Public Health Ch. 23: Poverty, Homelessness, Mental Illness, and Teen Pregnancy

19. A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of the following actions should be taken by the nurse? a.Apply for a grant to fund a mobile clinic to take health care to the clients. b.Distribute flyers to the homeless that detail the location of various types of health care services. c.Refer homeless clients to areas that provide temporary housing. d.Solicit donations for food and clothing to be distributed to the homeless.

ANS: A Accessibility refers to the ability of clients to obtain needed health care services. Although all of these options lead to opportunities for improvement in health, either directly or indirectly, only applying for a grant for a mobile clinic can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places.

20. According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a.$21,200 b.$23,050 c.$25,200 d.$27,050

ANS: B According to the Federal Register in January 2012, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $23,050.

12. The nurse is making a postpartum visit to a teenage mother and her month-old infant. Which of the following assessments would be most important? a.Assessing for mother's ability to fulfill her own growth and development tasks b.Assessing for mother's knowledge about normal infant growth and development c.Assessing how much the teenage mother's own mother is helping her cope with child care d.Assessing whether the baby's father is being helpful to the mother

ANS: B Although the nurse might assess for any and all of these options, the primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse.

5. Which of the following is the most rapidly growing group of homeless? a.Adolescents b.Families with children c.Persons in crisis d.Single men

ANS: B Families with children are the fastest-growing segment of the homeless population.

2. Which of the following racial groups experiences the highest incidence of poverty? a.Non-Hispanic Whites b.Blacks c.Hispanics d.Asians

ANS: B In terms of racial differences in the rate of poverty, non-Hispanic Whites had a rate of 9.9 %; Blacks had a rate of 27.4% and Hispanics had a rate of 26.6% (U.S. Bureau of the Census, 2012).

8. A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern? a.Elevated blood pressure b.First prenatal visit at 5 months' gestation c.Persistent homelessness d.Positive STD test

ANS: C All these assessment findings are of concern and need attention. However, pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus, being homeless is the most dangerous sign of those listed.

16. Which of the following groups is most at risk for suicide? a.Adolescents under age 20 b.Men over age 85 c.Females 25 to 45 years of age d.Women over age 65

ANS: B Men over age 85 are in the highest risk category for suicide.

11. A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider when providing care? a.All teen pregnancies are considered high-risk. b.Limited self-care knowledge can lead to pregnancy complications. c.Pregnant teens are likely to receive prenatal care late in the pregnancy. d.Pregnant teens may have limited financial resources to pay for care.

ANS: A All of these statements are true; thus it is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy.

18. A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. Which of the following actions by the nurse demonstrates the use of secondary prevention to limit caregiver stress? a.Asking caregivers how they are doing and suggesting coping strategies b.Encouraging caregivers to periodically leave the house for a couple of hours c.Establishing support groups for caregivers of older parents d.Referring some activities to neighbors and friends

ANS: A Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed. Also, encouraging caregivers to periodically leave the house for a couple of hours could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

7. The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the following would be the best action to take to improve client outcomes? a.Provide antibiotics to all homeless persons with chronic, nonhealing wounds b.Offer daily access to a room with soap, water, and bandages c.Hand out free bandaging supplies following each clinic visit d.Perform regular monitoring of the client's wound condition

ANS: B Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits.

4. A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child? a.Concern that the child is being mistreated by other children b.Concern that the child has developmental delays c.Concern that the child is given adequate food during lunch d.Concern that the child may need to sit in the front in order to be able to see well

ANS: B Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Poverty-stricken children may be hungry and fatigued and have dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children also experience higher rates of school absenteeism, academic failure, and emotional and behavioral maladjustments. The stress of homelessness can be seen in withdrawal, depression, anxiety, aggression, regression, and self-mutilation. Homeless children may have delayed communication, more mental health problems, and histories of abuse.

9. A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following actions would the nurse most likely take? a.Assist teen mothers to learn about their body changes during pregnancy. b.Develop programs that allow teen mothers to complete their education. c.Offer courses in proper care of babies and how to be a parent. d.Monitor pregnant teens to detect early problems with pregnancy.

ANS: B Single motherhood is increasing. A direct correlation exists between lack of education and poverty. Similarly, a direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth.

