CH FINAL CH15-32

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Vaccines

A preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease

Severe acute respiratory syndrome (SARS)

A previously unknown disease of undetermined etiology and no definitive treatment that was reported in early 2003 in places such as china and Hong Kong

Family nursing

A specialty area that has a strong theory base and consists of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness

Point source

A stationary location or fixed facility from which pollutants are discharged; any single identifiable source of pollution, e.g., a pipe, ditch, ship, ore pit, or factory smokestack

Sentinel

A surveillance system that monitors key health events when information is not otherwise available or in vulnerable populations to calculate or estimate disease morbidity

Family nursing theory

A theory whose function is to characterize, explain, or predict phenomena (events) evident within family nursing

describe the source of program evaluation.. program clients

(Attitude scales) Probably used most often Example: client satisfaction survey

describe the source of program evaluation.. program records

(Clinical records) Provide the evaluator with information about the care given to the client and the results of that care

As a liaion between resources in teh faith community and the local community the parish nurse's responsibilities include:

- Helpng clients know what resources are available to solve their problems - Helping individuals and families match the appropriate resource to their problems - Linking clients ith the appropriate services

As with other community health situations, the parish nurse along with the client does what?

- Identifies parameters of ethical concerns - Plans ahead with clients to consider health options in making ethical decisions - Supports clients in their journey to choose alternatives that will strengthen coping skills - Allows the client to grow stronger in faith and health - Considers teh "virtue ethics, such as careing, forgiveness and compassions, in their decision making"

A primary independent function of the parishnurses is that of personal health counseling which discusses ?

- health risk appraisals - Spiritual assessments - Plans for healthier lifestyles - Support and guidance related to numerous acute and chronic actual and potential health problems

steps of basic program planning?

-Definition of problem and need through data -Identify objectives and activities for alternatives -Evaluate problem solutions -Choose the solution -Select the best solution

Important aspects of quality improvement

-knowledge -skills -attitudes

c. Emergency departments and psychiatric units

. In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families?

d. There is no "safe" occupation or profession. Most adults spend about one third of their time at work. Every single industry grapples with serious hazard. No work is completely risk free.

1. An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace?

a. It is autonomous, because the occupational nurse works independently. b. The major focus is on the environment.

1. Which of the following describes how occupational health nursing differs from other nursing specialties? (Select all that apply.)

d. It provides a cost savings to the company.

10. Which of the following is the primary reason that large companies are becoming more involved in their employees' personal health and well-being?

b. Primary prevention

11. The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented?

c. Secondary prevention This does not meet the criteria for injury prevention because the injury has already occurred. The nurse is engaging in secondary prevention when providing treatment for the injury. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the foreign body from developing

12. An occupational health nurse is removing a foreign body from a patient's eye. Which of the following levels of prevention is being implemented?

b. Secondary prevention Secondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible moment in its course and elimination or modification of the hazard-producing situation

13. An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented?

d. To continue employment and income with limited duty as a rehabilitation effort after an injury

14. The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion?

b. To limit disability

15. An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change?

d. "Where do you work and what do you do there?"

16. A nurse is completing a health history on a client during a routine physical exam. Which of the following questions, which is often omitted, should be asked by the nurse?

d. "Where were you previously employed and what did you do there?"

17. A nurse is interviewing a person who has stated on her entry health form that she is retired. Which of the following is the most crucial question for the nurse to ask?

c. This data will help identify patterns in the risk factors associated with a particular subgroup.

18. A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic's clients. Which of the following best explains why the nurse is collecting this data

d. To observe effectiveness of safety education and equipment

19. As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse?

a. Each sick nurse Each worker represents a host within the worker population group.

2. A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor?

a. A majority of new jobs will be in service-oriented employment. b. Employees will often have compressed work weeks, shift work, and reduced job security. d. Many employees will be older and suffer chronic health problems.

2. An occupational health nurse should be aware of which of the following trends in the marketplace? (Select all that apply.)

c. Having employees use safety measures and personal protective equipment

20. Which of the following interventions regarding worker safety would be the least effective?

b. To ensure safe and healthful working conditions

21. Which of the following best describes the mission of OSHA?

b. Companies have improved safety of working conditions because worker's compensation insurance premiums are now based on previous claims.

22. Which of the following statements best describes how workers' compensation legislation has changed employer behavior?

c. Exhaustive inventory of chemicals and industrial hazards is completed.

23. Which of the following would most likely be one of the first steps taken in employer disaster planning?

c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown.

3. Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace? (Select all that apply.)

a. New workers employed less than 1 year The population group at greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job. Because of the inherent risks, the nurse should spend extra time with this group to decrease risk.

3. Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation?

a. The chemical Agents represent potential dangers or risk to the health and safety of workers. If the flask had broken and glass got into the employee's eye, then the flask would be an agent. However, in the case given, the chemical itself caused the damage

4. An employee in a laboratory drops a flask, resulting in a chemical splash into the employee's eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent?

b. To avoid the cost of liability suits, workers' compensation, etc. d. To meet legislated standards and avoid significant penalties for noncompliance

4. Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers? (Select all that apply.)

b. To compare the prospective employer's injury rate with similar employers' rates c. To learn more about the usual processes and products of the company as well as typical hazards

5. An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information? (Select all that apply.)

a. Housekeeping staff Transmission of tuberculosis (TB) within health care settings has reemerged as a major public health problem. Outbreaks of this type of TB have been reported in hospitals, and some workers have developed active drug-resistant TB. Many workers in these settings are employed as maintenance workers, security guards, aides, or cleaning people, who tend not to be well protected from inadvertent exposures, which include contaminated bed linen in the laundry, soiled equipment, and trash containing contaminated dressings or specimens.

5. Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB?

d. Sprains and strains In 2010, sprains, strains, and tears were by far the most frequent disabling conditions, accounting for 46.9% of days away from work (Bureau of Labor Statistics, 2011).

6. Which of the following is the most common disabling condition when measured by days away from work?

a. Anxiety, depression, and exhaustion An estimated 10% of Americans do some form of shift work that has the potential to lead to a variety of psychological and physical problems, including exhaustion, depression, anxiety, and gastrointestinal disturbance. Strategies to minimize the adverse effects of shift work, such as rotating shifts clockwise, are beneficial

7. A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion?

A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which of the following roles of the nurse is being used? A. Advocate B. Case manager C. Outreach worker D. Primary caregiver

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: A. child abuse. B. depression. C. intimate partner abuse. D. parent's resentment of the preteen.

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? A. Migrant farmworkers B. Seasonal farmworkers C. Underinsured D. Undocumented aliens

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: A. absolutely honest about what will be reported and what the family can expect. B. authoritarian in approaching the problem. C. cautious in reporting unconfirmed reports of violence. D. sincere in concern for the victims.

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

Which of the following persons is most likely to be assaulted? a. A young man b. A young woman c. An older man d. An older woman

Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder abuse? a. "Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." b. "Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us." c. "She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake." d. "We have to feed Mom baby food now because she has trouble chewing and swallowing regular food."

1. A unique characteristic of the standards of practice for school nurses is which of the following? Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students Requirement of bachelor's degrees in nursing and special certification in school nursing Restriction on delegation of care to other school personnel Use of research findings in the practice of school nursing

A In general, the National Association of School Nurses (NASN) standards align with those developed by the American Academy of Pediatrics (AAP) regarding giving health care to students in the schools. The AAP developed its own ideas about how nurses function in schools based on its assessment of school children's health needs. These guidelines are very similar to those written by the NASN. Additionally, the AAP recommends that the nurse be the head of a health care team that includes a physician (preferably a pediatrician), school counselors, the school psychologist, and members of the school staff including the administrators and teachers. DIF: Cognitive Level: Comprehension REF: Page 569

3. As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced, thereby increasing their resilience for future crisis situations. The characteristic of faith community nursing philosophy that best endorses this principle is that faith community nurse services: Emphasize strengths of individuals, families, and communities Focus on the faith community and its ministry Focus on the centrality of the spiritual dimension Consider health, spiritual health, and healing as an ongoing dynamic process

A Parish nurse services emphasize strengths of individuals, families, and communities. Parish nurses endorse this characteristic in their practice. As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced. This provides additional coping strengths for future crisis situations within the family and community. DIF: Cognitive Level: Application REF: Page 540

2. The faith community nurse role arose out of the challenges faced by families to succeed in meeting the demands of young children, teens, and aging parents as well as which of the following challenges? Inadequate training for caregivers Increased hospital length of stay Lack of consumer demand for health care decisions involvement Society's lack of accountability for health care decision making

A The beginning of the parish nurse movement coincided with shortening hospital stays, increasing demands on caregivers, inadequate training of caregivers, and family challenges to meet the needs of young children, teens, and aging parents. Parish nurse services were one way to coordinate care and foster continuity of care. The parish nurse services emphasized health promotion and disease prevention and provided the benefits of holistic care through the supportive faith community. DIF: Cognitive Level: Application REF: Page 539

7. A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological, and social services as components of the student health services. Additionally, the district has integrated family/community involvement, staff health promotion, and a commitment to a healthy school environment in its program design. This school district has adopted the school health service program scope of which of the following? CDC's Federal School Health Program Healthy Schools, Healthy Communities program Healthy People 2020 School-linked program

A The federal government, through the coordination of the CDC, has developed the Federal School Health Program. The plan includes eight parts: health education; physical education; health services; nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family/community involvement. DIF: Cognitive Level: Application REF: Pages 570-571

2. A second-grade child with cerebral palsy receives services from a physical therapist and occupational therapist during the child's academic day. The school nurse sets up the schedule to ensure that the therapists' visits do not unnecessarily affect the child's academic day negatively. This role of the school nurse is best described as which of the following? Case manager Counselor Consultant Direct caregiver

A The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. This may include the child who is disabled or chronically ill, who may be seen by a physical therapist, an occupational therapist, a speech therapist, or another health care provider during the school day. The nurse sets up the schedule for the child's visits so that those appointments do not unnecessarily have a negative effect on the child's academic day. Direct caregiver is the traditional role of the school nurse where immediate nursing care is provided. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse as counselor occurs when children go to the nurse to share important health information. DIF: Cognitive Level: Application REF: Page 570

9. The school nurse at the intermediate level arranges for a presentation by the trauma educator at the local regional medical center. Bicycle and helmet safety will be the primary topic at the school's open house. This is an example of which of the following school nurse roles? Community outreach Counselor Consultant Case manager

A When participating in community outreach, nurses can be involved in community health fairs, reaching others about influenza immunization programs, promoting health education fairs, and coordinating with local charities to provide education to the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. The school nurse as counselor is available to students who need to discuss confidential health matters. DIF: Cognitive Level: Application REF: Page 570

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. Soul loss d. Indigestion

A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the child turns 16, which of the following actions should be taken by the nurse (Select all that apply.) a. As an adult, the child is no longer eligible for school services without charge. b. The school must continue to provide needed appropriate education for the child. c. The school can exclude the child from any extra special activities. d. The school should prepare an updated individualized education plan.

A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school. A tertiary prevention intervention the school nurse should perform would be which of the following? a. Assess the child's language skills, motor abilities, and social abilities. b. Ensure that a telephone is available for calling emergency personnel or parents. c. Lead educational programs to address coping strategies and stress management techniques. d. Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience.

A. Adult day health

A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a. Adult day health b. Home health c. Long-term care d. Senior center

C. A durable medical power of attorney.

A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a. An advance directive b. A living will c. A durable medical power of attorney d. The Patient Self-Determination Act

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: A. denial. B. social drug use patterns. C. setting variable. D. coping.

A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

A The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker's environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases. Acupncture, behavior modification, and nicotine replacement products may all assist the client in stopping smoking. However, it has been demonstrated that the most effective method involves a combination of strategies.

A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? a. A combination of interventions, beginning with changing the environment b. Acupuncture to reduce the nicotine cravings c. Behavior modification through hypnosis d. Nicotine replacement products

A. Establish immunization clinics to prevent STDs.

A community health nurse is planning to implement an intervention to reduce the prevalence of sexually transmitted diseases in the community. Which of the following actions would most likely be taken by the nurse? a. Establish immunization clinics to prevent STDs. b. Educate people with HIV about the mode of transmission. c. Explain to women that HIV is transmitted to women usually by IV drug abuse. d. Develop a STD clinic to increase community access to services.

A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant organisms. Which of the following actions would be most appropriate for the nurse to implement? A. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. B. Notify the Centers for Disease Control regarding any unusual signs and symptoms related to a communicable illness. C. Reinforce the importance of receiving vaccinations according to recommended schedules. D. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections.

