ch 16 community

A school nurse has identified that there has been an increase in sexually transmitted infections (STIs) among the adolescents attending the school. Which intervention should be completed by the nurse? A. Arrange for the health department to come to the school to give information and treatment on a confidential basis B. Encourage the athletic coaches to distribute condoms in such a way that a boy can obtain them in private C. Have English teachers assign stories about the problems that result from adolescent pregnancy D. Have the bus drivers put a comic book about sexuality, STIs, and preventive measures on each seat

A Barriers to health care such as lack of transportation, concerns about confidentiality, and lack of access to preventive health services contribute to a high prevalence of STIs among teens. Having a free clinic in the school removes some of the barriers.

A man, who looked about 45 years old, gave a cashier at a grocery store the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers for some of the food he had just selected. Which conclusion can be drawn from this scenario? A. He had a teenage daughter who was pregnant or with a young child. B. He met the requirement for Aid to Dependent Families. C. He really knew how to beat the welfare system. D. He was handicapped, although his handicap was not immediately apparent.

A WIC provides federal grants to states for the purpose of serving nutritionally at-risk, low-income pregnant and postpartum women and their children up to five years of age. WIC programs provide highly nutritious foods, nutrition education and counseling, and screening and referral to needed services. To be eligible, women and children must meet income guidelines established by each state, and a health professional must determine they are at "nutritional risk." Women and children who participate in Medicaid, the Food Stamp program, or the Temporary Assistance for Needy Families program are automatically income eligible for WIC. This man would not be eligible for WIC assistance himself because this program is for women and children.

Which best explains why an employer would care about the health needs of local children? A. The children are the employer's future workforce. B. The employer needs positive media coverage and no scandals. C. The community will provide greater support to employers that have family-based policies. D. Staying home to take care of sick children will impact the productivity of the workplace.

ANS: A Business and industry have an enormous stake in the health of the nation's children. A strong, productive workforce is ensured only when the health, social, and educational needs of the next generation of workers are met. Furthermore, health risks cost employers in lost productivity and increased health care costs. Avoiding scandal and negative media coverage would not be a reason why employers would care about the health needs of the local children. The community does not provide greater support to businesses that have family-based policies. Although, businesses want to keep their employees at work instead of at home taking care of ill children, businesses are concerned with more than just the children of their employees. All children in the local community are a concern for employers as these are the future workforce.

Which best describes the screening tests that are completed on all newborns in the United States? A. It varies from state to state, somewhere between 0 and 25 tests. B. It varies from state to state, but all states have a common 26 conditions that are tested. C. Federal legislation mandates 29 tests. D. The number varies greatly by state and by hospital policy.

ANS: A Every infant born in the United States is screened shortly after birth for a number of genetic disorders. Newborn screening is state-based so the number of conditions that babies are screened for varies from state to state. All U.S. states and territories currently test for 26 health conditions including phenylketonuria, galactosemia, congenital hypothyroidism, and sickle cell disease.

A young mother was very proud because she had been taking her 9-month-old with her to various garage sales where she had purchased a lot of toys for very little money. Which would be the most appropriate response by the nurse? A. "Be sure there are no small pieces as young children can easily choke." B. "Fantastic. Saving money on toys will allow you to buy more fresh fruits and vegetables." C. "Toddlers love new toys; they will help with cognitive development." D. "You are doing an excellent job of giving your child lots of stimulation with new playthings."

ANS: A Infants and young children are at great risk for accidental injuries. The leading cause of injury death for children under the age of 1 year is accidental suffocation caused by choking or strangulation. Thus, it is important for the nurse to talk with the young mother about the dangers of toys with small pieces. Safety of the infant should be the primary concern of the nurse in this situation. Saving money on toys will not necessarily allow the young mother to be able to purchase more fruits and vegetables. The infant is nine-months old and would not be considered a toddler yet. It is not apparent in this situation if the toys are age appropriate for the infant or would provide the appropriate amount of stimulation for a child at this developmental level.

When the school health nurse suggested the school health clinic include sexual counseling and free condoms if requested, an angry woman yelled, "Why do I care if some girls have no morals and sleep around?" Which would be the most appropriate response by the nurse? A. "Because taxpayers spend billions each year for teenage moms and their babies." B. "Because your son may have to pay child support to that girl for the next 18 years!" C. "I understand your point of view, but since some parents don't teach their children morals, the school has to help." D. "We all should care for our neighbors and our neighbors' children."

