a core inner city.

A nurse in community health decides to form a contract with a family. The contract states that the family will designate one night as a family night. The nurse is most likely using the contract to: make sure the family does what is expected. encourage the family to put plans in writing. let the family know that this is a legal agreement. shift the responsibility so that it becomes a shared effort.

shift the responsibility so that it becomes a shared effort. Contracting involves a shift in responsibility and control toward a shared effort by the client and professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, its ability to make healthful choices is increased. Contracting is a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional.

The school nurse is interested in providing an anti-smoking program in a local middle school and is aware that programs are more effective for this age group when they focus on short-term versus long-term effects of smoking. Besides including health risks and cosmetic effects, the nurse should also consider: behavior modification techniques. effects on the environment. laws regarding tobacco sales to minors. social skills instruction to resist pressure to smoke.

social skills instruction to resist pressure to smoke. Anti-smoking programs directed toward children and teenagers are more successful if the focus is on short-term effects rather than long-term effects. Developmentally, children and teenagers cannot visualize the future to imagine the consequences of smoking. Teaching should include how advertising puts pressure on people to smoke.

A nurse in community health may have state-granted personal immunity for particular practice areas such as giving immunizations. If the state legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice, the legal theory that applies is: case law. respondeat superior. sovereign immunity. worker's right to know.

sovereign immunity. In some states, the legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice under the legal theory of sovereign immunity. Respondeat superior occurs when a nurse is directed to carry out a particular function and the employer becomes responsible for negligence, along with the individual nurse. Case law and the worker's right to know are not associated with the granting of personal immunity to nurses.

A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of: drug abuse. drug addiction. substance abuse. adverse drug reaction.

substance abuse. Substance abuse is the use of any substance that threatens a person's health or impairs social or economic functioning. This definition is more objective and universal than the government's definition of drug abuse, which is the use of a drug without a prescription or any use of an illegal drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed. Adverse drug reactions are associated with side effects.

Politics is simply described as: the ability to fund a special project. the art of influencing others. business conducted in the senate. interaction between the policymakers and the public.

the art of influencing others. Politics is the art of influencing others to accept a specific course of action. Therefore, political activities are used to arrive at a course of action (the policy). Law is a system of privileges and processes by which people solve problems based on a set of established rules. Policies are made not only by governments but also by institutions such as a health department or other health care agency, a family, or a professional organization. Politics are associated with funding, business conducted in the senate, and interaction between policymakers and the public, but these are not the correct definition of the term.

A public health nurse has identified the need to make amendments in an existing law concerning the TB health assessment of individuals sentenced to serve jail terms on weekends only, based on the current criminal justice system practices and potential health risk to the free-living community. To raise this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by: the executive branch of the government. the legislative branch of the government. local representatives. senate hearings.

the legislative branch of the government. Each of the government branches at the federal, state, and local levels plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues to address issues related to required laws and regulations as well as existing laws and regulations. However, each branch of government has separate and important functions. The legislative branch identifies problems, proposes debates, and passes and modifies laws to address identified problems.

Caring and the ethic of care is a core value of nursing in community health. Feminist ethics is pertinent to public health because: gender-related voices to moral judgment are applied. principles of utilitarianism are applied. differentiate distributive justice from beneficence. the role of political and social structures in health are recognized.

the role of political and social structures in health are recognized. Caring and the ethic of care are core values of public health nursing. Like virtue ethics and other communitarian views (i.e., the relationship and responsibility between the individual and the community), feminist ethics rejects abstract rules and principles. According to Rogers (2006), feminist ethics is pertinent to public health because it recognizes the role of political and social structures in health. These concepts are not associated with utilitarianism or the differentiation between distributive justice and beneficence.

A nurse in community health is conducting a parenting class for prospective parents that will focus on the development of new skills, identification of needed resources, planning, and other preparations for the arrival of a newborn. This intervention is addressing a potential risk associated with: biology. behavior. environment. transitions.

transitions. Transitions, or the movement from one stage or condition to another, are times of potential risk for families. Age-related or life event risks often occur during transitions from one developmental stage to another. They require families to learn new skills; change behaviors, schedules, or patterns of communication; identify needed resources; and make plans.

A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': dependence on their primary-care provider. normal sensory losses. reduced social contacts. underutilization of the mental health system.

underutilization of the mental health system. Older adults, because they may depend on others for care, are at risk for abuse and neglect. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underutilize the mental health system and are more likely to be seen in primary care or to be the recipient of care in institutions. The nurse can reach them by organizing health-promotion programs through senior settings or other community-based settings.

The major factor that has increased the danger of natural disasters is: El Niño. geography. trade winds. urbanization.

urbanization. The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms.

The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to: conduct a comprehensive assessment and formulate a plan for treatment. establish a long-term trust relationship to prevent disappointment. schedule appointments for appropriate immunizations for the children. use every opportunity to teach about preventive health care.

use every opportunity to teach about preventive health care. Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions of environmental hazards and violence and assurance of safe food and water.

A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of: disenfranchised populations. disadvantaged populations. vulnerability. vulnerable populations.

vulnerable populations. Vulnerable populations are those groups who have an increased risk to develop adverse outcomes. A vulnerable population group is a subgroup of the population, more likely to develop health problems as a result of exposure to risk or to have worse outcomes from a health problem than is the rest of the population. The risks are often cumulative risks from environmental hazards, personal behavior, or biological or genetic makeup.

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: immunizations. active tuberculosis (TB) cases. WIC enrollees. vulnerable populations.

vulnerable populations. When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.

The community-oriented nursing care function of policy development is supported by the ethical tenet of: competency. do no harm. what is ethical is also good policy. to each person a fair share.

what is ethical is also good policy. The voice of the community is the foundation on which policy is developed. Service to others over self is a necessary condition of what is "good" or "right." Service requires ethical action and what is ethical is also good policy. Therefore, moral leadership from nurses is critical to the development of ethical health care policies. Competency and do no harm refer to the assessment function of public health nursing. "To each person a fair share" applies to the assurance function of public health.