A community is experiencing an epidemic of the measles. The nurse is trying to determine if this problem is happening in other communities as well. Which of the following resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Morbidity and Mortality Weekly Report d. Weekly National Report of Communicable Diseases

A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most likely being completed? A. Disseminating information about mental health to community organizations B. Partnering with school health nurses for early identification of children who have evidence of mental health problems C. Providing case management services that link clients with serious mental illnesses to mental health and community support services D. Screening high-risk clients for the presence of mental disorders

Continuous Quality Improvement (CQI)

A continuous improvement in the quality of the product or service being delivered

ace

A current challenge for home health care is the issue of family responsibility for the role of caregiver. Which of the following statements reflects underlying factors that contribute to this home health care challenge? Select all that apply. a. Able family members with multiple obligations b. Debilitation of family members c. Number of women working outside the home d. Reimbursement to family e. Social support systems for caregivers

A current dramatic trend in nursing in community health involves: a. clinical surveillance. b. shifts in research focus. c. special needs programs. d. vulnerable population shifts.

A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? a. Continue activities as much as possible as if nothing had happened b. Continue to assess for shock and stress c. Help teachers discuss the disaster with their class d. Maintain school routines and activities

Hyperendemic

A disease/event that is found to have a persistently (usually) high number of cases

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? A. Assessment B. Case management C. Geriatrics D. Tertiary prevention

A family is concerned about the medical bills of their father, age 63, who is unemployed and has almost no savings. Which of the following statements by the nurse accurately explain how Medicaid and Medicare would work in this family's situation (Select all that apply.) a. "All your father's medical bills will be paid by whichever program is appropriate." b. "Choose any physician and just show them your Medicare or Medicaid card." c. "Your father must be homebound to qualify for Medicare assistance but less so for Medicaid." d. "Medicare is a federally funded program, but Medicaid is administered by your state."

A family member asks a home health nurse to explain the concept of hospice care. Which of the following would the nurse need to include as the fundamental underlying philosophy of hospice? a. Enabling the client to die at home b. Ensuring that the client's living will is upheld c. Placing experts in the position of power of attorney d. Providing comfort measures before death

A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a daycare center being the first location. What of the following advice should be given to them by their instructor? a. Base the program on the audience's development and maturity. b. Bring (borrow if necessary) a model of the heart to help explain its functioning. c. Focus on entertaining the learners. d. Have lots of handouts to reinforce the lesson.

C. Managing any chronic diseases to prevent complications and delay deterioration. D. Maximizing self-care capacity.

A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best assist them with healing? (Select all that apply.) a. Advocating for increased support for elderly persons b. Eliminating signs and symptoms of disease c. Managing any chronic diseases to prevent complications and delay deterioration d. Maximizing self-care capacity

Managed care

A health care system whose goals are to provide cost effective quality care.

A home health client has been taking 50 mg of meperidine, a narcotic analgesic, every 4 hours for pain. Which of the following statements made by a nurse to the client's physician indicates a need for further education on narcotics? a. "You need to decrease the time interval between doses to every 3 hours so that my client will maintain pain relief." b. "You need to discontinue that order before my client becomes addicted." c. "You need to increase the meperidine so that my client will achieve adequate pain relief." d. "You need to give my client something in addition to the meperidine."

ACD It would not be appropriate to ask to decrease the time interval in between doses as the increased use of acetaminophen may be damaging to the client's liver and kidneys. There is no evidence that this client is at risk for developing an addiction. Thus, demanding that this medication be discontinued may be a premature action by the nurse. However, the nurse should monitor the patient closely for signs and symptoms of potential addiction. Rather than adding another medication, the physician may want to consider changing the medication. It would be appropriate to ask the physician for a different medication to possibly assist with the client achieving optimal pain relief. It was once thought that opiods were by far the most effective drugs for pain relief; however, this belief is now being questioned.

A home health client has been taking acetaminophen with codeine, a narcotic analgesic, every 4 hours for pain following a hip arthroplasty. Which of the following statements made by a nurse to the client's physician indicates a need for further education on narcotics? (Select all that apply.) a. "You need to decrease the time interval between doses to every 3 hours so that my client will maintain pain relief." b. "You need to discontinue that order before my client becomes addicted." c. "You need to prescribe a different medication so that my client will achieve adequate pain relief." d. "You need to give my client something in addition to this medication."

A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurse's current focus? a. Outcome identification b. Planning c. Implementation d. Evaluation

D Denial is a primary symptom of drug addiction. A problem should be suspected if the client becomes defensive or exhibits other behavior indicating denial when asked about alcohol or other drugs. Confusion, a history of lying, and mental status changes would most likely not be the cause of the client's denial.

A home health nurse believes a client may be a drug addict. However, the client denies the use of drugs when questioned by the nurse. Which of the following is the most likely cause of the client's denial? a. Confusion resulting from dementia b. History of compulsive lying c. Mental status changes d. Use of addictive drugs

A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the best approach for the nurse to take? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

A home health nurse is working with a client who requires a catheter insertion and wound care. The nurse is also helping the client and family to develop positive coping skills and identify resources that will help the client to attain a state of optimal functioning. It is important for the nurse to specifically document nursing services provided because of which of the following? a. The agency is required to practice within the guidelines set up by regulatory agencies. b. Each criterion has minimum standards to which the program must adhere. c. Nurses are required to provide supervision of services. d. Reimbursement is dependent on the provision of skilled care.

A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital. Which of the following is the best explanation for this? a. Home care assessment includes not only the client but the supplies and equipment the family may have available for use. b. The home environment is less organized and equipped for the nurse's use. c. Family members must also be assessed for possible problems that could interfere with the primary client's recovery. d. To be effective, the home health nurse must earn the family's trust and work in partnership with them.

Host

A living organism, human or animal, in which an infectious agent can exist under natural conditions

A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of: A. drug abuse. B. drug addiction. C. substance abuse. D. adverse drug reaction.

A major emerging public health issue facing nursing in community health is: a. bioterrorism. b. health literacy. c. health ministries. d. welfare reform.

D Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. This client is already using IV drugs, thus, the nurse will be intervening at the tertiary level of prevention. Secondary and primary prevention strategies would not be appropriate when working with this client who already has a known problem

A male IV drug abuser admits to the nurse that he has no desire to stop using drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels him on how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases

D Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. When the wife lies for the husband, she is enabling the behavior to continue. The other options do not demonstrate the behavior of enabling, shielding the man from experiencing the consequences of the addiction.

A man is addicted to alcohol. In which of the following scenarios is a family member enabling the man to continue drinking? a. The wife asks the nurse to explain why her husband's continued drinking is dangerous. b. The son threatens to leave home because he finds the father's behavior embarrassing. c. The teenage daughter turns to a favorite teacher for emotional support. d. The wife tells her husband's boss that her husband is sick when he is actually inebriated.

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? a. "Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b. "It's just the right thing to do." c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d. "We're a religious God-fearing community, and we take care of each other."

C Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful

A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse

Total Quality Management (TQM)

A management philosophy that includes a focus on client, CQI, and teamwork

Tracer method

A measure of both process and outcome of care and is used today

Infectiousness

A measure of the potential ability of an infected host to transmit the infection to other hosts

A middle school student approaches the school nurse and asks, "Can I speak with you about something important?" The school nurse responds affirmatively but should also state which of the following? a. "Anything you tell me will be kept private and confidential." b. "If anything you tell me indicates that someone is in danger, the parents and school officials must be told." c. "It may be best for me to set up an appointment with the school counselor." d. "You can always speak to me if you are in trouble or when you need someone to talk to."

A migrant farmworker brings his daughter into 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.

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

A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, 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

ABC Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategies: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic appraisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions. Based on the inforamtion provided, there is no reason to suggest the the child needs to develop new friendships. Keeping consistent friendships may provide the support the child needs to avoid engaging in these behaviors

A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following strategies would the nurse suggest the mother implement? (Select all that apply.) a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. d. Encourage her daughter to develop new friendships.

C. "It depends on whether you trust your son to drive safely."

A mother says, "My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and other activities. Do you think I should let him have a car?" Which of the following statements would be the best response by the nurse? a. "Absolutely, it will help him recognize the cost of gas and maintenance." b. "Certainly. Most young men want their own car, and peer pressure can be painful." c. "It depends on whether you trust your son to drive safely." d. "No, adolescent males cannot be trusted with an automobile."

C Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men (except for males with chronic alcoholism). It is unlikely that the woman will win, as women are more affected by alcohol than men. It is also unlikely that they will both "win" at the same time because the alcohol will likely affect the woman facter than the man.

A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when the other passes out and cannot continue? a. If their drinks are the same size, they'll both pass out about the same time. b. If they play fair, they'll probably both vomit before passing out. c. The man will win. d. The woman will win.

A B C D E

A multisystem approach to community disease control would include such interventions as: (select all that apply) Select all that apply. a. community action programs. b. control of vectors. c. improved surveillance systems. d. legislation. e. provision of chemotherapy.

A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident. Which of the following types of care will he most likely receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

A new role for public health that is used in widespread public emergencies is: a. communicable disease control. b. first responder. c. incident commander. d. professional triage.

A new student's parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the student twice. Which of the following actions should be taken by the nurse to keep the child in school (Select all that apply.) a. Call the parents or mail another reminder. b. Report the problem to the teacher and the principal. c. Send the child home with a note saying the child cannot return until the immunization record is received. d. Suggest to the parents that if they don't have health care insurance, they may qualify for programs that provide immunizations free.

C. Tertiary prevention

A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

A nurse completes a self-assessment of performance as part of the home health nurse's annual evaluation. Which of the following terms best describes this activity? a. Collaboration b. Quality of care c. Performance appraisal d. Resource utilization

A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. Which of the following best describes this type of nursing? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing

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: A. abusive. B. codependent. C. coping. D. estranged.

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: A. engage in physical activity during leisure time. B. engage in preventive behaviors. C. perceive their overall health as less favorable. D. use seat belts.

A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) a. Cholera b. Hepatitis c. High blood level of lead d. Malaria

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

A nurse is completing a health history on a client during a routine physical exam. Which of the following questions, which is often omitted, should be asked by the nurse? a. "How is your family doing" b. "What problems have you been having" c. "What health concerns do you have today" d. "Where do you work and what do you do there"

A nurse is considering applying for a public health nurse position at a local health department. Which of the following minimum levels of educational preparation should the nurse have obtained? A. Associate degree in nursing B. Baccalaureate degree in nursing C. Master of science degree in nursing D. Training as a licensed practical nurse

A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his practice? A. Decisions are made at the federal level, disseminated at the state level, and carried out at the community level. B. Health of populations is only as good as the health of individuals that live and work in the community. C. Oversight of community health departments is the most important function. D. The interaction of the local-state-federal partnership is critical to success.

ABD

A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this agency (Select all that apply.) A. Delegating power to engage in certain activities such as quarantine B. Enforcing laws and regulations that protect public health C. Filing birth and death certificates whenever these occur within the state D. Monitoring health status of citizens within its geographic boundaries

AB Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person's own personal Responsibility for any changes made, and give Advice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of Self-efficacy. Having the client's family members tell the father that they understand his behavior does not encourage him to realize the need for change. Threatening a future possibility of prison would not provide encouragement to the father and may even challenge him to continue his behavior.

A nurse is helping a client's family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client's family members would be most effective? (Select all that apply.) a. "Express your love and your belief that he can change." b. "Point out that his behavior is his choice and his responsibility." c. "Let him know that you understand how much he loves being with his drinking pals and that you agree that their friendship is important." d. "Remind him that entering treatment is better than going to prison."

A. Educate a community group about hypertension control.

A nurse is implementing Wagner's Chronic Care Model. Which of the following actions would the nurse most likely take? a. Educate a community group about hypertension control. b. Create a budget for chronic disease management. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following actions is the nurse most likely taking? A. Identifying and treating clients in a sexually transmitted disease clinic B. Partnering with schoolteachers to teach and observe hand washing techniques in elementary school children C. Providing case management services that link clients with communicable diseases to health care and community support services D. Performing directly observed therapy (DOT) for clients with active tuberculosis

C. Monitoring blood glucose levels closely and modifying diet accordingly.

A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? a. Developing lifestyle improvement programs for women at risk for diabetes b. Presenting lifestyle management presentations at women's conferences c. Monitoring blood glucose levels closely and modifying diet accordingly d. Screening glucose levels of women at risk for development of diabetes

A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? a. Observe farmworkers for evidence of unsafe handling of pesticides. b. Provide teaching on how to handle pesticides to avoid or decrease exposure. c. Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. d. Treat a client who has pesticide exposure to prevent complications.