ANS: A Preventing pregnancy among teenagers can reduce the dropout rate, welfare dependency, low birth weight, and infant mortality. According to an analysis by the National Campaign to Prevent Teen Pregnancy, the estimated national cost of teen childbearing in the United States cost taxpayers (federal, state, and local) is at least $9.4 billion per year.

Which is consistent with the American Academy of Pediatrics (AAP) recommendations for breast-feeding? A. A mother combines breast-feeding with the introduction of complementary foods until the infant is 1 year old B. A mother supplements breast-feeding with formula when then infant is 4 months old C. A mother stops breast-feeding her infant after introducing solid foods D. A mother asks her employer to allow her to bring her infant to work so that she may breast-feed

ANS: A The AAP recommends exclusive breast-feeding for about the first six months of a baby's life, followed by breast-feeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breast-feeding for as long as mutually desired by mother and baby.

Which indicator would be most informative in assessing the health of a newborn? A. Apgar score at birth B. Birth weight and length of gestation C. Mother's education and income from employment D. When the mother began prenatal care at her local clinic

ANS: B Birth weight and length of gestation are the most important predictors of infant health. Although maternal education, income, and lack of prenatal factors are factors associated with preterm birth and low birth weight, at the time of birth it is most important to assess the weight of the infant and length of gestation. Using the Apgar score at birth is not as informative of a tool for assessing newborn health as the birth weight and length of gestation.

A mother was concerned about her child dying of some childhood disease, because that is how some of her siblings died before her family came to the United States. Which would be the most appropriate response by the nurse? A. "You should see your doctor immediately if you ever think your child is ill." B. "Your child has been immunized, so the biggest danger is from accidents." C. "You have made sure your child has all the right immunizations so you can quit worrying." D. "You're right to be concerned, since susceptibility runs in families."

ANS: B Childhood is generally a healthy time of life. The incidence of childhood disease has decreased because the majority of children receive a full complement of immunizations during infancy and toddlerhood. The leading threat to children's health is accidental injury and exposure to environmental toxins, abuse, and violence.

Which statement best explains why parents and nurses are often concerned about adolescents? A. Adolescents engage in sexual acts without using protection. B. Adolescents engage in very high-risk behaviors. C. Adolescents love driving but are not as skilled as they believe. D. Adolescents often experiment with alcohol or drugs.

ANS: B In their struggle to gain independence and with their sense of immortality, many adolescents engage in risk-taking behaviors, including alcohol and drug abuse, early and unprotected sexual activity, unsafe driving, and participation in delinquent and violent activities that threaten their health. To say adolescents engage in very high-risk behaviors is the inclusive answer, because all other responses name only one problem.

A mother explained that she had just dropped her 3-year-old off at her own mother's so she could come in for the required examination for her new job. She excitedly shared her hopes that she would be able to afford a used car rather than having to ride a bus all the time. Which would be the most appropriate response by the nurse? A. "I'm sure the exam won't show any problems. I'm so excited for you." B. "Don't forget to buy a child's seat when you get your car." C. "How do you think your child will adapt to you being at work all day?" D. "It's fantastic that you have a new job in this rough economy. Will your mother be able to continue to babysit?"

ANS: B Motor vehicle injuries are the leading cause of death for children from age 5 to 14 years in the United States. Many injuries occur because adults fail to secure children in car seats in the back seat of the vehicle or to insist that older children buckle up. the most important step that a parent can take to ensure a child's safety in a motor vehicle is to correctly secure him or her into a car seat, or seat belt when the child is older, for each ride. Safety of the toddler should be the primary concern for the nurse in this situation. The nurse should focus on the safety of the child in the response. Telling the mother that the exam will not show any problems provides false reassurance to the mother, as problems may be detected. Asking if the woman's mother will continue to babysit or how the child will adapt to the mother being at work are not relevant as this is a required examination for her new job.

A school nurse is trying to determine health trends when making plans for health programming in the school for the upcoming school year. Which would be the most appropriate action for the nurse to take? A. Conduct a survey in the community B. Do an online search of groups that might collect and analyze such data C. Examine records in the school health office to determine trends D. Interview local health officials regarding problems beginning to occur

ANS: B The federal, state, and local governments and many national organizations collect and analyze data to track the well-being of children and adolescents. For example, the U.S. Department of Health and Human Services (USDHHS) generates a yearly report, Child Health USA, on child population characteristics, health status, and health care utilization. Such data are readily accessible online. A number of key indicators are tracked on a regular basis by the federal statistical system so that trends are revealed. State and local data also are used to track the well-being of children. The most efficient use of the nurse's time would be to use data that already exists rather than trying to create new data. This could be done by performing an online search for existing data. Once the existing data is collected, the nurse may then need to look specifically at the data at the school or create a new data to examine new or existing problems.

