Week 2
ANS: C Family structure refers to the characteristics and demographics (gender, age, number) of individual members who make up the family. Structure defines the roles and the positions of family members.
In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a.Dynamics b.Function c.Structure d.System
ANS: D A major task of the post-visit phase is documenting the visit and services provided.
During which phase of the home visit does the nurse document what was accomplished? a.Pre-visit phase b.In-home phase c.Termination phase d.Post-visit phase
ANS: C Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability.
A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Health promotion
ANS: C The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.
. A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a.Family systems b.Structural-functional c.Family developmental d.Interactionist
ANS: A Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision. It serves as more of a medical model than the senior center, and individuals typically return home to their caregivers at night. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems and help would not be available.
A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a.Adult day health b.Home health c.Long-term care d.Senior center
ANS: C Durable medical power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so.
A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a.An advance directive b.A living will c.A durable medical power of attorney d.The Patient Self-Determination Act
ANS: A The goal of Healthy People 2020 is to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases and their complications. Nursing activities should align with these goals.
A community health nurse is planning to implement an intervention to reduce the prevalence of sexually transmitted diseases in the community. Which of the following actions would most likely be taken by the nurse? a.Establish immunization clinics to prevent STDs. b.Educate people with HIV about the mode of transmission. c.Explain to women that HIV is transmitted to women usually by IV drug abuse. d.Develop a STD clinic to increase community access to services.
ANS: A, C Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurses employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.
A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.) a.The family wont have to travel. b.It is cheaper for the family because of reimbursement requirements. c.Meeting at home is much more convenient for the family. d.The nurse wont be distracted by other clients or responsibilities. e.It would save money for the nurse and the clinic.
ANS: C, D With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity.
A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best assist them with healing? (Select all that apply.) a.Advocating for increased support for elderly persons b.Eliminating signs and symptoms of disease c.Managing any chronic diseases to prevent complications and delay deterioration d.Maximizing self-care capacity
ANS: D Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.
A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a.Call the agency and ask what she should do. b.Call the family, explain the situation, and try to reschedule. c.Fulfill the nurses commitment to the family and enter the home quickly. d.Drive away and notify the family from a safer location.
ANS: C During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The other options listed occur during the pre-visit phase.
A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? a.Determine the familys willingness for another home visit b.Establish the purpose of the visit c.Review the familys learning and other accomplishments of the visit d.Review the family record and reason for referral
ANS: A The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the familys connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the familys interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.
A home health nurse who is visiting a family for the first time asks, Could we review your extended family and other persons or groups with whom you interact each week? Which of the following provides the best rationale for the nurse asking this question? a.To assess the familys environment and social resources and risks b.To communicate with relevant others as needed c.To determine financial assets available to the family in case of serious need d.To understand the extended family relationships
ANS: A Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident.
A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a.Does your 4 year-old have a booster seat in the car? b.Have you noticed any physical problems as you go about your daily routine? c.What concerns do you have today? d.Why did you decide to come in for a checkup?
ANS: C Motor vehiclerelated injuries and violence are the leading causes of morbidity and mortality for adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son.
A mother says, My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and other activities. Do you think I should let him have a car? Which of the following statements would be the best response by the nurse? a.Absolutely, it will help him recognize the cost of gas and maintenance. b.Certainly. Most young men want their own car, and peer pressure can be painful. c.It depends on whether you trust your son to drive safely. d.No, adolescent males cannot be trusted with an automobile.
ANS: A Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughters (and grandchilds) needs.
A new mother is a full-time college student who lives with her parents, because the babys father has been imprisoned related to theft and drug abuse. The infants grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this familys needs? a.Developmental b.Interactional c.Structure-function d.Systems
ANS: C The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.
A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, My mom said she couldnt see you and you should go away. Which of the following actions should be taken by the nurse? a.Demand the child let the nurse into the home to talk to the mother. b.Interview the child as to how the family is doing. c.Leave a card with information on how to get in touch with the nurse . d.Point out that legally once an appointment has been made the mother needs to be seen.
