NRSG 333 Edelman - Chapter 25

Countries that don't have the capacity to manage political, social, economic and security risks are called ____. A Fragile states B 3rd world states C Socioeconomic weakened states D Poverty states

A

Which of the following statements is true concerning a life course approach? A This approach considers critical stages and transitions B This approach encourages meditation to uncover key data C This approach can be used regardless of level of health literacy D This approach is best used in conjunction with movement therapies

A Mikkelsen and colleagues (2019) suggest a life course approach. Unlike the disease-oriented approaches commonly used to manage one condition, a life course approach considers the critical stages, transitions, and settings individuals will experience in their life and through which they will work to maintain health. This approach would also take into consideration the social determinants of health, gender, equity, and human rights and would involve a close partnership with health care providers or health coaches who can offer guidance at various points of transition. This approach would also require improved health literacy through work with individuals, institutions, communities, and countries to achieve success in preventing and/or managing NCDs. Movement therapies have no relevance to this approach.

A nurse is providing care to HIV positive care recipients living in sub-Saharan communities in Africa. Which of the following statements is correct concerning HIV/AIDS as viewed from an international perspective? A It is a retrovirus spread by body fluids B It was first discovered in the mid-1970s C 10 million persons live with HIV cases occur world wide D The number of cases of HIV is on the rise compared to previous years

A Human Immunodeficiency Virus (HIV) - HIV is a type of virus known as a retrovirus. It is spread through body fluids. The effect of the virus is that the individual's immune system is slowly destroyed, sometimes to the point that the person cannot fight off other diseases or infections. This virus originated in animals and was probably present in humans by the late 1800s. However, it was not until the mid-1970s, that it became recognized as a strong threat to human life. When the medical community realized the scope of the issue, one of the responses was the creation and implementation of universal precautions, which remain in use today (CDC, 2019c). On a global scale, the United Nations (UNAIDS) reports that 37.9 million persons live with HIV, with 23.3 million taking medications. One point seven million were newly diagnosed in 2018, which is down 40% since the peak year of new diagnoses - 1997. Only 79% of those with HIV were aware of their diagnosis (UNAIDS, 2019).

What is the terminology used to describe the conditions in which people are born, grow, live and age according to the World Health Organization (WHO)? A Social determinants of health B Environmental home base C Immutable risk factor basis D Socioeconomic indicators

A The World Health Organization (WHO) has defined social determinants of health as "the conditions in which people are born, grow, live, work and age". The WHO brought together member states in 2011 to consider the social determinants of health. The resulting declaration signed by member states indicates a "global political commitment for the implementation of a social determinants of health approach to reduce health inequities" (WHO, 2011/2020). The determinants as outlined by WHO and PHAC are found in Box 25-1 at the end of the chapter. The PHAC added race/racism to the determinants of health. This is in recognition that "experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups" (PHAC, 2019).

Which of the following statements is correct concerning vaccines? A A decrease in herd immunity can result from vaccine hesitancy B Faith in vaccine efficacy is improving C MMR compliance in the UK is improving due to public service education D Herd immunity refers to increased cellular immunity from booster vaccines

A Vaccine hesitancy refers to the failure of individuals or families to participate in vaccination programs even when the vaccines are available. There are multiple rationales for this type of behavior. Headlines from around the world have highlighted not only groups that are refusing vaccinations on religious and other grounds, but that faith in the efficacy and necessity of vaccinations is waning even in global areas where uptake was previously excellent (Dube, Gagnon, MacDonald, and the Sage WORKING Group on Vaccine Hesitancy, 2015).When segments of the population engage in vaccine hesitancy, or refusal, the outcome can be a decrease in herd immunity. Herd immunity, also known as community immunity, is "a situation in which sufficient proportion of a population is immune to an infectious disease (through vaccinations and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community" (CDC, 2016). A recent report noted that MMR vaccine uptake in the United Kingdom population had declined for the fourth year in a row to 91.2%, for children before their second birthday (Wise, 2018). The WHO has set a 95% threshold for coverage for the MMR to achieve herd immunity. Thus it is easy to understand why herd immunity may be affected where uptake is poor, and one reason measles is making a worldwide resurgence.