A woman vows to quit smoking and drinking immediately upon the surprising news that she is 2 months pregnant. Which concern would the nurse have for this woman? A. Those with whom she shares living quarters might smoke or drink. B. Fetal damage may already have occurred. C. Peers may encourage her to resume old habits, and peer pressure is very strong. D. She won't be able to keep her vow.

ANS: B The fetus can suffer damage very early in pregnancy, even before a woman knows she is pregnant.

A school nurse at a high school suggests that all students have an educational unit on newborn care in their required health class. Which provides the best rationale for this suggestion? A. Because all adults should be knowledgeable in basic child care B. Because the first year of life is the most hazardous until old age C. To help convince students not to engage in sexual intercourse D. To demonstrate the incredible responsibilities in parenthood

ANS: B The first year of life is the most hazardous until the age of 65 years. Many parents, often out of ignorance, do intentional acts that were not meant to injure or kill the child. Many new parents feel unprepared to care for a newborn and lack knowledge of normal growth and development. Newborn education would not help convince adolescents not to engage in sexual intercourse. Although this education may show the responsibilities associated with parenthood and is important for all adults to have, the purpose of the education is to prevent injuries and accidents among the infant population.

Which individual is most likely to be the victim of violent crime? A. A 10-year-old white female B. A 15-year-old black female C. A 15-year-old black male D. A 10-year-old white male

ANS: C Black males are the racial group most likely to be victimized. Violence is more likely to occur with an adolescent than a child.

Using a public health perspective, which has responsibility for a child's health? A. The child's family B. The businesses in the community C. The entire community D. The school system

ANS: C Child health is affected by many factors; therefore, the responsibility for improving children's health rests with the entire community. This responsibility begins with parents and includes health care professionals, community groups, businesses, and the public sector. When a child gets older, he or she can be responsible for practicing healthy behaviors and obtaining proper health care.

A school nurse is trying to decrease the effects of an incredible health crisis attacking school children. Which action would be most appropriate for the nurse to take? A. Arrange for booster shots to maximize immunization protection against childhood infectious diseases B. Arrange for swine flu and regular flu shots each year C. Establish recreational programs that encourage physical exercise each day D. For those whose parents give permission, teach adolescents about the need for abstinence or "safe sex"

ANS: C Childhood obesity has become a health crisis in the United States. Obesity has more than doubled in children and tripled in adolescents over the past 30 years. An estimated one third of children are overweight or obese. Children who are overweight are more likely to develop cardiovascular disease, diabetes, bone and joint disease, sleep apnea, and face social discrimination which can lead to poor self-esteem and depression. Nurses can design and implement nutrition, healthy eating, and physical activities policies and standards in schools in order to address this health crisis. Immunizing against infectious diseases and the flu and teaching about the need for abstinence or "safe sex" does not address the obesity, which has become a health crisis throughout the United States.

which best describes why infant mortality rate is used as an international comparison of a country's health status? A. Every country, regardless of other priorities, focuses on care of infants and their mothers. B. It is easy to obtain and compare such data. C. It reflects medical care quality and access and public health practice. D. The World Health Organization requires these data be reported to them each year

ANS: C It is an important marker because it is related to several factors, including maternal health, medical care quality and access, socioeconomic conditions, and public health practices. Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status.

Which group of children is at the highest risk to have poor health? A. African American children living in a suburb B. Asian children living in an outer urban area C. Hispanic children living in the inner city D. White children living in a rural area

ANS: C Significant disparities persist in health status of white children versus children of color. However, children living in suburban areas and most outer urban areas experience superior access to health services compared with children living in rural areas and inner cities, especially if they are poor.

Which statement best describes how the United States compares with other countries on infant mortality rate? A. Best of all the industrialized nations B. About in the middle of the industrialized nations C. Near the bottom of the industrialized nations D. Gradually improving among the industrialized nations

ANS: C The United States ranks a dismal 27th in infant mortality behind most other industrialized nations, including Japan, Sweden, Spain, Hong Kong, Italy, France, and Canada. Fifty years ago, the United States ranked 12th. The gap in infant mortality between the United States and other nations has occurred in spite of the United States' comparatively high per capita spending on health care and technological advancements.