ANS: C When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions.
A nurse asks a family member, What has changed between you and your spouse since your childs head injury? Which of the following focuses of the family is the nurse assessing? a.The context b.The client c.A system d.A component of society
ANS: A, D The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the familys situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the familys willingness for a home visit. If the family does not have a phone, mail can be used to share information.
A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.) a.The reason for the visit b.Everything the nurse knows about the family c.How many visits will be planned d.The cost of the visit and how this may be paid
ANS: A The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time.
A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a.Bioecological systems theory b.Family systems approach c.Family developmental theory d.Interactionist theory
ANS: B, D During the beginning phase of the nurse-family interaction, three activities occurmutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.
A nurse enters a familys home for the first time. Which of the following goals should the nurse have? (Select all that apply.) a.Assessing each family member in detail both physically and psychologically b.Collaborating with the family to establish goals and a plan for meeting them c.Determining the exact relationship between each member of the family d.Exploring the familys perception of their problems and needs
ANS: C Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the family as context concept, the family serves as either a resource or a stressor to individual health and illness.
A nurse focuses on the care of the individual while viewing the clients family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurses view represent? a.Client b.Component of society c.Context d.System
ANS: A The nurses approach to the family should be positive and focused on competencies rather than on problems or deficits.
A nurse has been successful in creating improvement in a familys health. Which of the following characteristics is most likely displayed by the nurse? a.Skilled at recognizing and strengthening the familys competencies b.Skilled at obtaining referrals and resources for the family c.Skilled at communication and interpersonal relationships d.Skilled at assessing and naming the familys main problems
ANS: A Transitions (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. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.
A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? a.An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b.Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c.Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the childs immunizations are up to date. d.A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.
ANS: C Assessment is interactive. As you are evaluating families, they are evaluating you. Too much disclosure during the early contacts between the family and nurse may scare the family away. Slow the process down, and take time to build trust.
A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a.Confirm the reason for the assessment. b.Demonstrate culture awareness. c.Take time to build trust. d.Understand the family dynamics.
ANS: A Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.
A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? a.Contracting b.Crisis intervention c.Empowerment d.Strategic planning
ANS: C A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.
A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? a.I cant visit my husband in the hospital when Im at work all day. How can I be sure hes all right? b.My husband always handled our finances. Now that hes gone, Ill have to learn how to do this. c.I dont know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children. d.What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?
ANS: A Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.
A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a.Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b.Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c.Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d.Survey families in the community to determine whether they eat clay and how much clay they eat.
ANS: C With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurses self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the clients expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.
A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a.Assess the family and the home setting for both strengths and problems. b.Determine the familys expectations of a home visit. c.Establish rapport between the nurse and the family. d.Engage in extended social interaction as would be expected from any guest.
ANS: D Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.
A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a.Before eating, the family prayed, expressing gratitude for their blessings. b.During family play, jokes and laughter were heard. c.Each person had a private room with a door for alone time. d.Most of the conversation was between the father and the eldest daughter.
ANS: D Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.
A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a.Health promotion activities b.Illness prevention activities c.Risk reduction activities d.Unhealthy activities
ANS: C Marriage is indicated by a solid line on a genogram.
A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a.A broken line b.A dashed line c.A solid line d.Two parallel lines
ANS: A Use of electronic health records, provider reminders for key evidence-based care components, interprofessional teams communicating regularly and community health classes to educate people with chronic diseases are various ways the CCM is being implemented. Creating a budget is not a way to use CCM. Administration of immunizations and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.
A nurse is implementing Wagners Chronic Care Model. Which of the following actions would the nurse most likely take? a.Educate a community group about hypertension control. b.Create a budget for chronic disease management. c.Administer immunizations to community members. d.Conduct depression screenings in the community.
ANS: C Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes.
