388 Module 4 practice questions

A community health nurse is providing primary, secondary, and tertiary interventions for migrant workers. Sort each action by level of prevention.

1: -partner with employers to provide sunscreen for workers -educate workers about measures to decrease risks for musculoskeletal injuries 2: -provide flyers about recognizing presticide toxicity -provide tuberculin skin testing 3: -partner with physical therapy clinics to provide treatment for back injuries -provide nutrition education for workers who have complications of diabetes

A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? a. Evil eye b. Fallen fontanel c. Fright d. Indigestion

ANS: A A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye. Caida de mollera is known as fallen fontanel, empacho is known as indigestion, and susto is known as fright.

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? a. Be willing to enter into a long-term relationship with families. b. Direct and control the client's care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency.

ANS: A Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? a. Cancer b. Memory loss c. Skin rashes d. Headaches

ANS: A Chronic exposure to pesticides and chemicals may lead to cancer. Memory loss, skin rashes, and headaches are all potential side effects of short-term exposure to pesticides and chemicals.

In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? a. Absence of culturally competent care b. Availability of specialists c. Distance of health care facilities from the place of residence d. High cost of health care

ANS: A For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers. This is an additional barrier that is not faced by other rural residents. Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers, not just migrant workers.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate? a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b. Refer the man to a urologist to address the urinary bleeding. c. Suggest that the family take him to an urgent care center immediately. d. Treat the urinary infection and give the man medication to take to prevent the recurrence of infection.

ANS: A It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social assistance and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups. If the family is referred to a different provider or agency, it is likely that this follow-up will never occur. Only addressing the urinary infection, and not the homeless status of this family, does not provide the comprehensive services that are expected from a public health clinic.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service does these actions represent? a. Case management b. Client advocacy c. Holistic care d. Wrap-around services

ANS: A Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved. Client advocacy refers to actions taken on behalf of another. Because of the variety of actions being taken by the nurse, the nurse is functioning in a larger role than simply advocating for the client. Holistic care addresses providing care for physical as well as emotional and spiritual needs. The nurse is not addressing all of these aspects of care through this coordination. Wrap-around services refer to when comprehensive health services are available and social and economic services are "wrapped around" these services. These services are not being necessarily all being provided by the same clinic.

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a. At the city's homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs

ANS: A The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population, the homeless shelter would be an appropriate location. Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. Depending on the location of the community college, there may also be transportation issues.

A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? a. Emergency department for immediate care b. Migrant Health Act clinics c. OSHA, because the man was injured by farm machinery d. Workers' Compensation, because injury was at work

ANS: A The only source the nurse can count on using is sending injured workers to emergency departments for immediate care. Farming and ranching do not often fall under OSHA guidelines, because they are considered small enterprises. Therefore, safety standards are not enforceable, nor is Workers' Compensation insurance usually available for the agricultural industry. Although there are migrant health clinics, they are not always geographically convenient.

A 13-year-old resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? a. Advanced nurse practitioner b. Allergist c. Pediatrician d. Pulmonologist

ANS: A The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). Most urban adults are more likely to seek care from a medical specialist (allergist or pulmonologist). A pediatrician would provide care specific to children which may or may not be appropriate depending on the age of the resident.

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? a. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

ANS: A Vulnerability can be reversed by obtaining resources to increase resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience.

Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) a. "I always address the problem that the client believes is the most important." b. "I avoid asking clients for income or financial information, because this is an invasion of privacy." c. "I try to observe the client's cultural traditions as I complete my assessment." d. "I make sure to do a complete assessment, since we often don't know when the person will return to the clinic." e. "Understanding an individual's cultural experience is an important factor in meeting their needs."

ANS: A, C The nurse should focus on what data are needed to help the client that day with the problem the client believes is most important. It is important to keep the client's cultural traditions in mind when completing an assessment so that the nurse is able to provide culturally competent care. Because poverty is a primary cause of vulnerability, the nurse should include questions about the client's financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Readminister the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest X-rays.

ANS: B Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results. Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working.

Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation

ANS: B People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability. Breakdown of family structures, prejudice, and social isolation may all influence vulnerability to health problems but have not been identified as a primary cause.

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

ANS: B Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease. Primary prevention refers to actions taken to prevent the disease from occurring. Tertiary prevention refers to actions taken after the disease has already occurred. A screening test cannot be both secondary and tertiary preventions.

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a. A bill that establishes policies requiring all persons to pay the same cost for services regardless of income b. A bill that promotes universal health insurance coverage c. A bill that requires all health care providers to give care to uninsured persons without charge d. A bill that requires health care workers to report undocumented immigrants who present for treatment

ANS: B Social justice refers to providing humane care and social support to the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered, or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care. Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. A bill requiring all persons to pay the same cost for services regardless of income is not feasible. Multiple factors, including the benefits provided by individual health insurance, influence the amount of money individuals pay to receive health care services. A bill for universal health insurance could potentially influence this inequality. Health care providers are obligated to provide care to individuals in an emergency regardless of citizenship in the United States; thus, this bill would not be feasible given current standards. These options would also not support the philosophy of social justice.

A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? a. Avoiding touching the client except when necessary as part of the physical examination b. Calling the client by name, socializing before addressing the problem, and being very respectful c. Keeping all interactions direct, to the point, and targeted on the reason for presentation d. Maintaining a nonconfrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

ANS: B The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual's dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior. When interacting with Mexican immigrants, as well as some other cultures, establishing general rapport through conversation is expected rather than a direct, focused approach. It would be appropriate for a nurse to develop a therapeutic relationship with the client, not a nonconfrontational one.

Which of the following best describes a health professional shortage area (HPSA)? a. An area with inadequate health care facilities for residents b. An isolated area of underserved populations within an urban region c. A region with insufficient numbers of health care providers d. A rural region of the United States with a population density of less than 10,000

ANS: C An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often, rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties. The incorrect responses do not fit the definition of a HPSA.

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education? a. "If a client who does not speak English comes in, you must obtain an interpreter right away." b. "We try to take care of as many problems as possible in one visit, so when you interview the client, ask about additional concerns." c. "You will like working with Hispanic immigrants because they all have close-knit family structures." d. "You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

ANS: C Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence. It is important for the staff member to obtain an interpreter after learning that a client does not speak English, so this statement does not indicate the need for additional education. Addressing multiple concerns within one visit is also appropriate and does not indicate the need for additional staff education. Also, it is important for the staff member to recognize the importance of working around work schedules; thus, this action is appropriate and does not indicate the need for additional staff education.

A migrant farmworker presents to the clinic reporting an acute onset dizziness, intense thirst, vomiting, fatigue, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? a. Appendicitis b. Bacterial gastroenteritis c. Pesticide poisoning d. Viral illness

ANS: C Because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild symptoms of pesticide poisoning including headache, fatigue, dizziness, nervousness, perspiration, loss of appetite, thirst, eye irritation, and irritation of the nose and throat. Severe poisoning symptoms include fever, intense thirst, vomiting, muscle twitches, convulsions, inability to breathe, and unconsciousness. The work setting of a migrant farmer would lead the nurse to first consider pesticide poisoning as a potential underlying cause of these symptoms. However, some of these symptoms could potentially be present with appendicitis, bacterial gastroenteritis, or a viral illness.

A migrant farmworker brings his daughter to the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a. It was a rare occurrence, which probably won't be repeated. b. The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. c. Children may work on small farms because the family may need the additional income. d. The parents were busy working and didn't realize the child was outside so long.

ANS: C Children 12 to 13 years of age can work on a farm with the parents' consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family's economic survival. This child may be at risk for this occurring again because the family needs the income that is generated by the child's employment. The child is most likely working and not going outside to play. In order for this child to work, the parents also were working on the same farm with them but again need this child's income for survival.

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? a. Administration of skin tests to identify persons who have been infected with tubercle bacilli b. Assessing for signs and symptoms of active tuberculosis c. Directly observing clients with active tuberculosis as they take their antitubercular medications d. Interpretation of tuberculosis skin test findings

ANS: C Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB. Administering skin tests, assessing for signs and symptoms, and interpreting tuberculosis skin test findings are all examples of secondary prevention as these interventions are all focused on screening or the follow-up on a screening test.