When considering the benefits for the recipients, which is more beneficial: Medicaid or private insurance? A. Private insurance, because it is accepted by all providers, whereas Medicaid is not B. Private insurance, because it gives its beneficiaries more benefits than Medicaid gives C. Medicaid, because it includes early and periodic screening, diagnosis, and treatment services D. Medicaid, because it is available for all children

ANS: C Through the Early Periodic Screening, Diagnosis, and Treatment program, a child covered by Medicaid can receive a range of health and health-related services beginning in infancy. The program is designed to ensure availability and accessibility of health care resources and to help Medicaid recipients and their parents effectively use these resources. The program's services far exceed those usually covered by private insurance. Private insurance may not be accepted by all providers, as many insurance plans may limit the providers that can be seen under a certain insurance plan. Medicaid is not available for all children, only those from low-income families.

A woman confides in the nurse that she and her husband want to become parents as soon as possible. Which statement would be the best reply from the nurse? A. "Ask some young parents if you can babysit for a while to get in practice." B. "Can you afford to become parents with all the items a baby will need?" C. "Consider whether you are really ready to become parents." D. "Start living as healthy a lifestyle as possible right now."

ANS: D Adopting a healthy lifestyle and obtaining regular medical care before becoming pregnant can help to ensure a healthy pregnancy. Questioning the woman's statement would not be a therapeutic response from the nurse, rather the nurse should reply by providing support and education for the woman.

Which would be a source of care if families are employed at a salary above the poverty line, but at too low of an income for health insurance? A. Local health department clinics that provide care on a sliding scale B. Health care providers who donate time and pharmaceutical samples to free clinics c. School health clinicsd. D. The state Children's Health Insurance Program (CHIP)

ANS: D Although families may be able to get some assistance from any of the listed resources, the CHIP is a publicly subsidized health insurance program for children. It was specifically created for children whose family income is above Medicaid limits but whose families do not receive health insurance through the parents' employment (i.e., the working poor).

If most students have no intention of ever leaving their local community, which language should be chosen as the required foreign language in high school? A. French, as it is a very romantic language B. German, because many of the students' names are German C. Latin, as it is the basis for many other languages D. Spanish, to improve employment opportunities

ANS: D By 2050, Hispanic children as a percentage of the population are expected to grow to 32%, up from 25% in 2015. The percentage of children who are Hispanic has increased faster than that of any other racial or ethnic group. More immigrants speak Spanish, and care providers need to give culturally appropriate care. Speaking Spanish would be helpful. Because of these reasons, it would be most appropriate for Spanish to be selected as the required foreign language. Speaking French, German, or Latin would not be as practical as being able to speak Spanish.

Which factor is the single largest threat to child health? A. Child abuse B. Obesity C. Poor nutrition D. Poverty

ANS: D Poverty is the greatest threat to child health. Children in poverty have less access to nutritious food, shelter, and health care. They are often deprived of advantages such as good schools and may live in substandard housing, have stressful home lives, live surrounded by drugs and crime, and lack positive and nurturing adult role models.

A mother is assessing the safety of toy that her toddler received as a birthday gift. Which source would provide the mother with the most accurate information? A. Ask the toddler's daycare provider for her opinion. B. Call the department store where the toy was purchased. C. Explore the toy manufacturer's website. D. Search the Consumer product safety commission website.

ANS: D The Child Safety Protection Act of 1994 requires manufacturers, importers, distributors, and retailers to report choking incidents involving such products to the Consumer Product Safety Commission. The U.S. Consumer Product Safety Commission provides information about toy recalls.

According to the U.S. Department of Commerce, which rule must be followed by makers of toy guns? A. Darts from toy guns must be made of materials that will not penetrate skin. B. Toy guns cannot contain parts made of lead or lead-based paint. C. Reflective paint must be used on toy guns. D. Toy guns must be distinguishable from real guns.

ANS: D The U.S. Department of Commerce requires toy guns to be distinguished from real guns. In many cases, the toy industry has established voluntary safety standards to minimize risk of injury. There is not specific legislation from the U.S. Department of Commerce that outlines the materials that must be used in darts of toy guns or banning the use of reflective or lead-based paint or lead products.

A mother was debating whether or not to take her son to the clinic. His temperature was 104 F and rising so she gave him acetaminophen (Tylenol). Which will most likely be the deciding factor in the mother's decision? A. Whether or not the child is crying B. Whether or not the fever goes down after the Tylenol C. Whether or not the child seems to be getting better D. Whether or not the child is covered under insurance

ANS: D The ability to pay for health care greatly influences whether a parent takes a child to see a health care provider. Having health insurance would be the most important deciding factor in this situation, more important than if the child is crying, if the fever goes down, or if the child seems to be getting better.