A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? a.Developing lifestyle improvement programs for women at risk for diabetes b.Presenting lifestyle management presentations at womens conferences c.Monitoring blood glucose levels closely and modifying diet accordingly d.Screening glucose levels of women at risk for development of diabetes
ANS: A Connecting offenders with community-based mental health programs at the time of release from prison can decrease recidivism rates, because many incarcerated adults experience major psychiatric disorders. It would be impossible for the nurse to supervise all mentally ill offenders in the community. Increased prison time is not shown to decrease recidivism rates and education about available state resources is not the most important nursing intervention to provide for this population.
A nurse is working with incarcerated adults who are being released from prison. Which of the following nursing interventions would be most appropriate for the nurse to implement? a.Connect offenders with community-based mental health programs. b.Provide community supervision for mentally ill offenders. c.Advocate for increased prison time to decrease recidivism rates. d.Educate about available state resources.
ANS: C Risk reduction is a complex process that requires knowledge of risks and families perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the familys perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.
A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? a.Did any of the hunters in your family kill a deer this year? b.How do you keep your rifles safe from curious children? c.Where do you shoot with your handguns? d.Where do you keep your rifles locked when it is not hunting season?
ANS: B It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure.
A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a.Increasing sessions with the nurse b.Making referrals when appropriate c.Providing a formative evaluation of the relationship d.Refusing additional communication with the family
ANS: B It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family.
A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a.The assessment cannot be done unless the extended family is present. b.It may be difficult to find a convenient time for all family members to be present. c.Nurses have limited time to do home visits. d.Families are often scattered over a large area, making access difficult.
ANS: C Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurses second focus.
A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse does not yet know the community, which of the following programs would be good to plan first? a.Alcohol and tobacco cessation programs b.Cancer screening programs c.Cardiac health education programs d.Exercise for life programs
ANS: D A number of factors contribute to depression, including being female, having a family history of depression, unemployment, and chronic disease. All the options represent a loss, either potential or actual, but the statement about not caring about anything represents an actual symptom of depression.
A nurse is performing a health assessment on a young adult female. Which of the following comments by the client would cause the nurse to be concerned? a.I cant believe I didnt get that promotion. I thought I was the best candidate. b.I cant believe they didnt admit me to that graduate program with my good undergraduate grades! c.I cant believe how lonely it is around the house since my spouse died. d.I cant believe how little I care about anything anymore since that diagnosis.
ANS: B The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of pre-conceptual counseling.
A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling? a.Encourage the individual to choose abstinence. b.Ensure the individual is educated to make an informed choice about reproduction. c.Advocate for increased funding for reproductive services. d.Reduce the health risks of the individual.
ANS: C Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects by 50% to 70%. A recommendation was made that women capable of or planning a pregnancy take 0.4 to 0.8 mg of folic acid daily
A nurse is providing pre-conceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a.Iron b.Calcium c.Folic acid d.Vitamin C
ANS: D The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.
A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a.Resigning from employment, but retaining health insurance b.Sharing family information with colleagues c.Providing Medicaid to a family who cannot afford health insurance d.Taking a defined time off of work for family events without fear of job loss
ANS: A The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.
A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? a.Be sure to take a 30-minute walk each day. b.Call our office if you have any questions or concerns at all. c.Come back in 2 weeks for follow-up on your surgery. d.Continue to take the drug until it is gone, even if youre feeling better earlier.
ANS: B The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used. Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the familys strengths gives the nurse assets on which to draw in planning care.
A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a.Allowing the family to be noncompliant b.Building on the familys strengths and resilience c.Labeling the family as resistant d.Recognizing that the family is dysfunctional
ANS: A Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.
A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take? a.Conducting a sexual behavior survey with the adolescents b.Establishing in-school education related to transmission of sexual infections c.Providing free condoms at schools and universities d.Providing follow-up educational programs for those diagnosed with an STI
ANS: A, B, D Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the familys home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.