Which of the following is the most accurate description of a migrant farmworker? a. A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends b. A person who immigrates to the United States to "follow the crops" in performing seasonal farm work c. A person who moves from place to place to earn money performing seasonal agricultural work d. A person who specializes in the development of rural land for the purpose of farming

ANS: C The Office of Migrant Health of the US Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months and who establishes for the purpose of such employment a temporary abode." The emphasis in the definition of migrant farmworkers is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

1. Which classification applies to Delta County? A. A metro area B. A micro area C. A non-core area

ANS: C, a non-core area. Delta County's population of 15,000, approximately 12 persons per square mile, with the largest town having a population of 8,000 fits the definition of a non-core area. Non-core areas are defined as having no urban cluster of 10,000 or more residents, and the county as a whole has on average 14,000 residents. A metro area (A) contains a core urban area of 50,000 or more population. A micro area (B) contains an urban core of at 10,000 people (but fewer than 50,000).

1. Which term should Nurse Swabbs use to best describe Tonya's problem? A. Withdrawal B. Drug dependence C. Drug addiction

ANS: C, all of Tonya's money goes to getting drugs, and she has tried to quit before but relapsed. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed. Drug dependence (B) is a state of neuroadaptation (a physiologic change in the central nervous system) caused by the chronic, regular administration of a drug. With drug dependence, continued use of the drug becomes necessary to prevent withdrawal symptoms. Withdrawal (A) describes the symptoms that occur when a person who is drug dependent stops the use of the drug.

Which of the following factors predisposes many migrant farm workers to disenfranchisement? a. Being a minority group member b. Inability to attend religious services because of work requirements c. Previous experiences of physical abuse d. Short length of time in the community

ANS: D Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds. A person's inability to attend religious services or to have had experienced previous physical abuse are not specifically related to disenfranchisement of the population of migrant farmworkers.

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. d. Strongly consider not applying, because this population will be expensive to treat.

ANS: D Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care). Because of the major costs associated with providing care to this population and risks related to reimbursement, it would not be in the best interest of the agency to want to eagerly apply to provide care to this group.

An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a. Their personal belongings may be stolen while they are at the clinic. b. Immigration officials will send them back to their home country. c. The clinic personnel will look down on them and be biased against them. d. They weren't getting paid for that day, and continued employment is never certain.

ANS: D Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain. Most migrant farmworkers are legal residents or US citizens, not illegal immigrants. If the clinic personnel provide culturally competent care, they should not be biased or look down on this family when providing care. They should not be at any greater risk to have their belongings be stolen than on any other day when they leave their home.

Which individual has the greatest risk for becoming a member of the vulnerable population of the local community? a. A male diagnosed with a cardiac issue who recently moved in with his adult child b. A single mother who is studying for a law degree at the local university c. A 50-year-old married female who has worked as a server in local restaurants for her entire adult life d. A single male who has a history that includes a learning disability and a parent diagnosed with type 2 diabetes

ANS: D The WHO, consistent with Healthy People 2030, describes three overall determinants of health to be (1) the social and economic environment, (2) the physical environment, and (3) the person's individual characteristics and behaviors. The WHO also notes that individuals are unlikely to be able to directly control many of the determinants of health, and this is directly related to vulnerability. The seven WHO factors are as follows (WHO, 2015, pp. 1-2): 1. Income and social status: Higher income and social status are associated with better health. 2. Education: Low education is linked with poor health, more stress, and lower self-confidence. 3. Physical environment: Safe water and clean air; healthy workplaces; safer homes, communities, and roads; and good employment and working conditions, especially when the person has more control, all contribute to good health. 4. Social support networks: Family, friends, and community as well as culture, customs, traditions, and beliefs affect health. 5. Genetics, as well as personal behavior and coping skills, affect health. 6. Health services: Access and use of services affect health. 7. Gender: Men and women suffer from different types of diseases at different ages The single male with a history of learning disabilities and a family history of type 2 diabetes has several potential risk factors including those related to his social support network (being single); learning disabilities (effecting education and possible low self-esteem); and a first degree family history of a chronic disease (type 2 diabetes). While the life stories in the remaining options present the individual with risks, none have multiple risks like the male depicted in the correct option.