A nurse is interviewing a person who has stated on her entry health form that she is retired. Which of the following is the most crucial question for the nurse to ask? a. "Have you had any problems since leaving your employment" b. "How do you spend your time now" c. "What has retirement been like for you" d. "Where were you previously employed and what did you do there"

C. Cardiac health education programs.

A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse does not yet know the community, which of the following programs would be good to plan first? a. Alcohol and tobacco cessation programs b. Cancer screening programs c. Cardiac health education programs d. Exercise for life programs

D. "I can't believe how little I care about anything anymore since that diagnosis."

A nurse is performing a health assessment on a young adult female. Which of the following comments by the client would cause the nurse to be concerned? a. "I can't believe I didn't get that promotion. I thought I was the best candidate." b. "I can't believe they didn't admit me to that graduate program with my good undergraduate grades!" c. "I can't believe how lonely it is around the house since my spouse died." d. "I can't believe how little I care about anything anymore since that diagnosis."

B. Ensure the individual is educated to make an informed choice about reproduction.

A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

C. Folic acid

A nurse is providing pre-conceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a. Iron b. Calcium c. Folic acid d. Vitamin C

D There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. As the client learns how to eat and recognizes what she is eating, she is preparing for action. Therefore, the nurse should be encouraging and recognize that the client has begun serious change. This comment by the client demonsrates that the client is ready to take action and needs to be encouraged by the nurse. The incorrect responses are not encouraging replies that would promote the client to continue to move forward with these actions.

A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, "I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal." Which of the following would be most appropriate response from the nurse? a. "I'm so glad you're beginning to recognize the need to control your blood sugar." b. "Now you just have to make sure you don't give that habit up!" c. "Sounds like you're not ready to really plan your eating yet." d. "That is great. You've started to take action and make changes."

AD Supporting an increase in additional recreational facilities would engage the community members in healthy activities rather than having them potentially turn to substances for relaxation. Providing screenings for substance abuse in the community may assist community members in recognizing the problem sooner. It would not be appropriate to educate preschoolers about the long-term side effects of drugs and alcohol. Preschoolers have difficulty understanding long term effects. This education may be more appropriate for older students. Lobbying state legislators for increase in a higher cigarette tax may be beneficial, but this intervention is focused on a larger area than only the community where the nurse is working.

A nurse is screening a client for ATOD problems. Which of the following actions would the nurse most likely complete? (Select all that apply.) a. Assist with identifying help or resources. b. Advise about the need to enter a treatment program. c. Ask about how relationships with family members and friends have been affected. d. Assess amount and pattern of use.

A nurse is working at a local health department. Which of the following would most likely be completed by this agency? A. Enforcement of laws and regulations related to public health nationwide B. Filing of a certificate for any birth or death in a community C. Providing experts in various specialties to answer questions and respond as needed D. Surveying the state's public health needs

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 non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

A. Connect offenders with community-based mental health programs.

A nurse is working with incarcerated adults who are being released from prison. Which of the following nursing interventions would be most appropriate for the nurse to implement? a. Connect offenders with community-based mental health programs. b. Provide community supervision for mentally ill offenders. c. Advocate for increased prison time to decrease recidivism rates. d. Educate about available state resources.

A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic's clients. Which of the following best explains why the nurse is collecting this data? a. This data will be useful in a research study the nurse is conducting. b. This data will provide evidence of clinic resources being wasted on minor health problems. c. This data will help identify patterns in the risk factors associated with a particular subgroup. d. This data can be used to show trends that can be included in the next grant proposal for further funding.

A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion? a. Anxiety, depression, and exhaustion b. Family turmoil c. Physical illnesses d. Sleeping disorders

A nurse orienting to the home health role states, "I don't understand why we have to collaborate with so many other disciplines; this conflicts with the concept of nurses providing all direct care to the client in the home" Which of the following would be the best response? a. "The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care." b. "Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible." c. "Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base." d. "Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration."

B Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than does mainstream smoke.

A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother's arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home.

ACD

A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) a. "Community members will probably hold you in higher regard and will look up to you." b. "Expect to have less autonomy in a small town than you have working as a nurse in a medical center." c. "You may feel like an isolated outsider, because the community may not immediately accept you." d. "You will have to be very sensitive about the differences in the rural lifestyle."

C. Careful driving program

A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a. Anti-alcohol program b. Anti-smoking program c. Careful driving program d. Safe sex program

A. Accidents and injuries

A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a. Accidents and injuries b. AIDS c. Childhood obesity d. Vaccine-preventable diseases

A. Establish lifestyle improvement programs through local youth organizations.

A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? a. Establish lifestyle improvement programs through local youth organizations. b. Evaluate the food intake of a group of children for a 48-hour period. c. Provide education programs to overweight expectant parents. d. Evaluate the body mass index of children at regularly scheduled well-child exams.

A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor? a. Each sick nurse b. The communicable disease c. The hospital d. The patient

A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? a. Educate students about injury prevention measures b. Provide free condoms to sexually active students c. Screen for signs and symptoms of cancer d. Invite a guest speaker to talk about living with HIV

A. Life expectancy.

A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most likely use? a. Life expectancy b. Mortality rate c. Morbidity rate d. Health status

A nurse's Mantoux test is positive for exposure to tuberculosis. Which of the following conclusions should be drawn by the nurse? a. The nurse has been exposed to tuberculosis. b. The nurse has tuberculosis. c. The positive test result probably is due to a problem in the testing process. d. The test is inaccurate and needs to be repeated.

ABC

A nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) a. It is very difficult to obtain continuing education, except for online programs. b. Neighbors seem to expect the nurse to know everything about all health care and illness conditions. c. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d. People come to the health clinic before their situation becomes relatively serious.

B. Continue to abstain from alcohol and not use tobacco C. Eat foods high in calcium such as fortified skim milk.

A nurse's mother leans forward and says, "My best friend fell the other day and now she's in the hospital. I'm really worried about getting osteoporosis. What do you think I should do?" What should the nurse recommend? (Select all that apply.) a. Ask your doctor for hormone replacement therapy. b. Continue to abstain from alcohol and not use tobacco. c. Eat foods high in calcium such as fortified skim milk. d. Eat lots of green leafy vegetables.

C. Incontinence.

A particular chronic health problem that adversely affects the aging experience for which it is difficult to estimate the number of individuals affected or the associated cost to manage is: a. iatrogenic drug reactions. b. immobility. c. incontinence. d. intellectual impairment.

Health disparities

A particular type of health difference that is closely linked with social, economic and/or environmental disadvantage.

A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services. If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse? a. Call in another nurse to care for this client. b. Explain, from the nurse's perspective, all the reasons that abortion should be made illegal. c. Offer the student a combination of oral contraceptives to induce spontaneous abortion. d. Provide information on alternatives to abortion and give the client information on adoption agencies.

Concurrent audit

A process audit that evaluates the quality of ongoing care by examining the nursing process

Recognition

A process by which one agency accepts the credentialing status of and the credentials conferred by another agency

Certification

A process in which a person, an institution, or a program is evaluated and recognized as meeting certain predetermined standards to provide safe and ethical care.

A public health nurse has reviewed the objectives of Healthy People 2020. Which of the following should be the focus for programming in the community related to communicable diseases? A. Encouraging community members to engage in healthy behaviors B. Identifying high-risk sexual behaviors among community members C. Monitoring the sexual activity of adolescents D. Providing information about the hazards of multiple sexual partners

A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the following levels of prevention is being implemented? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Secondary and tertiary prevention

A recent news article reported the death of a 60-year-old road construction worker on a day with a posted heat advisory. An occupational health nurse would recognize the additional host factors that contributed to this fatality as which of the following? a. Age and work practices b. Gender and lifestyle c. Health status and age d. Work practices and health status

A 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

A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological, and social services as components of the student health services. Additionally, the district has integrated family/community involvement, staff health promotion, and a commitment to a healthy school environment in its program design. This school district has adopted the school health service program scope of which of the following? a. CDC's Federal School Health Program b. Healthy Schools, Healthy Communities program c. Healthy People 2020 d. School-linked program

B Research demonstrates that genes are responsible for about half of the risk for abuse of alcohol. Multiple genes play a role in a person's risk for the development of alcoholism. Research has not shown that the family environment is the main risk factor for alcoholism. Alcoholism is more common among men than women. Persons who are born with fetal alcohol syndrome are not alcoholics from birth and are likely to have metabolic or other disturbances.

A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth.

B One means of secondary prevention is to institute early detection (screening) programs in schools, the workplace, and other areas in which people gather to determine the presence of substance abuse. Primary prevention involves education before a problem occurs. Tertiary prevention occurs after the problem has occurred and aims to assist the client to the highest level of functioning.

A school health nurse is conducting drug screening to detect drug use by students before problems develop. Which of the following levels of prevention does this action represent? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary and secondary prevention

A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? a. Case manager b. Consultant c. Counselor d. Health educator

abd

A school nurse describes to teachers the characteristics of an adolescent who may be thinking about drastic violence. Which of the following behaviors would suggest the adolescent was having such problems (Select all that apply.) a. Being a gang member b. Damaging property c. Leaving the scene if another student is being bullied or hurt d. Mood swings

A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

A school nurse is administering medications at the school. Which of the following guidelines should be followed? a. A current drug reference should be available in case information is needed b. The nurse should administer medications brought in from home by the child c. Medications cannot be administered without a physician order d. Narcotics and controlled substances should be kept in a locked cabinet

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: A. delinquent behavior. B. drug use. C. field work. D. Migrant Education Program.

A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which of the following levels of prevention is being used by the nurse? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

C. Childhood obesity

A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for: a. asthma. b. attention deficit disorder (ADD). c. childhood obesity. d. poisoning.

A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? a. Ask the student if abuse has occurred. b. Call in the named student and ask him to remove his shirt. c. Discuss the conversation with the student's parents. d. Notify the legal authorities.

D Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. Side effects of crack cocaine and ice methamphetamine are similar and include increased breathing, rapid heart rate, high blood pressure, and increased body temperature. Tabacco use is associated with many chronic diseases and a person smoking tobacco would not display these symptoms.

A school nurse stops a student in the hall and asks whether the student has been having trouble with her eyes, which look rather red and dry. The female student yawns and says that she hasn't noticed any eye problems. However, she does confess to the school nurse that she has gained 15 pounds since she began smoking "special cigarettes." Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana

A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program. Which of the following is the school nurse most likely trying to prevent? a. Adolescent suicides b. Bullying c. Obesity d. Teenagers engaging in violence

C. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese.

A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be most effective? a. Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b. Increase nutrition programs in schools that teach children to make healthy food choices. c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d. Provide after-school and summer camps that focus on diet and exercise.

A second-grade child with cerebral palsy receives services from a physical therapist and occupational therapist during the child's academic day. The school nurse sets up the schedule to ensure that the therapists' visits do not unnecessarily affect the child's academic day negatively. This role of the school nurse is best described as which of the following? a. Case manager b. Counselor c. Consultant d. Direct caregiver

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? a. Inform all students, staff, and faculty of a possible rubella epidemic b. Inform all students, staff, and faculty of a possible measles epidemic c. Reassure the student that it is just a bad cold and will soon pass d. Tell the student to take two acetaminophen and drink lots of fluids

A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? a. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b. "Your daughter may have pinworms; let me teach you how to check for this." c. "Perhaps your child is not developmentally ready for group play." d. "Try to arrange more one-on-one time with your 3-year-old."

A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur? a. The results will probably be negative for HIV. b. The results will probably be positive for HIV. c. The probability of disease is so low there is no reason to be tested. d. The test results won't be reliable so soon after exposure.

B Bath salts are crystalline powder that can be swallowed, inhaled or injected and that is highly addictive. They contain man-made stimulations, cathinones, which are similar to amphetamines. They increase dopamine levels and create feelings of euphoria. Ecstasy raises the body's temperature, pulse rate, and blood pressure. Alcohol, heroin, and marijuana would all have a depressant effect.

A teacher sends a student to the school nurse because the student does not seem to be thinking clearly. The nurse notes that the student is having palpitations, as well as elevated pulse, blood pressure, temperature. Which of the following would most likely cause these symptoms? a. Alcohol b. Ecstasy (MDMA) c. Heroin d. Marijuana

A unique characteristic of the standards of practice for school nurses is which of the following? a. Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students b. Requirement of bachelor's degrees in nursing and special certification in school nursing c. Restriction on delegation of care to other school personnel d. Use of research findings in the practice of school nursing

Accreditation

A voluntary approach to QA is used for institutions

A widely recognized chemical health hazard in health care environments is which of the following? a. Burn-out b. Latex allergy c. Radiation d. Viruses

C The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. It is inappropriate to assume that the woman wants assistance from her mother. There is no evidence to suggest that the woman or her baby were in danger before he went to prison. Saying "you must hate him" is not appropriate, as it is not the nurse's role to tell the client how she should be feeling.

A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse? a. "I'm so sorry to hear that. Is your mother able to be with you?" b. "It's good that you and the baby are safe from him." c. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" d. "You must hate him for leaving you alone with a new baby!"