A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) a.The nurse can assess the family environment. b.The family will feel more comfortable. c.Families typically welcome others into their home. d.More family members can typically be involved.
ANS: D Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.
A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? a.Apply for emergency financial assistance on the familys behalf. b.Arrange for community members to assist with child care. c.Invite the mother to join a cancer support group. d.Teach the family how to navigate the health care system.
ANS: C Motor vehicle accidents are the leading cause of death among children and teenagers.
A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a.Anti-alcohol program b.Anti-smoking program c.Careful driving program d.Safe sex program
ANS: A Injuries are the number one cause of death for children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable. Obesity, although a significant problem, is not a common cause of death in children.
A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a.Accidents and injuries b.AIDS c.Childhood obesity d.Vaccine-preventable diseases
ANS: A Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.
A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? a.Establish lifestyle improvement programs through local youth organizations. b.Evaluate the food intake of a group of children for a 48-hour period. c.Provide education programs to overweight expectant parents. d.Evaluate the body mass index of children at regularly scheduled well-child exams.
ANS: B Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).
A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a.I make most of the decisions so the kids dont notice much difference. b.My daughter is pretty independent; shes active in both sports and theater. c.My son is old enough to get a job and help pay all these medical bills. d.My wife taught our daughter how to cook simple meals.
ANS: A Life expectancy is a measure that is often used to gauge the overall health of a population.
A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most likely use? a.Life expectancy b.Mortality rate c.Morbidity rate d.Health status
ANS: B, C It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limiting alcohol consumption; and avoiding smoking.
A nurses mother leans forward and says, My best friend fell the other day and now shes in the hospital. Im really worried about getting osteoporosis. What do you think I should do? What should the nurse recommend? (Select all that apply.) a.Ask your doctor for hormone replacement therapy. b.Continue to abstain from alcohol and not use tobacco. c.Eat foods high in calcium such as fortified skim milk. d.Eat lots of green leafy vegetables.
ANS: C Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant.
A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be most effective? a.Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b.Increase nutrition programs in schools that teach children to make healthy food choices. c.Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d.Provide after-school and summer camps that focus on diet and exercise.
ANS: D The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member.
A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a.Personal Responsibility and Work Opportunity Reconciliation Act b.Womens Health Equity Act (WHEA) c.Temporary Assistance for Needy Families (TANF) d.Family and Medical Leave Act (FMLA)
ANS: A, B, C Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer.
After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older friend asks the nurse, Im really scared of getting cancer. What can I do to avoid that kind of cancer? Which of the following recommendations should be made by the nurse? (Select all that apply.) a.Avoid smoking or much alcohol. b.Choose poultry or fish rather than red or processed meat. c.Eat lots of fruits, vegetables, and fiber each day. d.Try to get at least 8 hours of sleep a night.
ANS: D Hospice would be the best form of care for a person in the last stages of dying.
An elderly person is in the last stages of dying. Which type of care would be the best for him? a.Home health b.Assisted living c.Nursing home d.Hospice
ANS: B Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.
An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? a.Avoidance of alcohol b.Regular physical exercise c.Daily consumption of calcium-rich foods d.Monthly self-breast and testicular exams
ANS: C Smoking has been identified as the most important preventable cause of morbidity and mortality in the United States.
If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a.Alcohol b.Guns c.Tobacco d.Unprotected sex
ANS: C, D Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, conferring social status. Today, however, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health.
In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) a.Conferring appropriate social status b.Educating the younger members c.Ensuring physical and mental health d.Fostering interpersonal relationships and support
ANS: A HRT does not prevent heart disease. To prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active.
Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a.HRT does not prevent heart disease. b.Use of HRT is recommended to prevent osteoporosis. c.When used with complementary therapies, HRT is most effective. d.HRT is a contributing cause of breast cancer.
ANS: C Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.
Which of the following best describes a normative life event that can increase the risk for illness? a.A family is involved in a motor vehicle crash. b.A group of teens experiment with recreational drugs. c.A woman is pregnant with her first child. d.The family wage earner is laid off from his job.