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a. Disadvantaged families b. Multi-problem families c. Resilient populations d. Vulnerable populations

ANS: D Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations and do not appropriately fit the definition of "aggregates." Resilience refers to the ability to resist poor health outcomes, not to succumb to them.

How can the Community Mental Health Nurse (CHMN) strengthen her community's response to stressful events such as natural disaster and terrorism?

ANS: Developing community mental health responses and addressing physical health concerns are included in the role of the CHMN. CHMNs can assess the stress response of the community, educate the community about how to deal with stress, and intervene to prevent or alleviate disability and disease resulting from stress.

. What community resources are available for this population?

ANS: Examples of resources found in most communities that could assist abused and battered women are health departments, community mental health centers, the American Red Cross and other voluntary organizations, food and clothing banks, missions and shelters, nurse-managed neighborhood clinics, social service agencies such as Traveler's Aid and the Salvation Army, and church-sponsored health and social services.

. What community services could Nurse Little recommend and/or employ for Cole? For Cole's mother?

ANS: For Cole: Child Protective Services, child abuse prevention programs, programs for children of battered women, community support group, 24-hour hotline, and victim assistance programs. For Cole's mother: adult protective services, Parents Anonymous, wife abuse shelter, community support group, 24-hour hotline, legal advocacy or information, state coalition against domestic violence, and victim assistance programs. See Box 27.4 Common Community Services

1. As the nurse prepares to assess the clients she encounters in the clinic and the group meetings, what guidelines should she keep in mind?

ANS: Nurse Covich should create a comfortable, nonthreatening environment. She should learn as much as she can about the culture of the clients she is about to work with so that she will understand the cultural practices and values that may influence their personal health care practices. Nurse Covich should be sensitive to the fact that the individuals she is assessing may have priorities that are more important to them than their health (e.g., financial or legal problems). She should collaborate with others as appropriate, making sure to connect the client with someone who can help her. See the HOW TO box in the textbook Chapter 23.

What self-help groups or other community resources are available to clients with mental illness and mental health problems? (Hint: One such group would be Alcoholics Anonymous.)

ANS: Possible self-help and community sources are Alcoholics Anonymous, Al-Anon, American Anorexia/Bulimia Association, American Association of Suicidology, Anxiety Disorders Association of America, Attention Deficit Information Network, Children and Adults with Attention Deficit Disorders, Depressive/Manic Depressive Association, Gamblers Anonymous, National Center for Post-Traumatic Stress Disorder, National Center for Learning Disabilities, Obsessive-Compulsive Foundation, Overeaters Anonymous, Schizophrenics Anonymous.

What are some primary prevention activities the nurse can implement to promote the mental health of the community?

ANS: Primary prevention activities are aimed at preventing illness. The nurse can provide education to community members about mental health issues and stress reduction techniques. The nurse may provide support to the caregivers of family members with mental illness. Nurses can also network with other health care professionals to educate the public and policymakers about the value of preventative services for mental health.

What can Nurse Little do to prevent violence at the individual/family level?

ANS: Primary prevention of violence: provide education on the developmental stages and needs of children, teach parenting skills, and teach stress-reduction techniques. Secondary prevention of violence: conduct assessment during routine examination, assess for marital discord, counsel for at-risk parents, and assist with controlling anger. (See the Levels of Prevention box in Chapter 27 in the textbook.)

. What interventions can Ryan try to help Tonya prevent relapse?

ANS: Ryan can help Tonya develop an increased sense of responsibility for her own success, identify her talents, motivate her to dedicate her life to helping society, provide realistic appraisals and feedback, encourage education and skills training, and increase cooperative solutions to problems.