D. Family and Medical Leave Act (FMLA)

A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a. Personal Responsibility and Work Opportunity Reconciliation Act b. Women's Health Equity Act (WHEA) c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA)

10. Secondary prevention activities are the largest responsibility of the school nurse and may include which of the following? (Select all that apply.) Establishing an emergency plan when a child or staff member needs immediate care Giving medications to children during the school day Participating in developing an individual education plan (IEP) for students with long-term health needs Screening for vision, hearing, height and weight, oral health, TB, and scoliosis Teaching standard precautions to all staff

A, B, D, E Secondary prevention involves caring for children when they need care and is the largest responsibility of the school nurse. It may include such activities as caring for ill or injured children or staff (including the development of an emergency plan and appropriate training of staff in standard precautions, first aid, and relevant emergency procedures); screening and assessing children; making appropriate referrals; giving medications; identifying abuse and neglect; communicating with health care providers; preventing suicide and violence; and responding to disasters. DIF: Cognitive Level: Application REF: Pages 574-575

A unique characteristic of the standards of practice for school nurses is which of the following A. Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students B. Requirement of bachelor's degrees in nursing and special certification in school nursing C. Restriction on delegation of care to other school personnel D. Use of research findings in the practice of school nursing

A. Alignment with the american academy of pediatrics guidelines for providing healthcare to student

A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological and social services as components of the Student Health Services additionally the district has integrated family community involvement staff health promotion and a commitment to the help school environment and its program design this school district has adopted the school health service program scope of which of the following A. CDC's Federal School Health Program B. Healthy Schools, Healthy Communities program C. Healthy People 2020 D. School-linked program

A. CDC's federal school health program

A second grade child with cerebral palsy receive services from a physical therapist and occupational therapist during the child's academic day the school nurse that's up a schedule to ensure that the therapist visits do not unless they are really affect the child's academic de- lis this role of the school nurse is best described as which of the following A. Case manager B. Counselor C. Consultant D. Direct caregiver

A. Case manager

The school nurse at the intermediate level arrangements for a presentation by the trauma educator at the local regional medical center bicycle and helmet safety will be the primary topic of the school's open house this is an example of which of the following school nurse roles A. Community outreach B. Counselor C. Consultant D. Case manager

A. Community outreach

A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? A. Cultural B. Environmental C. Political D. Social

A. Cultural

Secondary prevention activities are the largest responsibilities of the school nurse and may include which of the following A. Establishing an emergency plan when a child or staff member needs immediate care B. Giving medications to children during the school day C. Participating in developing an individual education plan (IEP) for students with long-term health needs D. Screening for vision, hearing, height and weight, oral health, TB, and scoliosis E. Teaching standard precautions to all staff

A. Establishing an emergency plan when a child or staff member needs immediate care B. Giving medications to children during the school day D. Screening for vision, hearing, height and weight, oral health, TB, and scoliosis E. Teaching standard precautions to all staff

Which of the following are factors that may contribute to vulnerability? A. Exercise habits B. Crime C. Peeling lead paint D. Social isolation E. Illiteracy

A. Exercise habits B. Crime C. Peeling lead paint D. Social isolation E. Illiteracy 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. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problemsDIF: Cognitive Level: KnowledgeREF: Pages 375, 376

A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: A. advocacy. B. culturally competent care. C. partnership. D. social justice.

A. advocacy

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: A. carrying heavy book bags. B. changing to home education. C. decreasing fluid intake to avoid nausea. D. keeping up her grades.

A. carrying heavy book bags.

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

A. 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).DIF: Cognitive Level: KnowledgeREF: Page 375

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: A. developmental delays. B. ear infections. C. frequent colds and infections. D. irritability.

A. developmental delays.

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: A. limitations in following treatment protocols. B. limited number of transient treatment facilities. C. transition to persistent poverty. D. use and abuse of tobacco, alcohol, and illicit drugs.

A. limitations in following treatment protocols.

Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? (Select all that apply.) A. Assessment of the individual's health does not determine the overall family system's health. B. Family functioning affects the health of individuals. C. Family system assessment specifically addresses the individual's health. D. The individual's health affects family functioning. E. Simultaneous assessment of individual family members and the family system as a whole is important to family health.

ANS: B. Family functioning affects the health of individuals. D. The individual's health affects family functioning. E. Simultaneous assessment of individual family members and the family system as a whole is important to family health.

What terms are used to describe healthy families? (Select all that apply.) A. Families with strengths B. Dysfunctional C. Functional families D. Resilient families E. Resistant families

ANS: A. Families with strengths C. Functional families D. Resilient families

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

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

ANS: A Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision. It serves as more of a medical model than the senior center, and individuals typically return home to their caregivers at night. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems and help would not be available.

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

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

18. A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. Wait, said the new mother. Why is my son getting two shots? Which of the following statements would be the best response by the nurse? a. One injection protects your son, while the other encourages his body to build up immunity. b. One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him. c. Since youve already been infected with the virus, your son needs twice as much protection. d. The second shot is just to make sure the first one works.

ANS: A Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection.

Which of the following is the best way to ensure good nutrition in infants? a. Breastfeeding only b. Feed them only brand-name baby foods c. Feed them only brand-name cereals d. Feed them only brand-name formulas

ANS: A Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity.

Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager

ANS: A Children under the age of 4 years and children with special needs are at highest risk for abuse.

ANS: A Connecting offenders with community-based mental health programs at the time of release from prison can decrease recidivism rates, because many incarcerated adults experience major psychiatric disorders. It would be impossible for the nurse to supervise all mentally ill offenders in the community. Increased prison time is not shown to decrease recidivism rates and education about available state resources is not the most important nursing intervention to provide for this population.

A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? A. Contracting B. Crisis intervention C. Empowerment D. Strategic planning

ANS: A Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a. HRT does not prevent heart disease. b. Use of HRT is recommended to prevent osteoporosis. c. When used with complementary therapies, HRT is most effective. d. HRT is a contributing cause of breast cancer.

ANS: A HRT does not prevent heart disease. To prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active.

A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? A. "Does your 4 year-old have a booster seat in the car?" B. "Have you noticed any physical problems as you go about your daily routine?" C. "What concerns do you have today? D. "Why did you decide to come in for a checkup?"

ANS: A Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness

ANS: A Injuries are the number one cause of death for children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable. Obesity, although a significant problem, is not a common cause of death in children.

ANS: A Life expectancy is a measure that is often used to gauge the overall health of a population.

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

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

A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take? A. Conducting a sexual behavior survey with the adolescents B. Establishing in-school education related to transmission of sexual infections C. Providing free condoms at schools and universities D. Providing follow-up educational programs for those diagnosed with an STI

ANS: A Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

ANS: A Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.

Toward whom is the TLC model targeted? a. Caregivers of older persons with health problems b. Community organizations that offer services for the elderly c. Elderly clients with health problems d. Nurses who care for older clients

ANS: A The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management.

A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? A. "Be sure to take a 30-minute walk each day." B. "Call our office if you have any questions or concerns at all." C. "Come back in 2 weeks for follow-up on your surgery." D. "Continue to take the drug until it is gone, even if you're feeling better earlier."

ANS: A The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

ANS: A The goal of Healthy People 2020 is to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases and their complications. Nursing activities should align with these goals.

A nurse has been successful in creating improvement in a family's health. Which of the following characteristics is most likely displayed by the nurse? A. Skilled at recognizing and strengthening the family's competencies B. Skilled at obtaining referrals and resources for the family C. Skilled at communication and interpersonal relationships D. Skilled at assessing and naming the family's main problems

ANS: A The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits.

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" Which of the following provides the best rationale for the nurse asking this question? A. To assess the family's environment and social resources and risks B. To communicate with relevant others as needed C. To determine financial assets available to the family in case of serious need D. To understand the extended family relationships

ANS: A The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? A. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. B. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. C. Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the child's immunizations are up to date. D. A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.

ANS: A Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

ANS: A Use of electronic health records, provider reminders for key evidence-based care components, interprofessional teams communicating regularly and community health classes to educate people with chronic diseases are various ways the CCM is being implemented. Creating a budget is not a way to use CCM. Administration of immunizations and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

A new mother is a full-time college student who lives with her parents, because the babies father has been imprisoned related to theft and drug abuse. The infants grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this families needs? A. Developmental B. Interactional C. Structure-function D. Systems

ANS: A Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughters (and grandchildren's) needs.

A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? A. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. B. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. C. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. D. Survey families in the community to determine whether they eat clay and how much clay they eat.

ANS: A Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.

A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? A. Bio-ecological systems theory B. Family systems approach C. Family developmental theory D. Interactionist theory

ANS: A The bio-ecological systems theory describes how environments and systems outside of the family influence the development of a child over time

Which of the following statements best explains why family functions and structures create unique challenges in family nursing? A. Function and structure change over time. B. Function and structure do not apply to all family units. C. Some clients do not have families. D. Traditional families are rare in society.

ANS: A The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the twenty-first century exciting and challenging.

Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.) a. A 16-year-old who is living on his own (not with his parents) b. A pregnant adolescent c. An adolescent in an emergency situation d. An adolescent whose diagnosis has a serious prognosis

ANS: A, B, C Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the "mature minors doctrine." This allows youths 15 years of age and older to give informed medical consent if it is apparent that they are capable of understanding

After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older friend asks the nurse, "I'm really scared of getting cancer. What can I do to avoid that kind of cancer?" Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Avoid smoking or much alcohol. b. Choose poultry or fish rather than red or processed meat. c. Eat lots of fruits, vegetables, and fiber each day. d. Try to get at least 8 hours of sleep a night.

ANS: A, B, C Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer.

2. A woman and man who have come to the health clinic begin to argue loudly. You gave me an STD! the man yells. The woman screams back, Not me. I dont have an STD! Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. Actually, youre very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done. b. Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary. c. Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again. d. You may be able to get treatment from your pharmacist so you wont have to be embarrassed like this again.

ANS: A, B, C Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STD test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person.

Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) A. Agency's policies regarding eligibility for services B. Family's feelings about the home visit and willingness to continue C. Nurse's perception of the amount of time needed to complete required tasks D. Reimbursement policies of third-party payers

ANS: A, B, D Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the family's willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurse's time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurse's perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available.

A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) A. The nurse can assess the family environment. B. The family will feel more comfortable. C. Families typically welcome others into their home. D. More family members can typically be involved.

ANS: A, B, D Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the families home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.

A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.) A. The family won't have to travel. B. It is cheaper for the family because of reimbursement requirements. C. Meeting at home is much more convenient for the family. D. The nurse won't be distracted by other clients or responsibilities. E. It would save money for the nurse and the clinic.

ANS: A, C Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurse's employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.) a. Assess schools and day care centers for environmental "friendliness." b. Share nutritional information with all students in the school. c. Develop home and environmental assessment guides. d. Teach all school personnel how to use rescue inhalers.

ANS: A, C Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day-care centers for lack of asthma triggers.

Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) A. Why the data are needed B. How best to interview each individual in the family C. The most convenient time for you to visit the family D. The rationale or purpose of the visit

ANS: A, C, D Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. It can be assumed that the nurse would already know agency policies. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual). Therefore, the preferred time to visit is when most family members will be available. Similarly, it is more informative to see the family in their home setting than to establish a different site for the visit.

A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.) A. The reason for the visit B. Everything the nurse knows about the family C. How many visits will be planned D. The cost of the visit and how this may be paid

ANS: A, D The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the family's situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the family's willingness for a home visit. If the family does not have a phone, mail can be used to share information.

In applying the developmental theory, a family nurse determines the developmental stage of the family based on: A. age of the eldest child. B. family strengths. C. individual growth patterns. D. overall tasks of the family.

ANS: A. age of the eldest child.

The nurse in community health uses information about family structure, household composition, marriage, divorce, birth, death, adoption, and other family life events to forecast and predict stresses and developmental changes experienced by families and identify possible solutions to family challenges. This best describes the study of: A. family demographics. B. family functions. C. family health. D. family resilience.

ANS: A. family demographics.

The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: A. fosters equal family and provider commitment to success. B. facilitates outcomes-oriented family nursing research. C. decreases the need for nurse contact and intervention. D. removes barriers to needed services to achieve success.

ANS: A. fosters equal family and provider commitment to success.

Process of identifying and analyzing an individuals prognostic characteristics of health and comparing them with those of a standard age-group. providing a prediction of a person's likelihood of prematurely developing the health problems that have high morbidity and mortality in this country. A. Health risk B. Health risk appraisal C. Health risk reduction D. Family health

ANS: B

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

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

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

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

21. A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. Dont you know HIV children are immunosuppressed? she exclaimed. Which of the following would be the nurses best response? a. All children have to have these immunizations before they can attend school. b. Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized. c. Im so sorry; I forgot for a moment your child was HIV positive. d. The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them.

ANS: B Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Many states do have a no shots, no school law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up

ANS: B Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider.