Which of the following statements is correct concerning global disease transmission? (Select all that apply.) A Fragile states face higher risks of transmission from emerging infections B The frequency of pandemics is decreasing C The Covid-19 virus may have its origin in animal sources of disease D Fifty percent (50%) of the earth's forests remain intact

A C Historically, pandemics occurred about every 10 years or so. More recently pandemics are occurring with greater frequency. Examples of recent pandemics include Severe Acute Respiratory Syndrome (SARS) (2003), Influenza A H1N5 (bird flu) (2007), H1N1 (swine flu) (2009), Middle East Respiratory Syndrome (MERS) (2012), Ebola (2014) (Ross, Crowe, & Tyndall, 2015), and coronavirus (COVID-19) (2019).And so the question, why is the frequency of pandemics increasing and what can be done to reverse the course? First, why is the frequency increasing. Only about 15% of the earth's forests remain intact. As animals lose their natural environment, they relocate. Often animal relocation and human movement into the area cleared of the forest contribute to humans and animals living in closer proximity. This increases the potential for animal to human transmission of diseases previously occurring only in the animal population. Currently, about 60% of new human illnesses come from an animal source (Lustgarten, 2020). An example is the description of initial infection for COVID-19 being transmitted to humans by a bat.Fragile and vulnerable settings are also at higher risk for development and transmission of and death from emerging infections, and COVID-19 is particularly problematic as it can be spread by an individual for up to 14 days even when the individual has no symptoms and never exhibits the disease. Fragile states lack the resources and infrastructure for clean water, safe food handling, protective housing, and adequate health care.

Which of the following are classified as one of the four main types of NON communicable disease? (Select all that apply.) cancer inflammatory bowel disease cardiovascular disease chronic respiratory disease diabetes

A C D E Noncommunicable diseases are those that cannot be transmitted directly from one person to another, are chronic, and have a slow progression. With noncommunicable diseases there are often strategies individuals can employ to prevent the disease and/or to slow its progression. The four main types of noncommunicable diseases (NCDs) are cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma), and diabetes. These four types of NCDs account for over 80% of all premature NCD deaths. And 85% of those premature deaths occur in low and middle income populations (WHO, 2018b). Contributing factors to the development of NCDs include unhealthy diets, physical inactivity, exposure to tobacco smoke or the harmful use of alcohol Recent information suggests global climate change also has an impact.

Which of the following statements is correct concerning Dengue fever? A Most cases will require hospitalization B It is transmitted by the Aedes mosquito C 75% of those exposed will become infected D The vaccine is strongly recommended for all persons

B Dengue Fever - is a virus that is spread to humans through being bitten by an infected mosquito of the Aedes species. The same mosquitos can spread other diseases such as Zika. Close to half of the world's population lives in areas where this mosquito can spread disease, which are generally tropical and subtropical areas, including parts of United States. Mosquitos tend to be more prevalent in urban and suburban areas, where humans are more plentiful.There are four variations of Dengue fever, and mosquitos in a given area can carry all four. An individual can get each kind in his or her lifetime. Up to 500 000 persons each year on a global basis have experienced severe Dengue fever requiring hospitalization (WHO, 2019d). Health promotion and prevention activities for Dengue primarily focus on avoidance of mosquito bites, although there is a Dengue vaccine. The recommendation for the vaccine is that it only be given to persons who have already experienced one of the versions of Dengue fever.For those persons who are exposed through mosquito bites, approximately 25% will actually become ill. Fever is the primary symptom, with variations of: pain behind the eyes and in muscles, joints and bones, nausea/vomiting, and rash. Treatment is symptom related, as well as supporting the individual. Most cases will not require hospitalization, and recovery is common in approximately one week (CDC, 2019b).