2. How can the nurse help empower the clients she sees at the shelter

ANS: She can empower the clients by: (1) ensuring that health-promoting strategies are culturally and linguistically appropriate, (2) understanding that the women are at the shelter for only a short time, so a wide range of services should be available in one location, (3) advocating for the clients' needs as necessary, especially in the policy-making arena, and (4) building on the skills that a client already possesses.

2. What barriers to care contribute to the Browns' difficulty in accessing health care?

ANS: The Browns must travel 60 miles to get to the nearest hospital, are unable to pay for care, and lack the knowledge to procure services. Furthermore, outreach services are limited (mostly maternal-infant care), and health care providers are sparse in Delta County.

3. What are some resources the nurse can use in providing services to the Brown family and the rest of the community?

ANS: The National Center for Farmworker Health, Inc. (NCFH) provides fact sheets for professionals and client health tips for patients. The Centers for Disease Control and Prevention (CDC) has a grant program in which they partner with local areas to establish community-based programs to eliminate health disparities among minority groups. The Health Resources and Services Administration (HRSA) and the National Rural Health Association (NRHA) provide resources.

What indicators for child abuse are apparent in this case?

ANS: Unexplained injuries (bruises on Cole's arm) and scars on Cole's back. (See the How to box in Chapter 27 of the textbook for a list of ways to recognize actual or potential child abuse.)

What approach should Nurse Swabbs take for teaching teens to abstain from illegal drug use?

Basic drug prevention programs for young people should combine efforts to increase resiliency factors with drug education. Role playing and other interactive programs are useful in teaching many of the skills for resisting drug experimentation. The "just say no" approach does not help young people because: (1) children are naturally curious and drug experimentation is often a part of normal development, (2) children from dysfunctional homes often use drugs to get attention or escape from an intolerable environment, and (3) this approach does not address the powerful influence of peer pressure.

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

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

A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. Which strategy would the nurse consider most effective when working with these clients? Create a trusting environment and establish a therapeutic relationship. Collaborate with the local united way to obtain funding for primary care services. Dialogue with local clergy to address the unmet primary care need for homeless persons. Form a community partnership to establish a clinic for homeless persons.

Create a trusting environment and establish a therapeutic relationship. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

case study

Delta County has a population of 15,000, which is approximately 12 persons per square mile. The largest town has a population of 8,000. There are two primary care physicians and two nurse practitioner-managed clinics in the area. Delta County has two dentists, but neither accepts Medicare nor Medicaid. The closest hospital is 60 miles away. Two nurses from the health department provide some health care services for the county, primarily maternal-infant health care services (i.e., well-child visits). Tanya Brown is a 35-year-old African American female living in Delta County. Mrs. Brown has lived in Delta County since she was a child, growing up on her parents' 100-acre soybean farm. She is a stay-at-home mother with four small children: a 2-year-old girl, a 6-year-old boy, and 9-year-old twin boys. Her husband, Bill, is trying to get a permanent job, but for now does seasonal farm work. Mr. and Mrs. Brown cannot afford private health insurance and do not qualify for Medicaid. Mrs. Brown was recently diagnosed with type 2 diabetes, but she cannot afford the medications the nurse practitioner prescribed.

case study

Eliza Little is a registered nurse at a community activity center. The activity center provides daycare for working parents and sports and drama activities for youth. Nurse Little provides first aid care and health education classes for the children and their parents. Cole Donavan is a 5-year-old boy who stays at the daycare during the day while his parents are at work. Nurse Little has noticed that Cole frequently visits the clinic, often just for a hug. Every time Nurse Little sees Cole, she notices a new bruise. At first Nurse Little contributed this to Cole being an active little boy. However, as time went on, she became suspicious of the frequent bruising. When Nurse Little asked Cole about his bruises, he said he didn't remember what he did to get them. Once, when Nurse Little was letting Cole down after a big hug, his shirt got caught on the door handle, revealing several diagonal scars across his back. When Nurse Little asked Cole how he got the scars, he immediately looked scared and refused to talk. When Cole's mother came to the daycare to pick up her son, Nurse Little asked whether she could talk to her. Nurse Little explained how she discovered the scars and noticed the frequent bruises on Cole's arms. Nurse Little asked what it was like at home and whether Mrs. Donavan knew how Cole was injured. Mrs. Donavan was quiet for a long time and then whispered, "He beats us. He hurts Cole to hurt me."