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

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

Which of the following best describes the use of genomic health care? A. Assists with understanding family relationships B. Assists with determining familial health risks C. Useful in learning about environmental risk factors D. Useful in detecting risk for developing cancer

ANS: B Genomic health care can give health care providers the tools that they need to use a person's unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a person's risks for the same diseases that other family members experienced. Genomic

15. Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a cauliflower appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

ANS: B HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter.

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

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

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

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

19. A client with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a. Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered. b. This therapy is recommended to make sure that you receive the treatment you need and the infection doesnt become resistant to the drugs. c. This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember. d. Tuberculosis medications are very expensive so this method ensures that government money doesnt get wasted on those who will not take the drugs.

ANS: B It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment.

An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? A. Avoidance of alcohol B. Regular physical exercise C. Daily consumption of calcium-rich foods D. Monthly self-breast and testicular exams

ANS: B Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

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

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

Which of the following is of the greatest concern for the nurse who works with high school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex

ANS: B Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality for adolescents. Thus, this would be the greatest concern for the nurse working with high school students.

Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families? A. Understanding of same sex marriage laws within the state B. Understanding of personal feelings of working with members of this community C. Assessment of the family structure within the LGBT family D. Assessment of sexual orientation in a safe environment

ANS: B Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.

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

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

A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? A. "I make most of the decisions so the kids don't notice much difference." B. "My daughter is pretty independent; she's active in both sports and theater." C. "My son is old enough to get a job and help pay all these medical bills." D. "My wife taught our daughter how to cook simple meals."

ANS: B Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

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

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

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

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

20. A nurse is concerned about the prevalence of tuberculosis among migrant farmworkers. Which of the following activities would be best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

ANS: B Tertiary prevention is carried out among persons already infected with the disease. In this instance DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems.

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

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

During a family nursing assessment, a parent questions whether God is punishing the family, because one of the children has just been diagnosed with leukemia. The most facilitative response by the nurse would be: A. "God is loving and doesn't punish people." B. "Tell me more about your family's spiritual beliefs." C. "That is not part of my religious belief system, so I don't know." D. "Why do you think your family needed to be punished?"

ANS: B The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change.

ANS: B The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of pre-conceptual counseling.

A parent with two school-age children has just finished a family health assessment questionnaire. The parent asks the nurse why one of the questions asks whether there is a neighborhood playground. The nurse's best response would be: A. "Don't worry about it. We are going to talk about all this anyway." B. "It's important to good health to have adequate recreation resources." C. "We want to be able to report any dangerous playground equipment to the city." D. "We want to know what kind of neighborhood you're in so we can assess income.":

ANS: B The importance of social risks to family health is gaining increased recognition. A family's health risk increases if they are living in high-crime neighborhoods, communities without adequate recreation or health resources, in communities with major noise pollution or chemical pollution, or in other high stress environments.

14. When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs. b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. c. The presence of an STD in women with cervical cancer may lead to congenital defects in offspring. d. The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.

ANS: B The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information.

The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? A. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. B. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. C. The family member who prepares food will probably prepare meals based on the diet plan for all the family. D. The family member who prepares food will probably prepare special meals for the newly discharged member.

ANS: B Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. However, if family members are supportive, they will want to try to help the ill member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill members needs without making drastic changes in the overall eating patterns of the family.

Which of the following factors must be considered before deciding on an appropriate plan of action? A. Family agrees to the nurses plan. B. Family is capable of the required actions. C. Family will learn better coping skills from the nurses plan. D. Nurse has informed family how to complete the required actions.

ANS: B Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The plan cannot be the nurses choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.

The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? A. The family is lacking a strong support system. B. The families basic needs are being met. C. The couples in-laws are unavailable to share their expertise about child care. D. The married couple is excited about their first baby.

ANS: B In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? A. Increasing sessions with the nurse B. Making referrals when appropriate C. Providing a formative evaluation of the relationship D. Refusing additional communication with the family

ANS: B It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and an assumptive evaluation meeting for formal closure

A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? A. The assessment cannot be done unless the extended family is present. B. It may be difficult to find a convenient time for all family members to be present. C. Nurses have limited time to do home visits. D. Families are often scattered over a large area, making access difficult.

ANS: B It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family

A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? A. Allowing the family to be non-compliant B. Building on the families strengths and resilience C. Labeling the family as resistant D. Recognizing that the family is dysfunctional

ANS: B The labels of dysfunctional, non-compliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used. Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the families strengths gives the nurse assets on which to draw in planning care.

A nurse doing a family assessment asks the client, "Have any of your blood relatives had mental illness?" The nurse is asking this question to: A. Determine whether the family is stable. B. Assess for biological risk factors. C. Decide whether this family member needs medication. D. Demonstrate open-mindedness about mental illness

ANS: B Healthy People 2020 identified the following major categories as being: inherited biological risk, including age-related risks, social and physical environmental risks and behavioral risks as well as health care risks. Although single risk factors can influence outcomes, the combined effect of several risks has greater influence.

ANS: B, C It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limiting alcohol consumption; and avoiding smoking.

3. The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, Im sorry to bother you when youre not feeling well, but I need to ask you a few questions. Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. Do you know how you got this infection? b. Who lives with you? c. Where are you employed? d. Where do you usually eat?

ANS: B, C The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the clients place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others.

A nurse enters a family's home for the first time. Which of the following goals should the nurse have? (Select all that apply.) A. Assessing each family member in detail both physically and psychologically B. Collaborating with the family to establish goals and a plan for meeting them C. Determining the exact relationship between each member of the family D. Exploring the family's perception of their problems and needs

ANS: B, D During the beginning phase of the nurse-family interaction, three activities occur—mutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.

1. In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a. The child develops allergies with sneezing. b.The child persists in biting behavior or is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school.

ANS: B, D Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Strong disapproval by parents of well children is an opportunity to teach these persons how HIV is transmitted.

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

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

The problem of the working poor and uninsured places a major burden on the current health care system that affects those families and the community in general. Nurses in community health see this as a major: (select all that apply) A. Behavioral issue. B. Policy issue. C. Health risk issue. D. Social issue. E. Nursing issue.

ANS: B,C,D Economic risk is one of the foremost predictors of health. It is useful to know whether families' resources are adequate to meet their needs. The standard of living they are comfortable with is not the measure of risk. If the main wage earner is employed but receives no medical benefits, and the salary is not sufficient for health promotion or illness-related care, the family may qualify for available government-sponsored programs. This is a major policy issue of concern to nurses.

A family nurse is working with a married couple that has decided to remain child-free. The nurse recognizes this decision as a: A. biological necessity. B. contemporary family function. C. religious belief decision. D. threat to family survival.

ANS: B. contemporary family function.

A nurse in community health is working with a single parent of three children, ages 4, 6, and 8. The 6-year old has cerebral palsy. The 4-year-old has asthma. The maternal grandmother lives with the family and has diabetes. The nurse understands the importance of working within the context of the existing family structure and community resources because families are: A. Restrictive to outside intervention or involvement. B. responsible for providing/managing the care of their members. C. unable to manage the stress of complex health needs. D. restricted in their ability to identify interventions

ANS: B. responsible for providing/managing the care of their members.

ANS: C

A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? A. "I can't visit my husband in the hospital when I'm at work all day. How can I be sure he's all right?" B. "My husband always handled our finances. Now that he's gone, I'll have to learn how to do this." C. "I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children." D. "What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?"

ANS: C A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.

Which of the following families is at high risk for health problems? A. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. B. A man knows that his grandfather, father, and older brother all died of cardiac disease. C. A man is currently unemployed and despairs about finding a position. D. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

ANS: C A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

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

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

1. Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Herpes

ANS: C At the time of this writing, HBV infection can be prevented by immunization; vaccines for the remaining options are not yet available.

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

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

ANS: C Durable medical power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so.

A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? A. Determine the family's willingness for another home visit B. Establish the purpose of the visit C. Review the family's learning and other accomplishments of the visit D. Review the family record and reason for referral

ANS: C During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The other options listed occur during the pre-visit phase.

A nurse in community health is conducting an assessment on a family of four. During the course of the assessment, the nurse collects information about previous generations of the family and siblings. The results are used to create a diagram for the family that displays the family unit across generations. Further discussions occur regarding the patterns of health and illness that relate to biological health risks. The diagram is called: A. An ecomap. B. A family plan. C. A genogram. D. A risk plot.

ANS: C Genogram is a drawing that shows the family unit of immediate interest and includes several generations, using a series of circles, squares, and connecting lines. Basic information about the family, relationships in the family, and patterns of health and illness can be obtained by completing the genogram with the family.

Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent b. Has not had a PSA test c. Has a father or brother who has had prostate cancer d. Has benign prostatic hypertrophy (BPH)

ANS: C Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer.

ANS: C Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurse's second focus.

ANS: C Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant.

Which of the following best describes a normative life event that can increase the risk for illness? A. A family is involved in a motor vehicle crash. B. A group of teens experiment with recreational drugs. C. A woman is pregnant with her first child. D. The family wage earner is laid off from his job.

ANS: C Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.

One member of an older couple has just retired. This is considered a: A. Developmental stage that will help the family with stress reduction. B. Non-normative event that will have psychological impact on the family. C. Normative event and can increase the family's risk for illness. D. Normative event and will have little effect on the family' well-being.

ANS: C Life events can increase the risk for illness. Normative events are those that are generally expected to occur at a particular stage of development or the life span. If the event is normative, families may be able to identify needed resources, make plans to cope with the change, learn new skills, and prepare for the event and its consequences. This kind of anticipatory preparation can increase the family's coping ability and decrease stress and negative outcomes. However, when the event is nonnormative, or unexpected, families have little or no time to prepare and the outcome can be increased stress, crisis, or even dysfunction.

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

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

A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? A. A broken line B. A dashed line C. A solid line D. Two parallel lines

ANS: C Marriage is indicated by a solid line on a genogram.

ANS: C Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality for adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son.

Which of the following clients would cause the nurse the most concern? A. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another B. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods C. The client who is employed and often works 12 hours a day without moving from the computer desk D. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

ANS: C Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.

Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? A. "What helps you to cope with situations involving your wife's cancer?" B. "How has your child's illness affected the behavior of your other children?" C. "Tell me about any illnesses your other family members have." D. "Who do you turn to for support outside your immediate family?"

ANS: C Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health.

3. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurses assessment, the child admitted that her mother was working but didnt make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a. The child is accident-prone and clumsy. b. The child is being bullied and pushed around by other children. c. The child is more likely to have school absences. d. The child is in need of a vision screening.

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

A nurse is providing pre-conceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a. Iron b. Calcium c. Folic acid d. Vitamin C

ANS: C Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects by 50% to 70%. A recommendation was made that women capable of or planning a pregnancy take 0.4 to 0.8 mg of folic acid daily (USPSTF, 2009).

A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? A. "Did any of the hunters in your family kill a deer this year?" B. "How do you keep your rifles safe from curious children?" C. "Where do you shoot with your handguns?" D. "Where do you keep your rifles locked when it is not hunting season?"

ANS: C Risk reduction is a complex process that requires knowledge of risks and families' perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the family's perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

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

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

If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a. Alcohol b. Guns c. Tobacco d. Unprotected sex

ANS: C Smoking has been identified as the most important preventable cause of morbidity and mortality in the United States.

ANS: C Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes.

ANS: C Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability.

A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, "My mom said she couldn't see you and you should go away." Which of the following actions should be taken by the nurse? A. Demand the child let the nurse into the home to talk to the mother. B. Interview the child as to how the family is doing. C. Leave a card with information on how to get in touch with the nurse . D. Point out that legally once an appointment has been made the mother needs to be seen.

ANS: C The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

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

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

Which of the following situations would most likely indicate elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparent's house breaking items. c. A young man repeatedly steals money from his grandmother. d. An elderly person demands that the family come for dinner.

ANS: C Theft or mismanagement of money or resources is an element of abuse.

Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia is considered to have more medical complications than anorexia.

ANS: C Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight, purging is associated with bulimia, and anorexia is considered to have more complications than bulimia.

A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? A. Assess the family and the home setting for both strengths and problems. B. Determine the family's expectations of a home visit. C. Establish rapport between the nurse and the family. D. Engage in extended social interaction as would be expected from any guest.

ANS: C With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurse's self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client's expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? A. Confirm the reason for the assessment. B. Demonstrate culture awareness. C. Take time to build trust. D. Understand the family dynamics.

ANS: C Assessment is interactive. As you are evaluating families, they are evaluating you. Too much disclosure during the early contacts between the family and nurse may scare the family away. Slow the process down, and take time to build trust.

A nurse focuses on the care of the individual while viewing the clients family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurses view represent? A. Client B. Component of society C. Context D. System

ANS: C Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the family as context concept, the family serves as either a resource or a stressor to individual health and illness.

In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? A. Dynamics B. Function C. Structure D. System

ANS: C Family structure refers to the characteristics and demographics (gender, age, number) of individual members who make up the family. Structure defines the roles and the positions of family members.