Which is a predicted outcome secondary to global warming? A Warmer air hold less moisture so less rainfall will occur B Heavier rains and snowfall will likely result C The southwest will experience more precipitation D Fish will not be affected but land animals will be significantly impacted

B Global warming is affecting almost every stage of the water cycle, including evaporation, precipitation, surface runoff and stream flow, oceans, snowpack, and clouds. Warmer air holds more moisture and will pull more water from lakes, oceans, soil, and plants, affecting drinking water supply and agriculture. The warmer, wetter air, when combined with a cold front, will cause heavier rains and snowfall, contributing to more flooding from rain and potentially more flooding with heavier snow melt.Global warming will also affect where the precipitation falls, leading to more precipitation in the northeast and less in the southwest. With drier vegetation, wild fires in the west will likely be more frequent and cause greater areas of devastation. As precipitation patterns change, the food supply is also likely to be affected. Heavier rainstorms have the potential to deplete agricultural land of nutrients important to the crops grown and to pollute rivers and streams with a variety of substances not currently present in the water supply. In addition to contaminating our drinking water, it may also be harmful to fish, causing a decrease in that food supply (Fecht, 2019).

Which of the follow suggestions are consistent with strategies for decreasing greenhouse gas emissions? A Increase household water use to cool and hydrate the air B Use renewable energy sources C Minimize trees in backyard to protect ozone layer D All of the above are recommended suggestions

B It is the efficiencies in lifestyle created over time with our "advances" in technology and conveniences available to us that contribute to the development of greenhouse emissions. As individuals it will be important to make lifestyle changes as well. Suggestions include: 1) eating less meat as it requires more energy to produce than plant-based food; 2) consider modes of transportation and choose those that require less fuel; 3) plant trees to help remove carbon dioxide from the atmosphere (Nunez, 2019); 4) use renewable energy to power your home; 5) use energy efficient appliances; 6) use less water; 7) don't buy more food than you will use to avoid throwing food out; 8) use energy efficient light bulbs; and 9) unplug electronic devices rarely used (Denchak, 2017).

Which of the following statements is accurate concerning primary care? A Global emphasis on primary care is a new concept B The WHO has promoted a renewed commitment to primary care C Primary care cannot occur without a universal health care system in place D The primary healthcare progression model is a sliding scale payment system

B The WHO notes that "primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life" (WHO, 2019a). Several authors posit that primary health care is the backbone of universal healthcare systems. Regardless of one's stance or beliefs on universal healthcare, the fact remains that many of the actions and strategies already mentioned in this chapter and throughout this book rely on the presence of and reasonable access to primary health care. Even in the U. S., where there is significant debate on whether health is a right or a privilege to be purchased, the increasing preparation of and emphasis on primary care nurse practitioners and telehealth delivery systems testifies to the importance of a strong and accessible primary health care system.Global emphasis on primary health care is not new. The first primary health care declaration was signed at Alma-Ata in 1978 and remains the touchstone for all future efforts. More recently, in 2018, the WHO hosted a conference in Astana, Kazakhstan. At this conference there was a renewed global commitment to primary care.One example of an activity that contributes to all goals of PHCPI is the primary health care progression model for measuring primary health care system capacity. While primarily targeting middle- and low-income countries, this model can be used anywhere. The goal of this tool is to use common metrics to measure capacity and performance within a given country. These data can then not only point the way for strategies for improvement within that country, they can provide comparable data for global progress. The 32-measure tool was developed through participatory methods, and piloted in five countries.

Which of the following statements is correct concerning antimicrobial resistance? A Unlike bacteria and viruses, parasites and fungi cannot mutate B Tuberculosis is no longer resistant to antibiotics C HIV is at risk of becoming drug resistant D Gonorrhea has not yet developed resistance to 3rd generation cephalosporins

C

A nurse is working with UNAIDS to fight against HIV/AIDS at the global level. Which of the following activities would the nurse most likely be involved in? A Teaching persons how to initiate respiratory precautions especially masks. B Teaching persons to disinfect the toilet with bleach after use by an HIV positive person. C Promoting measures which lead to early diagnosis. D Avoid shaking hands in social settings to minimize skin-to-skin exposure.

C AIDS is the final state of HIV infection. During the 1970s and 80s, a diagnosis of HIV signaled certain death, with often just a few years between HIV diagnosis, AIDS, and death from complications of AIDs. Significant misinformation was present in the early years, with fears of infection from shaking a diagnosed person's hand, to using the same toilet as an infected person. Further research resulted in the knowledge that HIV was transmitted though specific body fluids, including semen, blood, rectal and vaginal fluids and breast milk. However, excellent precautions, and the discovery of antiretroviral drugs has changed the outlook globally for persons with HIV.Better treatment also includes the early diagnosis of infections that arise in persons with altered immune systems (called opportunistic infections). With all the treatments available today, individuals with HIV can enjoy almost the same length of life as those who do not have HIV (CDC, 2019c).