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

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

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

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

A community-oriented nurse wants to begin a program to reduce health inequality. What action by the nurse would be most successful? Use a successful model and divide the tasks among volunteers in the community. Gather a group of acute and community health care providers to brainstorm solutions. Conduct research on the prominent causes of inequity within the community. Invite a cross section of health professionals and lay people to join the action team.

Gather a group of acute and community health care providers to brainstorm solutions. A cross-sectoral approach would be the best way to work on this problem. This means that nurses and other health professionals must partner with stakeholders outside of traditional public health and health care delivery systems to design multi-level solutions for improving health. Effective cross-sectoral work is collaborative. When diverse people and organizations collaborate, they work together in inter-connected ways to achieve a common goal.

Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) Select all that apply. Reduced eligibility for entitlement/assistance programs Higher incidence of acute and chronic disease Lack of awareness of care options Crisis-oriented health care, usually in emergency departments Higher risk of physical trauma

Higher incidence of acute and chronic disease Lack of awareness of care options Crisis-oriented health care, usually in emergency departments Higher risk of physical trauma Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis-oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.

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

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

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

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

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

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

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

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

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

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

Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) Select all that apply. Worse health outcomes despite access Multiple risk factors but equal health outcomes No difference in access or outcomes Better access to health care services but poor health outcomes Greater likelihood of exposure to risk factors

No difference in access or outcomes Greater likelihood of exposure to risk factors Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

A public health nurse is implementing strategies to improve the care of clients who have mental health issues. Match each situation to the level of prevention the nurse is providing. Screening a client whose partner recently died for suicide risk. Teaching a client who has schizophrenia about medication interactions. Providing support programs for new parents. Primary Secondary Tertiary

Primary providing support programs for new parents Secondary: screening a client who's partners died for suiciede risk Tertiary: teaching a client who has schizophrenia about medicaiton interactions

What does a community-oriented nurse newly assigned to a rural community learn about the characteristics of rural and small-town life? Select all that apply. Fractured family and social systems Role of churches as socialization centers Work of many residents in high-risk occupations Openness to people new to the community Informal social and professional relationships

Role of churches as socialization centers Work of many residents in high-risk occupations Informal social and professional relationships The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").

case study

Ryan Swabbs is a master's-prepared nurse who works at a drug rehabilitation center in Mumfordsville. Nurse Swabbs provides individual and group counseling for clients in the process of controlling or stopping their drug addiction. Tonya Lamburg is a teenage mother who has entered the drug rehabilitation center. Tonya's 2-year-old son is staying with Tonya's mother until Tonya is able to return home. Tonya is 16 years old and wants to stop drinking alcohol and using cocaine. Nurse Swabbs is assigned to Tonya's case. At their first meeting, Nurse Swabbs assesses Tonya's level of drug abuse and readiness for change. Tonya has been at the center for 1 week and has not used any drugs since checking in. Tonya shares that she has repeatedly tried to quit alcohol and cocaine "cold turkey" but started to feel "bad and shaky" and went back to using to stop the withdrawal symptoms. "I have no money. I can't pay for food for my baby. Everything goes to pay for booze or to get high," said Tonya. "I dropped out of school when I got pregnant. Everywhere I try to work, I get fired. I decided to get help when I saw my baby get into my coke stash. I don't want my boy to die. I don't want to die."

A public health nurse is meeting with community leaders about interventions to assist specific populations. Which statement should the nurse make when discussing health disparities among these populations? A Some populations have multiple risk factors that impact their health outcomes.​​​​​​​ B Some populations are more affected by nonmodifiable genetic factors than by social determinants of health.​​​​​​​ C Some populations demonstrate chronic overuse of the health care system.​​​​​​​ D Some populations have negative cultural beliefs about the health care system.