A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? A. Family systems B. Structural-functional C. Family developmental D. Interactionist

ANS: C The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.

A nurse asks a family member, What has changed between you and your spouse since your child's head injury? Which of the following focuses of the family is the nurse assessing? A. The context B. The client C. A system D. A component of society

ANS: C When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions

The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) A. A reassessment of resources should be done if the plan does not work. B. Individual family members must all be willing to make the plan their first priority. C. Goals must be realistic and feasible. D. Ongoing negotiation is central to the process.

ANS: C, D In contracting, an important aspect is obtaining the family's view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The family's inability to change "as easily and quickly as they had hoped" does not mean the plan is not workable—only that more time and effort may be necessary.

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

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

ANS: C, D With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity.

In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) A. Conferring appropriate social status B. Educating the younger members C. Ensuring physical and mental health D. Fostering interpersonal relationships and support

ANS: C, D Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and acculturation, including religious faith, education, conferring social status. Today, however, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health.

The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? A. Families are defined by genetic ties. B. Family names are needed to confer status. C. Members of a family are self-defined. D. Traditional family functions have been redefined.

ANS: C. Members of a family are self-defined.

Which of the following behaviors results in men being less healthy than women? a. Concentration on sports, hunting, and other dangerous recreational choices b. Employment in stressful positions more so than women c. Preference to spend money on priorities other than health care d. Reluctance to visit physicians

ANS: D A major obstacle to improving men's health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of U.S. men see a doctor, nurse practitioner, or physician assistant compared with 74% of women (AHRQ, 2010).

During which phase of the home visit does the nurse document what was accomplished? A. Pre-visit phase B. In-home phase C. Termination phase D. Post-visit phase

ANS: D A major task of the post-visit phase is documenting the visit and services provided.

ANS: D A number of factors contribute to depression, including being female, having a family history of depression, unemployment, and chronic disease. All the options represent a loss, either potential or actual, but the statement about not caring about anything represents an actual symptom of depression.

17. Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

ANS: D Both HBV and HIV are blood-borne pathogens. Health care workers may be exposed to either from needle stick injuries and mucous membrane splashes. However, HBV remains alive outside the body for a longer time than does HIV and thus has greater infectivity. The virus can survive for at least 1 week dried at room temperature on environmental surfaces, and therefore infection control measures are crucial in preventing transmission. There is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease.

A nurse in community health decides to form a contract with a family. The contract states that the family will designate one night as a family night. The nurse is most likely using the contract to: A. Make sure the family does what is expected. B. Encourage the family to put plans in writing. C. Let the family know that this is a legal agreement. D. Shift the responsibility so that it becomes a shared effort

ANS: D Contracting involves a shift in responsibility and control toward a shared effort by the client and professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, its ability to make healthful choices is increased. Contracting is a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional.

A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? A. Apply for emergency financial assistance on the family's behalf. B. Arrange for community members to assist with child care. C. Invite the mother to join a cancer support group. D. Teach the family how to navigate the health care system.

ANS: D Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

22. A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

ANS: D Erythema alone does not indicate a positive finding. For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10 mm induration would be a positive finding in an immigrant from a region with high TB infection. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? A. Health promotion activities B. Illness prevention activities C. Risk reduction activities D. Unhealthy activities

ANS: D Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

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

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

An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice

ANS: D Hospice would be the best form of care for a person in the last stages of dying.

Which of the following will provide the highest benefit to an older adult's well-being? a. Eligibility for Medicare and Social Security b. Higher socioeconomic status, income, and education c. Senior citizen privileges such as senior citizen centers and senior citizen discounts d. Social networks that give support and meaning to life

ANS: D Medicare, Social Security, senior privileges, and high socioeconomic status, income, and education are all extremely helpful to older adults. However, social networks that give support and meaning to life are a major factor that can contribute to ongoing health and vitality. One of the biggest dangers is social isolation.

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

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

Many families have financial resources that allow them to maintain themselves but limit the quality of their purchasing power. Food high in fat and calories may be affordable, whereas fresh fruits and vegetables may not be affordable. A federal program that attempts to promote healthier diets for vulnerable populations is: A. Medicaid B. Medicare C. Supplemental Security Income (SSI) D. Women, Infants, and Children (WIC)

ANS: D Nutritious diets are important in preventing illness and promoting health. A U.S. Department of Agriculture (USDA) study examined the effects of its Women, Infants, and Children (WIC) nutrition program. The study found that children who participated in WIC were more linked to the health care system than children who were not. Children in WIC were more likely to receive both preventive and curative care more often than children not participating in WIC.

A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? A. Call the agency and ask what she should do. B. Call the family, explain the situation, and try to reschedule. C. Fulfill the nurse's commitment to the family and enter the home quickly. D. Drive away and notify the family from a safer location.

ANS: D Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty

ANS: D Poverty is a strong and underlying current factor that affects all special groups.

ANS: D The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member

23. A high school student is planning to volunteer at the hospital after school, so she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a. I will be using tiny tines to administer the TB antigen to the skin on your arm. b.Notify the clinic immediately if you experience any redness or itching at the test site. c. The areas should be kept dry until you return; cover it with plastic wrap when bathing. d. You will need to return in 2 to 3 days to have any reaction interpreted.

ANS: D The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters.

16. A client who is very upset says to the nurse, But we always used a condom! How could I have genital warts? Which of the following would be the best response by the nurse? a. Are you positive you always used a condom? b. Condoms dont always work. c. The condom might have had a tear in the latex. d. Skin to skin contact to a wart may have occurred outside the area that the condom covers.

ANS: D The challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur.

A nurse in community health is conducting a parenting class for prospective parents that will focus on the development of new skills, identification of needed resources, planning, and other preparations for the arrival of a newborn. This intervention is addressing a potential risk associated with: A. Biology. B. Behavior. C. Environment. D. Transitions.

ANS: D Transitions, or the movement from one stage or condition to another, are times of potential risk for families. Age-related or life event risks often occur during transitions from one developmental stage to another. They require families to learn new skills; change behaviors, schedules, or patterns of communication; identify needed resources; and make plans.

Nursing interventions and approaches for helping individuals and families to assume an active role in their care should focus on empowerment rather than on enabling. The underlying principle to empowerment is: A. Client dominance. B. Decreased competence. C. Professional dominance. D. Professional-client partnership.

ANS: D Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. For families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action.

A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? A. Before eating, the family prayed, expressing gratitude for their blessings. B. During family play, jokes and laughter were heard. C. Each person had a private room with a door for alone time. D. Most of the conversation was between the father and the eldest daughter.

ANS: D Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.

Which of the following terms refers to government actions that have a direct or indirect effect on families? A. Family funding B. Family legislation C. Family planning D. Family policy

ANS: D Government actions that have a direct or indirect effect on families are called family policy

The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the mans married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the family? A. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. B. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. C. There is no family here, only three adults sharing resources between themselves and two biologically related children. D. The family includes whoever the adults state are family members.

ANS: D Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A family may range from the traditional nuclear model with extended family to such postmodern family structures as single-parent families, step families, same-gender families, and families consisting of friends.

A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? A. Resigning from employment, but retaining health insurance B. Sharing family information with colleagues C. Providing Medicaid to a family who cannot afford health insurance D. Taking a defined time off of work for family events without fear of job loss

ANS: D The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.

The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? A. How many children do you have, and who is the father of each? B. Is there a register of families who are members of this commune? C. Tell me about your significant other. D. Who are the members of your and your child's family?

ANS: D The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning.

Which of the following theories views the family as a whole with boundaries that are affected by the environment? A. Family developmental theory B. Structural-functional theory C. Family role theory D. Family systems theory

ANS: D The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory

Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? A. Life cycle theory B. Family developmental theory C. Family systems theory D. Bio-ecological systems theory

ANS: D. Bio-ecological systems theory

The family systems theory encourages nurses to view both the individual clients as participating members of a whole family. What is the major weakness of the systems framework? A. Views families from both a subsystem and a supra-system approach B. Defines the direction of interactions C. Views the family as an agent of change D. Focuses on the interaction of the family with other systems

ANS: D. Focuses on the interaction of the family with other systems

Resilience

Ability to withstand many forms of stress and deal with several problems simultaneously without developing health problems.

According to the American Academy of Pediatrics, which of the following activities are expectations for a school health nurse? a. Ensuring that children with health problems are accepted by their peers b. Driving children home if parents can't pick them up c. Giving emergency care in the school or during school events d. Giving medications as needed if children are ill

suicide

Act or an instance of taking your own life voluntarily and intentionally.

Cumulative Risks

Additive effects of multiple risk factors.

Active immunization

Administration of all or part of a microorganism to stimulate an active response by a host's immunological system, resulting in complete protection against a specific disease

A. Avoid smoking or much alcohol. B. Choose poultry or fish rather than red or processed meat. C. Eat lots of fruits, vegetables, and fiber each day.

Managed care organizations (MCOs)

Agencies such as health maintenance organizations and preferred provider organizations designed to monitor and deliver health care services within a specific budget

Environment

All of those factors internal and external to the client that constitute the context in which the client lives and that influence and are influenced by the host and agent-host interactions; the sum of all external conditions affecting the life, development, and survival of an organism

10. Nurses are reclaiming their tradition of healing and affirming the independent functions of nursing. A heritage of health and healing can also be found in the foundations of faith communities through activities such as: (select all that apply) holding grief groups. providing meals to families in crisis. sponsoring health fairs. visiting the homebound. volunteering in community AIDS care groups.

All the above The earliest accounts of concern for others stem from communities of faith. In the roots of many faith communities are concerns for justice, mercy, and the need for spiritual and physical healing. An important aspect of living one's spirituality and religion is being a part of a community of faith from birth to death, throughout illness and wellness. Individuals who encounter physical and emotional illness and brokenness and who are able to call upon their faith and religious traditions can increase coping and realize spiritual growth. This increases resilience. Faith communities established health ministries to support congregations and communities in achieving this objective. DIF: Cognitive Level: Application REF: Page 536

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: a. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. resistance.

Smallpox

An acute contagious febrile disease caused by a pox virus and characterized by skin eruption with pustules, sloughing, and scar formation

An effective industrial disaster plan is a written plan that is shared with all who will be involved, such as the internal first responders, external community-based emergency personnel (transportation, fire, EMS, hospitals), and other key resources in the community. Another factor that influences the effectiveness of an industrial disaster plan is which of the following? a. Addressing activities for work areas that are at greater risk b. Conducting a response agency worksite walk-through c. Testing with a biannual drill d. Training specific employees for fire brigade procedures

An eighth-grader is brought to the emergency department by a parent for unusual skin blistering and discoloration around the nose and lips. The parent states that the child will not say what caused the injury. The nurse should consider the possible use of: A. crystallized methamphetamine. B. inhalants. C. MDMA (Ecstasy). D. PCP (phencyclidine).

D. Hospice

An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice

An employee in a laboratory drops a flask, resulting in a chemical splash into the employee's eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent? a. The chemical b. The employee c. The flask d. The laboratory

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.

healthy ppl 2020

An example of a national program based on a needs assessment Healthy People documents have been published every 10 years since 1980.

An example of secondary prevention for infectious disease prevention is: A. malaria chemoprophylaxis. B. Pneumocystis carinii pneumonia (PCP) chemoprophylaxis for people with AIDS C. quarantine. D. restaurant inspections.

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? a. "Certain pets and farm animals may be Salmonella carriers." b. "It is possible to transmit Salmonella by person-to-person contact." c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d. "Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

An occupational health nurse is removing a foreign body from a patient's eye. Which of the following levels of prevention is being implemented? a. Injury prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change? a. To prevent injury b. To limit disability c. To provide primary prevention d. To provide tertiary prevention

An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Tertiary care prevention

An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace? a. Find employment in physical labor; at least your body will be in good condition. b. Professional positions are the safest choice for employment. c. White collar positions provide the least risk for injury. d. There is no "safe" occupation or profession.

abd

An occupational health nurse should be aware of which of the following trends in the marketplace (Select all that apply.) a. A majority of new jobs will be in service-oriented employment. b. Employees will often have compressed work weeks, shift work, and reduced job security. c. A majority of positions will still be held by males. d. Many employees will be older and suffer chronic health problems.

An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information (Select all that apply.) a. To assess how others have rated the company in relation to employment there b. To compare the prospective employer's injury rate with similar employers' rates c. To learn more about the usual processes and products of the company as well as typical hazards d. To learn how employees feel about the employer

epidemic

An occurrence of a disease within an area that is clearly in excess of expected levels (endemic) for a given time period

Event

An occurrence of a phenomenon of health that can be discretely characterized; it can be environmental, occupational, or biological, naturally occurring, or person induced

Common source outbreak

An outbreak in which a group is exposed to a common noxious influence such as the release of noxious gases

Propagated outbreak

An outbreak that does not have a common source and spreads gradually from person to person over more than one incubation period

Mixed outbreak

An outbreak with a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza

A. Poverty

An underlying current throughout the special population groups with health disparities is: A. poverty. B. aging. C. minority groups. D. children.