Which of the following statements is true concerning influenza? A Strains (variants) are common for Covid-19 but are unusual with influenza B The best prevention for influenza is wearing a mask in public C Predicting which strains to include in the flu vaccine is challenging D Influenza rarely affects children

C Influenza Pandemic - Influenza is highly contagious. Individuals are most likely to infect others 3-4 days after symptoms begin, but for some the range of contagion can vary from one day before symptoms to 5-7 days after demonstrating illness. Symptoms include fever/chills, cough, sore throat, nasal stuffiness, muscular aches, and fatigue (CDC, 2020). Influenza can strike at any age, although the very young and elderly are more susceptible to complications and severe cases. Influenza is often mild, and frequently resolves on its own. However, the attack can be severe, and lead to death.There are multiple strains of influenza virus, and frequent mutations within the viruses ensure that there are always new strains arising. The best prevention for influenza is an annual vaccine. Every year, a vaccine is created that addresses the strains that are believed to be the most likely to strike at that point in time. However, it is difficult for scientists to ensure they have the right "mix," as these decisions must be made long before an influenza season begins, to ensure that sufficient amounts of that year's vaccine are developed, produced, and disseminated across the globe for use in clinics and other health care facilities. At the time of writing, there is a global race to create a successful vaccine for COVID-19.

Which of the following statements about the Zika virus is NOT correct? A The actual disease is generally mild for most people B Zika virus can cause microcephaly of the newborn C Tick control measures should be put in place to control Zika D Zika can have neurological complications including Guillain-Barre syndrome

C Zika Virus - Zika is another disease spread through the bite of the Aedes species mosquito. There is now documented evidence of transmission from sexual contact, and from mother to fetus during pregnancy, there have been no confirmed cases of transmission of Zika through blood transfusion (CDC, 2019c). This disease has only been documented since 2007. The actual disease is generally mild, and many persons may experience it without symptoms, or indeed, realizing that they have it. The larger concern with Zika is the influence on other diseases and conditions. This is particularly true for the pregnant woman who experiences Zika virus. This infection may result in preterm birth, miscarriage and microcephaly and other congenital concerns (WHO, 2018c). Further it has been linked to neurological complications, which can include Guillain-Barré syndrome (WHO, 2018c).Health promotion and prevention strategies for Zika virus are similar to those of Dengue fever, highlighting the avoidance of mosquito bites. Women who are pregnant and wanting to become pregnant should take extra precautions including planning or avoiding travel to affected global areas where possible.

Which country emits the most climate-warming greenhouse gases? A India B The United States C China D Venezuela

C China, the world's largest emitter of climate-warming greenhouse gases, is more recently responding to local and global pressure to reduce air pollution. China's economy is heavily industry based and making changes in polluting emissions will take time and considerable effort. But those efforts are beginning as the government is ordering industry and utility providers to change the means by which they create power. To provide alternate forms of energy, the Chinese government is investing significantly in wind and solar power. The government is also encouraging individuals to give up coal-powered furnaces and stoves in their homes (Gardiner, 2017). As a result of the significant pollution in China, a study is under way to determine the effect of phased-in measures that will decrease pollution. Final evaluation of the pollution levels present after the measures are implemented are due in 2020 (Cai et. al., 2016).