Some populations have multiple risk factors that impact their health outcomes.

case study

Susan Teal is the director of the community mental health service agency, Healthy Minds, in Robertsville. Healthy Minds seeks to prevent exacerbations of mental illness through team care, case management, outreach, and a variety of rehabilitation models. Healthy Minds sees clients of all ages and socioeconomic levels who suffer with serious and persistent illnesses. In the beginning, Healthy Minds was a follow-up service for patients seen at Robertsville Psychiatric Hospital; however, services have expanded to reach all people in the community. Ms. Teal is coordinating an in-service for all new nurses working at Healthy Minds. The purpose of the in-service is to orient the novices to their roles as community mental health nurses, to educate them about the factors of mental health that affect community services, and to inform them of other possible referral resources in the area that are available for their clients.

case study

The Hearts in Hands Shelter is a halfway house for abused women who have left their partners. The shelter provides individual and group counseling, a job finding service, and other programs aimed at making the women independent. Women staying at the shelter must help with cooking, cleaning, and childcare in order to continue living there. Robin Covich is the newly hired nurse practitioner at the shelter. Nurse Covich has experience working with vulnerable populations; however, this is her first experience working with abused and battered women. She sees clients for acute problems in the shelter's clinic and attends the group counseling meetings with the mental health nurse who leads the meetings.

A community health nurse is developing an education program about substance use disorders. Which statement should the nurse include when discussing nicotine and smoking? A Smoking is the fifth-most preventable cause of death in the United States​​​​​​​. B Nicotine is a central nervous system depressant.​​​​​​​ C Withdrawal effects from smoking are minimal.​​​​​​​ D Tolerance to nicotine develops quickly.

Tolerance to nicotine develops quickly.

A supervisor of school nurses is preparing a presentation about child maltreatment and neglect. When discussing manifestations, why does the nurse include possible manifestations such as underweight and poor hygiene with neglect instead of physical abuse?

When generating solutions, the nurse should recognize that neglect occurs when a child's basic needs, such as nutrition and hygiene needs, are not met. Physical neglect often occurs in situations associated with poverty and includes failure to provide medical care, shelter, adequate clothing, hygiene, and food

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

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

For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize addiction is a health problem, drug addiction can be successfully treated, accurate information can help people make responsible decisions about drug use, and: illegal drugs are the category of abused drugs. over-the-counter (OTC) drugs are "good drugs." prescription drugs rarely cause dependence. any drug can be abused.

any drug can be abused. The harm reduction model, is a public health approach. That recognizes the following: Addiction is a health problem. Any drug can be abused. Accurate information can help people make responsible decisions about drug use. People who have ATOD or SUD problems can be helped. This approach accepts that psychoactive drug use is endemic, and it focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and get treatment for addicted persons.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

housing for migrant workers. When migrant workers reach a worksite, housing may not be available, it may be too expensive, or it may be in poor condition. Housing conditions vary among states and localities. Housing for migrant farmworkers may be in camps with cabins, trailers, or houses. Some even live in cars or tents if necessary. National data about the type and quality of housing occupied by farmworkers are limited; however, data indicate that the housing is generally crowded by federal standards. Poor-quality and crowded places of residence can contribute to health problems such as tuberculosis (TB), gastroenteritis, and hepatitis and to exposure to high levels of lead.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The nurse is establishing a secondary prevention program for adolescents at risk for ATOD. The nurse will include a focus on: encouraging competitiveness and success in sports. screening and referring for psychiatric disorders. focusing on short-term goals and solutions. teaching adolescents to "just say no."

screening and referring for psychiatric disorders. Secondary prevention includes screening in order to obtain prompt treatment. A program focusing on secondary prevention would use evidence-based screening tools and a referral network.

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

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

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

use every opportunity to provide comprehensive services. Comprehensive services are health services that focus on more than one health problem or concern. For example, some nurses use stationary or mobile outreach clinics to provide a wide array of health promotion, illness prevention, and illness management services in migrant camps, schools, and local communities. A single client visit may focus on an acute health problem such as influenza, but it also may include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions in environmental hazards and violence and assurance of safe food and water.

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

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

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

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