ANS: D Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A family may range from the traditional nuclear model with extended family to such postmodern family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.
The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the mans married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the family? a.The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b.There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c.There is no family here, only three adults sharing resources between themselves and two biologically related children. d.The family includes whoever the adults state are family members.
ANS: B Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. However, if family members are supportive, they will want to try to help the ill member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill members needs without making drastic changes in the overall eating patterns of the family.
The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a.The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b.The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c.The family member who prepares food will probably prepare meals based on the diet plan for all the family. d.The family member who prepares food will probably prepare special meals for the newly discharged member.
ANS: C, D In contracting, an important aspect is obtaining the familys view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The familys inability to change as easily and quickly as they had hoped does not mean the plan is not workableonly that more time and effort may be necessary.
The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) a.A reassessment of resources should be done if the plan does not work. b.Individual family members must all be willing to make the plan their first priority. c.Goals must be realistic and feasible. d.Ongoing negotiation is central to the process.
ANS: D The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning.
The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a.How many children do you have, and who is the father of each? b.Is there a register of families who are members of this commune? c.Tell me about your significant other. d.Who are the members of your and your childs family?
ANS: B In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.
The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a.The family is lacking a strong support system. b.The familys basic needs are being met. c.The couples in-laws are unavailable to share their expertise about child care. d.The married couple is excited about their first baby.
ANS: A The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management.
Toward whom is the TLC model targeted? a.Caregivers of older persons with health problems b.Community organizations that offer services for the elderly c.Elderly clients with health problems d.Nurses who care for older clients
ANS: C Physiological health involves issues related to physical wellness or illness. Other components of health in Neumans model include psychological health, sociocultural health, developmental health, and spiritual health.
Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a.What helps you to cope with situations involving your wifes cancer? b.How has your childs illness affected the behavior of your other children? c.Tell me about any illnesses your other family members have. d.Who do you turn to for support outside your immediate family?
ANS: A, B, C Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the mature minors doctrine. This allows youths 15 years of age and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated.
Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.) a.A 16-year-old who is living on his own (not with his parents) b.A pregnant adolescent c.An adolescent in an emergency situation d.An adolescent whose diagnosis has a serious prognosis
ANS: D A major obstacle to improving mens health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of U.S. men see a doctor, nurse practitioner, or physician assistant compared with 74% of women
Which of the following behaviors results in men being less healthy than women? a.Concentration on sports, hunting, and other dangerous recreational choices b.Employment in stressful positions more so than women c.Preference to spend money on priorities other than health care d.Reluctance to visit physicians
ANS: B Genomic health care can give health care providers the tools that they need to use a persons unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a persons risks for the same diseases that other family members experienced. Genomic health care is broader than detecting risk for developing cancer.
Which of the following best describes the use of genomic health care? a.Assists with understanding family relationships b.Assists with determining familial health risks c.Useful in learning about environmental risk factors d.Useful in detecting risk for developing cancer
ANS: B Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider.
Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a.Education for women about breast cancer b.Early detection programs with referral to ongoing access to a care provider c.Primary prevention programs d.Tertiary care through long-term follow-up
ANS: C Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer.
Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a.Being of Caucasian descent b.Has not had a PSA test c.Has a father or brother who has had prostate cancer d.Has benign prostatic hypertrophy (BPH)
ANS: A Children under the age of 4 years and children with special needs are at highest risk for abuse.
Which of the following children is most at risk for being abused? a.A 1-year-old b.A 6-year-old c.A 9-year-old d.A teenager
ANS: C Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesnt move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.
Which of the following clients would cause the nurse the most concern? a.The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b.The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c.The client who is employed and often works 12 hours a day without moving from the computer desk d.The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center
ANS: A, B, D Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the familys willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurses time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurses perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available.
Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) a.Agencys policies regarding eligibility for services b.Familys feelings about the home visit and willingness to continue c.Nurses perception of the amount of time needed to complete required tasks d.Reimbursement policies of third-party payers
ANS: D Poverty is a strong and underlying current factor that affects all special groups.