Which action should be taken by a typical community preparing for the expected demographic changes in the United States? A. Build more elementary schools B. Build more high schools C. Build more colleges D. Build more adult condominiums

ANS: D The number of children will increase, but the proportion of children as compared with adults has been decreasing since the mid-1960s. Consequently, more housing for adults is needed.

A nurse is caring for a woman, who has just found out she is pregnant. The woman begins crying and says, "But I'm not trying to get pregnant!" Should this response by the woman be concerning to the nurse? A. No, because women may not consciously be aware of an unconscious desire to be a mother B. No, because about half of all pregnancies in the United States are unintended C. No, because she admitted having unprotected sexual intercourse D. Yes, because pregnancy can usually be avoided by appropriate precautions

B This response should not surprise the nurse because approximately half of pregnancies in the United States are unintended. Thus, it is important that women have good preconception health throughout their reproductive years to help ensure optimal fetal health and development should pregnancy occur.

A nurse was given the following data about the children attending school in two area communities:School Asthmatic Children Number of Children in School Number of Persons in CommunityCenterville Elementary 25 1000 15,000Centertown Suburban Elementary 25 1000 15,000Centerville Junior High 35 1500 15,000Two Oaks Elementary 5 200 5000Two Oaks Junior High 10 300 5000Totals: 100 4000 55,000What is the rate of asthma in the school-age population? a. 5:1000 b. 25:1000 c. 100:20,000 d. 400:2000

BWith 100 asthmatic children among 4000 total children, the rate is 100:4000, simplified to 25:1000.

A mother was very proud that she had cut back smoking from two packs a day, which she had smoked for years, to only half a pack a day. Which would be the most appropriate response by the nurse? A. "I wish all smoking moms could see your example!" B. "I'm so proud of you. You're down to only 25% of what you used to smoke!" C. "That must have been difficult, but you're probably still getting nicotine, so it's important you quit entirely." D. "Your baby will really appreciate your efforts at quitting, especially if you do not resume after the baby is born."

C Quitting is best. Merely reducing cigarette use during pregnancy may not be enough to benefit the fetus because women who cut back tend to inhale more deeply or take more puffs to get an equivalent amount of nicotine. The nurse's response must be supportive and recognize the mother's efforts but also continue to encourage total quitting.

A nurse is trying to determine who would be the most appropriate person to make a health care decision for an adolescent, the adolescent or the parent. Which consideration will the nurse need to make? A. The need for cultural competence B. The need for access to care C. The need for client autonomy D. The need for client privacy and confidentiality

C This situation addressed the need for client autonomy. When considering client autonomy, the nurse must consider the following questions. In the specific case, who should make health care decisions for a young client, especially when opposing opinions arise? The client? The parents or guardian? The nurse or other health care professional? At what age does a child become mature enough to participate in such decision-making? What laws does any given state have that affect adolescent client autonomy? What should the community health nurse do if he or she believes the client's or parent's decisions are not in the best interest of the client?

What proportion of U.S. citizens are children? a. 12% b. 16% c. 20% d. 24%

D

A school nurse is developing a health education program for third grade students about how to play safely. Which provides the best rationale for this nursing action? A. The kids were playing chicken in front of the school buses each day. B. The students are at the age when they begin to engage in risky behaviors. C. Toys can have unexpected hazards from lead paint to small swallowable parts. D. Without proper head protection, many sports can lead to traumatic brain injury

D Head injury from cycling and other wheeled sports, such as skateboarding, is a leading cause of child death and disability. Without proper head protection, a fall from as little as two feet can cause traumatic brain injury. The use of helmets and proper protective equipment can substantially reduce the risk of injuries. Adolescents are the population who begin to engage in risky behaviors. As third graders, these children are not typically at risk for swallowing small parts from toys. Although the education may provide information about why it is not safe to play chicken in front of the school buses, this is a behavior that should be stopped by the rules and regulations that are in place at the school.

How do the policies on children's health in the United States differ from the policies on children's health in other industrialized nations? A. Most industrialized nations, including the United States, have similar policies. B. U.S. policies are more market based and less social justice based. C. U.S. policies are voluntary, whereas in most countries they are required by law. D. Although industrialized nations have policies on children's health, the United States does not.

D In the United States, the government's role in promoting or ensuring children's health is more limited than in many other countries. Other countries often have defined policies on children's health; the United States does not. Not only do such policies indicate that children are a priority of the citizenry, but they also help shape the operation of programs and their funding.