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: A. affordable care. B. discrimination. C. fragmented services. D. language barriers.

An upset mother calls the school nurse and says, "How dare you say my child has lice My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? a. "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." b. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." c. "You may have been traveling. Lice are often found in motels." d. "I'm sure you're correct; one of my volunteers probably made an error. I'll recheck."

An urban school-based clinic is located in a school district where many of the children lack health insurance. The school nurse continues to provide screening, assessment, first aid, and record keeping but can refer students who require additional services to the nurse practitioners that staff the school-based health center (SBHC) on the school grounds. The SBHC is federally funded under which of the following? a. CDC's Federal School Health Program b. The Affordable Care Act c. Healthy People 2010 d. School-linked program

As a result of recent social policy changes, public health agencies have shifted their emphasis from a focus on primary health care services to a focus on core public health activities because of new and re-emerging public health issues. A critical aspect of ensuring the public health system's ability to address these issues is: a. additional regulation. b. adequate funding. c. bioterrorism strategy. d. media coverage.

As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse? a. To document employee efficiency and effectiveness at their jobs b. To look for evidence of personal protective equipment being torn or destroyed c. To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day d. To observe effectiveness of safety education and equipment

D The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors. The purpose of the nurse requesting this funding is to address the problem of substance abuse, not obesity. This program may offer an alternative to children and keep them safe and off of the streets; however, the primary objective is to address the overall healthy lifestyle of these youth.

At a county board meeting, a nurse reports statistics on drug use in the school. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? a. Help prevent obesity and boredom. b. Offer alternatives to being "on the streets." c. Prevent children from getting in trouble before their parents get home from work. d. Promote healthy lifestyles with physical activity.

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions

At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? a. Consultant b. Community outreach c. Counselor d. Researcher

At the end of each school term, the school nurse schedules an equipment safety assessment of each school playground in the district. The school nurse uses the guidelines of the U.S. Consumer Protection Safety Commission and prepares a report of the findings for the school board for planning purposes. This intervention by the school nurse is an example of which of the following? a. Community outreach b. Primary prevention c. Secondary prevention d. Tertiary prevention

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? A. Emotional abuse B. Emotional neglect C. Physical abuse D. Physical neglect

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: A. fleeing to a shelter. B. homicide. C. possessive behavior. D. spontaneous abortion.

During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client indicates a lack of insight into his violent behavior? a. "I have been taking out my frustrations with work on my girlfriend." b. "I love my girlfriend and didn't want to hurt her; it was an accident." c. "It might be a good idea for me to temporarily leave the house when I feel myself becoming angry." d. "When I drink alcohol, I become more abusive toward my girlfriend."

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

The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which of the following should be the first action that is taken by the nurse? a. Arrange for the couple to attend marital counseling. b. Develop a plan for the wife's escape if the violence starts again. c. Teach the client how to avoid initiating her husband's anger. d. Work with the client on development of self-esteem.

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: A. community deterioration. B. health care costs. C. juvenile delinquency. D. population density.

Which of the following best describes a principle of care that the nurse should abide by when working with abusive families? a. Confront the abuser and shame him into penitence and a desire to change. b. Demonstrate respect for all family members, including the abuser. c. Exclude the abuser from family meetings because the abuser is the one creating problems. d. Notify the abuser's clergyman, boss, and others who can exert pressure for change.

Which of the following is the most likely reason for a man to rape a woman? a. Because the woman was asking for it b. For power and control c. Provoked by the woman's dress and behavior d. Sexual pleasure and release

Which of the following is the underlying science or area of study on which public health is based? A. Biostatistics B. Epidemiology C. Medicine D. Social sciences

Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child? a. "I have stopped using a switch on my child, and I am learning to count to 10 before reacting." b. "I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." c. "I use time-outs when my child acts out or is naughty. Sometimes my child doesn't cope well with this, but I am persistent." d. "When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are."

7. Communities of faith strive to be caring communities and strongly value the fellowship among members. The faith community nurse recognizes that sharing concerns with pastoral staff and fellow congregants gains valuable support to promote optimal healing. The ethical issue of concern in this matter is: group rights. individual rights. statements of faith. virtue ethics.

B Confidentiality is of the utmost importance in parish nursing practice. An individual's right to privacy is an ethical issue. The nurse values client confidentiality while delicately assisting the client and client's family to "share" concerns with pastoral staff and fellow congregants. This sharing gains valuable support to promote optimal healing. The nurse is often the staff member who helps the family to the stage of acceptance of a health concern. How much to share and when to share a concern is indeed a private affair and a part of the important journey of healing. DIF: Cognitive Level: Application REF: Page 543

4. An effective program strategy for health promotion efforts guided by the Healthy People 2020 framework that can be used by the faith community is establishing: food pantries. health fairs. statements of faith. volunteer training.

B Health fairs are effective strategies for health promotion efforts guided by the Healthy People 2020 framework. These and similar activities promote increased health of the entire community, and they include persons of all ages, encourage enthusiasm, offer fellowship and leisure, and reduce duplication of effort. DIF: Cognitive Level: Knowledge REF: Page 544

4. At the end of each school term, the school nurse schedules an equipment safety assessment of each school playground in the district. The school nurse uses the guidelines of the U.S. Consumer Protection Safety Commission and prepares a report of the findings for the school board for planning purposes. This intervention by the school nurse is an example of which of the following? Community outreach Primary prevention Secondary prevention Tertiary prevention

B Injuries are the leading cause of death in children and teenagers. The school nurse educates children, teachers, and parents about preventing injuries. School nurses also provide information on how to prevent playground injuries. They assess school playgrounds for equipment safety on the basis of the U.S. Consumer Product Safety Commission guidelines. DIF: Cognitive Level: Application REF: Page 573

8. An urban school-based clinic is located in a school district where many of the children lack health insurance. The school nurse continues to provide screening, assessment, first aid, and record keeping but can refer students who require additional services to the nurse practitioners that staff the school-based health center (SBHC) on the school grounds. The SBHC is federally funded under which of the following? CDC's Federal School Health Program The Affordable Care Act Healthy People 2010 School-linked program

B School-based health centers are family-centered, community-based clinics run within schools under a federally funded program. These clinics give expanded health services, including mental health and dental care, in addition to the more traditional health care services. The Affordable Care Act of 2010 appropriated $200 million to improve and expand services at SBHC. They can vary in size, hours, and days of operation, or administrative model (i.e., school clinic, health center, school-linked program). They are successful because they focus on bringing health care services to children in a community school location and are coordinated with the school health program. DIF: Cognitive Level: Knowledge REF: Page 571

5. A key characteristic of faith community nursing services is to facilitate collaborative health ministries in the faith communities by: embracing individuals across the life span. respecting diverse traditions of faith. requiring statements of faith. using a Judeo-Christian theological framework.

B The faith community nurse incorporates faith and health and employs the nursing process in providing services to the faith community as well as to the community served by the faith community. Facilitating collaborative health ministries in the faith communities is an important component of the practice. While the curricula of faith community nursing practice stem from a Judeo-Christian theological framework, parish nursing respects diverse traditions of faith communities and encourages adaptation of the programs to these faith traditions. DIF: Cognitive Level: Knowledge REF: Pages 540-541

8. To ensure the success of a faith community's health ministry program, the parish nurse must ensure that the wellness committee addresses issues of: experiential preparation. financing and fundraising. referrals. retired professionals.

B The faith community nurse is called on to partner with potential supporters in finding funds. The nurse is accountable for money spent and for fundraising, whether the position is salaried or voluntary. Educational and promotional materials, equipment, travel time, continuing education, and malpractice insurance are selected areas that must be included in a budget of the parish nurse. If these materials are not budget items, services may be limited. The nurse must communicate the importance of these areas and the associated funding to the faith community and the wellness committee to ensure the success of any program. DIF: Cognitive Level: Comprehension REF: Page 544

3. A middle school student approaches the school nurse and asks, "Can I speak with you about something important?" The school nurse responds affirmatively but should also state which of the following? "Anything you tell me will be kept private and confidential." "If anything you tell me indicates that someone is in danger, the parents and school officials must be told." "It may be best for me to set up an appointment with the school counselor." "You can always speak to me if you are in trouble or when you need someone to talk to."

B The school nurse may be the person whom children trust to tell important secrets about their health. The school nurse has a reputation as being a trustworthy person to whom the children can go if they are in trouble or when they need to talk to someone. Nurses in this situation should tell the children that if anything they reveal points out that someone is in danger, the parents and school officials must be told. DIF: Cognitive Level: Application REF: Page 570

9. Which of the following dimensions is an essential component of parish nursing? Assertiveness Compassion Organizational skills Fiscal responsibility

B The spiritual dimension is central to the practice of parish nursing. Nursing embodies the physical, psychological, social, and spiritual dimensions of clients into professional practice. Although parish nursing includes all four, it focuses on intentional and compassionate care, which stems from the spiritual dimension of all humankind. DIF: Cognitive Level: Comprehension REF: Page 540

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

B. Health Literacy

A middle school student approaches the school nurse and asks can I speak with you about something important the school nurse responds affirmative Lee but should also state which of the following A. "Anything you tell me will be kept private and confidential." B. "If anything you tell me indicates that someone is in danger, the parents and school officials must be told." C. "It may be best for me to set up an appointment with the school counselor." D. "You can always speak to me if you are in trouble or when you need someone to talk to."

B. If anything you tell me indicate that someone is in danger the parents and school officials must be told

At the end of each school term the school nurse schedules and equipment safety assessment of each school playground in the district the school nurse uses the guidelines of the US consumer protection Safety Commission and prepares a report of the findings for the school board for planning purposes this intervention by the school nurse is an example of which of the following A. Community outreach B. Primary prevention C. Secondary prevention D. Tertiary prevention

B. Primary prevention

An urban school based clinic is located in a school district where many of the children like health insurance the school nurse continues to provide screening, assessment, first aid, and recordkeeping but can refer students who require additional services to the nurse practitioners the staff the school based health center on the school grounds the SBHC is federally funded under which of the following A. CDC's Federal School Health Program B. The Affordable Care Act C. Healthy People 2010 D. School-linked program

B. The Affordable Care Act

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: A. direct financial subsidies for children. B. funds to insure currently uninsured children. C. outreach efforts to enroll eligible children in Medicaid. D. prospective payments for child services.

B. 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 reductionsDIF: Cognitive Level: ApplicationREF: Page 379

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: A. disenfranchisement. B. health disparities. C. loss of independence. D. resilience.

B. health disparities.

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: A. developmental disorders. B. mental health problems. C. parental neglect. D. violence potential.

B. mental health problems.

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

Which of the following factors may lead to increased violence? (Select all that apply.) a. Adequate social support b. Feelings of powerlessness c. Violence shown in the media d. Living in a crowded environment

BCD

Social justice

Based on the principles of equality in which the worth of every member is respected and valued.

Family functions

Behaviors or activities performed to maintain the integrity of the family unit and to meet the family's needs, individual members' needs, and society's expectations

Accountability

Being responsible for care and answerable to the client

what're some resources of program planning?

Benefits to clients, nurses, and employing agencies Focuses attention on what the organization and health provider are attempting to do for clients Assists in identifying the resources and activities that are needed Reduces role ambiguity Reduces uncertainty within the program environment Increases the abilities of the provider and the agency to cope with the external environment Helps the provider and the agency anticipate events Allows for quality decision making and better control over the actual program results Strategic planning

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: A. child neglect. B. family secrets. C. father-daughter incest. D. impaired family functioning.

A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most likely displayed? a. He has threatened harm to his school peers. b. He is between the ages of 15 and 19. c. He is depressed and has a history of being sexually abused. d. He has been accused of abusing an animal.

A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking? a. Encouraging others to interfere when they see children hit or hurt in a public place b. Referring caregivers to community respite centers if abuse is beginning to occur c. Lobbying for passage of legislation to outlaw physical punishment in schools d. Screening each pregnant woman privately for intimate partner abuse

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: A. advocate for government programs to treat survivors. B. demonstrate the provider's commitment to address the need for services. C. increase awareness of community resources to address violence and abuse. D. increase the number of individuals identified as perpetrators.