Which of the following is NOT a risk factor which leads to the development of non-communicable diseases? A Tobacco use B Sedentary lifestyle C Excessive alcohol D Drinking coffee every day

D

Which of the following statements is correct concerning air pollution? A It contributes to 1 million additional deaths globally each year B Most pollutants are relatively large particles becoming trapped in the lungs C Pollution causes significant COPD but impact on heart disease is minimal D Fine particles from pollutants penetrate the lungs then enter the circulation

D

Which of the following statements is NOT correct concerning the Ebola virus? A Hemorrhaging can occur with Ebola in addition to diarrhea and vomiting B Blood and body fluids can transmit Ebola C The FDA approved a vaccine for Ebola in 2019 D Ebola cannot be transmitted by bed sheets or clothing

D Ebola - is a deadly virus that can be transmitted from animals to humans, or from humans to humans. While this virus is primarily present in sub-Saharan Africa, the nature of global travel can ensure that the potential for spread is clearly worldwide. There are several Ebola virus strains that have been identified, however, only certain ones affect humans (CDC, 2019d). Human to human transmission is through blood or body fluids from an infected person with signs and symptoms, the corpse of a person who died with Ebola, or contaminated bedding or clothing of an infected person. It is noted that Ebola can be found in semen of recovered persons (CDC, 2019e). While few people in North America have been affected, there were some highly publicized cases during the 2014 outbreak. During that outbreak, over 28,000 persons were infected, over 11,000 died (Branswell, 2019).Following an incubation period of 2-21 days, symptoms generally appear. The first symptoms are known as "dry symptoms" - fatigue, fever, aches and pains. The disease then progresses to "wet" symptoms - diarrhea and vomiting, bruising and hemorrhaging. Part of the difficulty in diagnosing is the similarity of dry symptoms to other diseases. If precautions are not observed, the time period of incubation or dry symptoms can provide an excellent path to spreading the virus to other persons. (CDC, 2019f).Scientists around the world have been working on a vaccine for Ebola. One such vaccine, which was trialed for use in 2018-2019, was approved by the European Commission in November, 2019, and it was approved by the U.S. Food and Drug Administration in December, 2019 (Branswell, 2019; CDC, 2019g). Approval was based in part on the documented effectiveness during the trials of the vaccine. A significant thrust of health promotion is for all health care workers to ask questions of every patient - about travel to affected areas, possibility of exposure. A second health promotion strategy is the consistent use of universal precautions.

In 2015, agreement was formed among various nations as formal effort to combat climate change? What was this agreement named? A The Global Climate Initiative B The Greenhouse Compact C The Switzerland Pact D The Paris Agreement

D Global attention has been given to managing climate change in an effort to stop the negative impacts on global health. The Paris Agreement, a formal effort to combat climate change, was developed in 2015. The major aim of this agreement is to strengthen the global response to maintaining a near steady temperature for the earth, with the agreement limiting the increase in temperature during the 21st century to 2 degrees Celsius. A more ambitious goal was also discussed that would keep the rise in temperature to 1.5 degrees Celsius. In all, the Paris Agreement holds participating countries accountable for limiting global temperature increase, decreasing greenhouse gas emissions, having participating countries take stock every five years of their progress toward the goals.Additional conserving and enhancing efforts include replanting forests that have been cut down, encouraging countries to set even higher ambitions for stopping the negative impacts than are identified in the agreement, encouraging adaptation and resilience to diminish vulnerability to climate change. The importance of averting, minimizing and managing damage due to climate change is the focus as is the responsibility of developed countries to assist developing countries relative to these efforts, and providing climate change education to the public (UNFCCC, 2018).

Which of the following statements is correct concerning the Covid 19 Pandemic? A We are not definitively sure of the country of origin but we suspect China B Historically pandemics occur on average every 40 to 50 years C New Zealand has been largely spared due to its isolation and island status D The incidence and mortality rate has differed from country to country

D A pandemic is a situation where a new strain of virus arises, and spreads quickly through a given population. At the time of writing this textbook, the world is engaged in a global pandemic of a novel coronavirus that leads to the disease known as COVID-19. Originating in China, it has now spread to almost every corner of the world. Over time, the world has faced different pandemic situations. Each time, governments and organizations believe they are learning from the challenges that could not be met in the previous situation. However, each time it's also clear that those same governments and organizations were not adequately prepared to manage the challenges of the current pandemic, that some global agency failed to sound the alarm early enough, or that countries failed to take warnings seriously. The response to the pandemic has differed from country to country, as has the incidence and mortality rate, with those countries heeding the warnings and responding more quickly demonstrating better outcomes.Historically, pandemics occurred about every 10 years or so. More recently pandemics are occurring with greater frequency.