Which of the following factors has the largest impact on health disparities among all populations? a.Ethnicity b.Education level c.Lifestyle choices d.Poverty
ANS: B Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The plan cannot be the nurses choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.
Which of the following factors must be considered before deciding on an appropriate plan of action? a.Family agrees to the nurses plan. b.Family is capable of the required actions. c.Family will learn better coping skills from the nurses plan. d.Nurse has informed family how to complete the required actions.
ANS: C A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.
Which of the following families is at high risk for health problems? a.A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b.A man knows that his grandfather, father, and older brother all died of cardiac disease. c.A man is currently unemployed and despairs about finding a position. d.A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.
ANS: A, C Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day-care centers for lack of asthma triggers.
Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.) a.Assess schools and day care centers for environmental friendliness. b.Share nutritional information with all students in the school. c.Develop home and environmental assessment guides. d.Teach all school personnel how to use rescue inhalers.
ANS: B Motor vehiclerelated injuries and violence are the leading causes of morbidity and mortality for adolescents. Thus, this would be the greatest concern for the nurse working with high school students.
Which of the following is of the greatest concern for the nurse who works with high school students? a. Alcohol use b.Motor vehicle accidents c.Sports-related injuries d.Unprotected sex
ANS: A Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity.
Which of the following is the best way to ensure good nutrition in infants? a.Breastfeeding only b.Feed them only brand-name baby foods c.Feed them only brand-name cereals d.Feed them only brand-name formulas
ANS: A, C, D Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. It can be assumed that the nurse would already know agency policies. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual). Therefore, the preferred time to visit is when most family members will be available. Similarly, it is more informative to see the family in their home setting than to establish a different site for the visit.
Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a.Why the data are needed b.How best to interview each individual in the family c.The most convenient time for you to visit the family d.The rationale or purpose of the visit
ANS: B Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.
Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families? a.Understanding of same sex marriage laws within the state b.Understanding of personal feelings of working with members of this community c.Assessment of the family structure within the LGBT family d.Assessment of sexual orientation in a safe environment
ANS: C Theft or mismanagement of money or resources is an element of abuse.
Which of the following situations would most likely indicate elder abuse? a.A daughter refuses to visit her mother due to work commitments. b.A child runs around a grandparents house breaking items. c.A young man repeatedly steals money from his grandmother. d.An elderly person demands that the family come for dinner.
ANS: A The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the twenty-first century exciting and challenging.
Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a.Function and structure change over time. b.Function and structure do not apply to all family units. c.Some clients do not have families. d.Traditional families are rare in society.
ANS: D Government actions that have a direct or indirect effect on families are called family policy.
Which of the following terms refers to government actions that have a direct or indirect effect on families? a.Family funding b.Family legislation c.Family planning d.Family policy
ANS: D The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory.
Which of the following theories views the family as a whole with boundaries that are affected by the environment? a.Family developmental theory b.Structural-functional theory c.Family role theory d.Family systems theory
ANS: D Medicare, Social Security, senior privileges, and high socioeconomic status, income, and education are all extremely helpful to older adults. However, social networks that give support and meaning to life are a major factor that can contribute to ongoing health and vitality. One of the biggest dangers is social isolation.
Which of the following will provide the highest benefit to an older adults well-being? a.Eligibility for Medicare and Social Security b.Higher socioeconomic status, income, and education c.Senior citizen privileges such as senior citizen centers and senior citizen discounts d.Social networks that give support and meaning to life
ANS: C Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight, purging is associated with bulimia, and anorexia is considered to have more complications than bulimia.
Which statement about eating disorders is correct? a.Individuals with anorexia frequently complain about weight loss. b.Purging is associated with anorexia. c.Most women with bulimia are concerned with the shape and weight of their body. d.Bulimia is considered to have more medical complications than anorexia.