10. A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, which of the following comments by a parent would cause concern? a."I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." b."My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c."My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d."I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

ANS: B Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy.

1. A nurse was shocked when late one night she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. Which of the following is the most likely explanation for a healthy young adult engaging in such behavior? a.He ate his meal but wanted more and had no more money. b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c. A friend had thrown his meal away, and he thought he could find his friend's untouched food. d. He was doing this to fulfill an obligation of fraternity initiation at the college.

ANS: B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.

2. A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.) a.Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. b.Cuddle and hold the baby while smiling and gazing into the baby's eyes. c.Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face. d.Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes.

ANS: B, D Suggestions for promoting interaction between an adult and a baby include the following: maintaining a distance of 8 to 10 inches from the baby, smiling, and making eye contact. Talk to the baby, but avoid "baby talk." Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). Babies love to play and enjoy "taking walks" and looking at brightly colored objects or toys that make noises.

15. A community mental health nurse is working within the community to help prevent youth violence. Which of the following interventions would most likely be implemented by the nurse? a.Distributing literature that associates violence with a lack of intelligence b.Explaining to youth why youth violence is detrimental to society c.Partnering with associations to provide alternative activities that improve social skills d.Recommending increased funding to prosecute and jail teens associated with violent activity

ANS: C Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act.

14. Which of the following is the leading cause of disability for Americans 15 to 44 years of age? a.Accidents b.Arthritis c.Major depressive disorder d.Workplace injuries

ANS: C Major depressive disorder is the leading cause of disability for Americans between the ages of 15 and 44 years.

3. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a.The child is accident-prone and clumsy. b.The child is being bullied and pushed around by other children. c.The child is more likely to have school absences. d.The child is in need of a vision screening.

ANS: C Poverty also increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. These children may also be hungry and fatigued and experience dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism (Emerson, 2004).

21. A nurse is working to improve her self-awareness in order to provide better client-centered care to clients living in poverty. Which of the following questions should the nurse ask herself? a.What would I do if I lived in poverty? b.What can be done to get poor people motivated to work? c.How have the media images of poor persons shaped my image of poverty? d.How can community resources assist those living in poverty?

ANS: C Self-awareness is a key component of providing authentic, genuine client-centered care. To clarify their own values and perspectives about poverty, nurses should ask themselves questions about poverty and persons living in poverty. These questions should cause the nurse to reflect on how his or her ideas of poverty have been developed. The only question that relates to the nurse reflecting on how personal values and perspectives have been developed is, "How have the media images of poor persons shaped my image of poverty?" The other questions address how to address the issue of poverty or concerns of the nurse but do not address increasing the nurse's self-awareness.

17. A nurse is trying to decrease the risk for depression among older adults. Which of the following interventions should the nurse implement? a.Encourage moving to a nursing home where others of the same age reside. b.Monitor for signs and symptoms of depression. c.Organize an exercise and health promotion program at the local senior citizen center. d.Teach older clients to focus on their strengths rather than their weaknesses.

ANS: C The depression rate among older adults is half that of younger people, but the presence of a physical or chronic illness increases rates of depression. Depression rates for older adults in nursing homes range from 15% to 25%; thus, encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underuse the mental health system and are more likely to be seen in primary care or to be recipients of care in institutions. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

1. A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describe why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a.Her friends were suggesting ways to make the problem go away. b.She knew she could not be pregnant because her boyfriend said he used a condom. c.She was afraid her parents would pressure her to terminate the pregnancy. d.She kept hoping the pregnancy would just go away.

ANS: C, D Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, because they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Being told that a condom was used doesn't make it so. The girl should know whether a condom was used or not without relying on verbal statements.

6. Which of the following statements best describes why health care of the homeless is so expensive to the community? a.Health conditions of the homeless require increased preventive services. b.Homeless clients typically make more clinic visits for multiple health problems. c.Homeless people spread contagious diseases to those they pass on the street. d.Most care to homeless people takes place in hospital emergency departments.

ANS: D Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore, health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics.

13. A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mother asks, "Do you think my son is crazy?" Which of the following is the most appropriate response by the nurse? a."Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b."Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c."Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." d."Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

ANS: D Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. With more time the nurse can help the mother deal with feelings of having a "crazy" family member and the effects of such behavior on the whole family.