A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities. Which of the following parents in attendance would be most at risk for abusing his or her own child? a. A new mother who has joined a parents' support group b. A father who is overwhelmed and exhausted by overtime work c. A depressed father who was laid off from work and is missing his work colleagues d. A mother who is missing her career challenges and friends but enjoying being home with her baby

A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect? a. Bruises in various stages of healing b. Failure of parent to attend parent-teacher conferences or return teacher phone calls c. Lack of weight gain and wearing dirty clothes d. Lice in the hair

Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community? A. Community health clinics B. Federal health agencies C. Local health agencies D. State health agencies

Which of the following is a common factor typically found in those who abuse others? a. Fear and belief that others are "out to get them" b. Poor self-esteem and unawareness of alternatives c. Previous observations of violent behaviors to manage conflict d. Difficulty keeping commitments

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

Which of the following is the top risk factor for intimate partner homicide? a. There is a gun in the house. b. The husband has made threats against wife before. c. The wife has previously called 911 because of husband's beating her. d. The woman's young daughter also lives with them.

Which of the following statements best explains the primary reason why violence is so high among young African-American men? a. Men tend to be more violent than women. b. They are young and thus lack maturity. c. Unemployment is higher in this population. d. Violent tendencies are transferred genetically along racial lines.

The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: A. 6 months for white mothers. B. 10 months for white mothers. C. 3 months for African-American and Hispanic/Latino mothers. D. 12 months for African-American and Hispanic/Latino mothers.

C. 3 months for African-American and Hispanic/Latino mothers.

It is estimated that one in 15 males becomes a father during his teen years. The nurse should be aware that many young men facing paternity have specific challenges such as: (select all that apply) A. acting as though they are interested when they are disinterested. B. avoiding prenatal care involvement. C. desiring and needing to be involved with their children. D. being rejected by the young woman's family. E. rejecting their role as a father.

C. desiring and needing to be involved with their children. D. being rejected by the young woman's family.

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: A. complicated to address. B. costly to serve. C. invisible to the community. D. resilient to the community.

C. 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.DIF: Cognitive Level: ApplicationREF: Page 376

Intermittent or continuous source

Cases may be exposed periodically or uninterrupted over a period of days or weeks

Agent

Causative factor, such as a biological or chemical agent, invading a susceptible host through an environment favorable to produce disease

bce

Changes in the workforce will pose new challenges to protecting worker health and safety. Which of the following trends will influence business strategies to increase health status, employment longevity, and satisfaction of workers? Select all that apply. a. Expanded younger workforce b. Female workforce increasing c. Increase in minority workers d. Job shifts to manufacturing e. More racially diverse workforce

sexual abuse

Coerced sexual acts ranging from fondling to rape or sexual degradation; it can happen to children or adults and be perpetrated by anyone inside or outside the family.

Human capital

Combined human potential of the people living in a community.

Linguistically appropriate health care

Communicating health-related assessment and information in the recipient's primary language, when possible and always in a language the recipient can understand.

Licensure

Contract between the profession and the state whereby the profession is granted control over who can enter into and who exits from the profession

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: A. competition. B. unemployment. C. survivor guilt. D. work-related stress.

A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse? a. The daughter's inability to do well in school b. Intimacy problems with the daughter's boyfriend c. The mother's abuse of the daughter over a long period of time d. Sexual abuse by the father

A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? a. Abide by the mother's wishes because this information was provided in confidence. b. Arrange for counseling for the boyfriend at the earliest possible availability. c. Encourage the mother to take the child and find alternate housing right away. d. Report the incident to child protective services or other appropriate legal authority.

A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while being raped? a. Confusion b. Satisfaction c. Sexual release d. Helplessness

A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would most likely have a positive effect? a. Being assertive and taking control of decisions because family members cannot be expected to have this ability b. Focusing attention on family weaknesses that need to be fixed before healing can begin c. Pointing out things that victims should do differently to avoid antagonizing the abuser d. Soliciting ideas from the family regarding what they feel will improve their situation

Which of the following is a core competency required of public health nurses? A. Knowledge in the use of high-technology diagnostics B. Knowledge of the implementation of electronic medical records C. Skill in the physical assessment of complex clients D. Skill in developing policy and planning programs

Which of the following statements is the best explanation as to why some countries are more violent than others? a. Civilized societies are less violent than primitive societies. b. Geographical differences are the primary factor. c. Population differences are the main determinant—for example, having more males than females. d. Violence is a learned behavior controlled or allowed by social norms.

1. An academic medical center and a local senior living complex employ a parish nurse. The faith community nurse also holds a faculty position at the university's school of nursing. This nurse is practicing a type of parish nursing known as the: advanced practice model. clinical specialty model. congregation-based model. institution-based model.

D In an institution-based model of faith community nursing, which includes greater collaboration and partnership, the nurse may be in contractual relationships with hospitals, medical centers, long-term care facilities, or educational institutions. DIF: Cognitive Level: Application REF: Page 537

6. The future of school nursing is very strong and will be further enhanced by the future trend in which of the following? Development of an HIV/AIDS health curriculum Enhanced use of picture boards Improving the air quality of school buildings Telehealth and telecounseling

D The amount of health care being given in the schools is increasing. In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. The school nurse is responsible for keeping up with the latest changes in health care and health practice so that the health of children in the schools can be enhanced by new trends in health care. DIF: Cognitive Level: Knowledge REF: Page 581

6. An example of the use of the nursing process within a faith community nursing practice is the: contractual agreement. evidence of a mature faith. polity of the faith community. use of health appraisals.

D The parish nurse uses the nursing process for assessment, program planning, and evaluation. An example of an assessment intervention would be the use of health risk appraisals, spiritual assessments, and other assessment tools to provide personal health counseling. DIF: Cognitive Level: Knowledge REF: Page 545

5. A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school. A tertiary prevention intervention the school nurse should perform would be which of the following? Assess the child's language skills, motor abilities, and social abilities. Ensure that a telephone is available for calling emergency personnel or parents. Lead educational programs to address coping strategies and stress management techniques. Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience.

D The school nurse gives nursing care related to tertiary prevention when working with children who have long-term or chronic illnesses or with special needs. This may include participation in the development of an individual education plan (IEP); identification of medication, therapy needs, and/or physical, auditory, or visual limitations; and interventions to ensure the appropriate placement of the child in the classroom environment or physical accommodations required, which enhances the child's learning experience. DIF: Cognitive Level: Application REF: Page 578

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? A. Assessment level B. Design level C. Evaluation level D. Implementation level

D. Implementation level

A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school and tertiary prevention intervention the school nurse should perform would be which of the following A. Assess the child's language skills, motor abilities, and social abilities. B. Ensure that a telephone is available for calling emergency personnel or parents. C. Lead educational programs to address coping strategies and stress management techniques. D. Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience.

D. Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience

The future of school nursing is very strong and will be further enhanced by the future trend in which of the following A. Development of an HIV/AIDS health curriculum B. Enhanced use of picture boards C. Improving the air quality of school buildings D. Telehealth and telecounseling

D. Telehealth and telecounseling

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: A. at home. B. full term. C. identical twins or triplets. D. low-birthweight babies.

D. low-birthweight babies.

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': A. dependence on their primary care provider. B. normal sensory losses. C. reduced social contacts. D. underutilization of the mental health system.

D. underutilization of the mental health system.

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: A. conduct a comprehensive assessment and formulate a plan for treatment. B. establish a long-term trust relationship to prevent disappointment. C. schedule appointments for appropriate immunizations for the children. D. use every opportunity to teach about preventive health care.

D. use every opportunity to teach about preventive health care. Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also 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 of environmental hazards and violence and assurance of safe food and water.DIF: Cognitive Level: ComprehensionREF: Page 384

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: A. poverty. B. resilience. C. risk. D. vulnerability.

D. 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.DIF: Cognitive Level: ApplicationREF: Page 376

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: A. disenfranchised populations. B. disadvantaged populations. C. vulnerability. D. vulnerable populations.

D. vulnerable populations.

Emerging infectious diseases

Diseases in which the incidence has increased in the past tow decades or has the potential to increase in the near future

Communicable diseases

Diseases of human or animal origin caused by an infectious agent and resulting from transmission of that agent from an infected person, animal, or inanimate source to a susceptible host. Not all communicable diseases are communicated from host to host. For example, tetanus is transmitted from inanimate source to a person but then cant be passed from the infected person to another person

During a recent heat advisory, baggage handlers at the local airport were placed on a 1-hour shift rotation. This work-health interaction demonstrates the theoretical application of which of the following? a. Aggregate populations b. Epidemiologic model c. Host risk factor d. Occupational exposure

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

Each client in the Medicare home care program must be under the care of a doctor (medicine, podiatry, or osteopathy). The home health nurse must involve the doctor in developing a plan of care. The role of the doctor in the home health interdisciplinary team is to do which of the following? a. Achieve the optimal level of functioning by teaching b. Certify/recertify the medical necessity and plan of care c. Deal with the social, emotional, and environmental factors that affect well-being d. Provide maintenance, preventive, and restorative treatment for clients

C. Exploitation

Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as: A. neglect. B. incompetence. C. exploitation. D. self-determination.

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? Emotional abuse Emotional neglect Physical abuse Physical 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.DIF: Cognitive Level: ApplicationREF: Page 464

what're the steps of program evalution progress?

Engage stakeholders : who are involved in planning, funding, and implementing the program Describe the program Focus the evaluation design Gather credible evidence - significant evidence Justify conclusions - based on the data Ensure use and share lessons planned

describe the aspects of program evaluation, sustainability

Enough resources to continue the program

Utilization review

Ensure that care is needed and that the cost is appropriate

Documentation

Essential to the evaluation of quality care in any organization

Retrospective audit

Evaluated the quality of care through evaluation of the nursing process at the end of a program or as an audit of the long-term impact of a program within the health care system

Process

Evaluating activities as they relate to standards and expectations of health providers in the management of client care

Structure

Examples of structure are facilities, equipment, characteristics of the administrative organization, client mix, and the qualifications of health providers

Which of the following are factors that may contribute to vulnerability? Select all that apply. Exercise habits Crime Peeling lead paint Social isolation Illiteracy

Exercise habits Crime Peeling lead paint Social isolation Illiteracy 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. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problemsDIF: Cognitive Level: KnowledgeREF: Pages 375, 376

Emotional abuse

Extreme debasement of a person's feelings so that he or she feels inept, uncared for, and worthless.

Factors that contribute to newly emerging or reemerging infectious disease can be related to microbial adaptation and changes made by the infectious agent. However, most of the emergence factors are related to environmental changes and: a. consequences of human activities/behaviors. b. increase in the number of vectors. c. industrialization and urbanization. d. unpredictable variances in the climate.

neglect

Failure to act as an ordinary, prudent person; conduct contrary to that of a reasonable person under a specific circumstance. The failure of a caregiver to provide services that are necessary for the physical and mental health of an individual.

physical neglect

Failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care.

A situation whereby the demands of the situation exceed the resources and coping capacity of the family...

Family crisis

A condition including the promotion and maintenance of physical, mental, spiritual and social health for the family unit and for individual family members...

Family health

Dysfunctional families

Family units that inhibit clear communication within family relationships and do not provide psychological support for individual members

what're levels of program objectives?

First level has general and broad objectives. Then the specific objectives describe: Measurable behavior Circumstances under which the behavior is observed Minimal acceptable standard for performance of the behavior

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 drug addiction can be successfully treated, anyone may develop drug dependence, and: A. any drug can be abused. B. illegal drugs are the category of abused drugs. C. prescription drugs rarely cause dependence. D. over-the-counter (OTC) drugs are "good drugs."

For the nurse to fully understand the threat associated with the release of biological agents and participate in an appropriate response, the Centers for Disease Control and Prevention (CDC) has stated that the biological agents most likely to be employed are those that both have a potential for high mortality and can be easily disseminated to produce: A. immediately severe symptoms. B. major panic and social disruption. C. multisyndrome effect. D. person-to-person transmission.

elder abuse

Form of family violence against older members. It may include neglect and failure to provide adequate food, clothing, shelter, and physical and safety needs; it can also include roughness in care and actual violent behavior toward the elderly.

Assessing factors that determine or influence whether disease or other unhealthy results occur...

Health risk

Control or reduce risk factors and minimize the incidence of associated disease and premature mortality; risk reduction is reflected in greater congruity between appraised and achievable age...

Health risk reduction

Comprehensive Services

Health services focusing on more than one health problem or concern.

Home health agency types, whether official, private and voluntary, combination, hospital based, or proprietary, are similar in terms of which of the following? a. Conditions of participation (COP) for Medicare and Medicaid b. Federal income tax exemption status or accreditation status c. Governance models and administrative structures d. Homemaker services or service contracting practices

Home health care can be defined as a broad spectrum of health and social services offered in the home environment to recovering, disabled, or chronically ill persons. Participation in providing the needed maintenance care for the home care client is essential by which of the following? a. Chaplain b. Family caregivers c. Home health aides d. Physician

Skills

Identify gaps between local practices and best practice

Outbreak detection

Identifying a rise in the frequency of a disease above the usual occurrence of the disease

C. Tobacco

If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a. Alcohol b. Guns c. Tobacco d. Unprotected sex

Herd immunity

Immunity of a group or community

Immunity to disease through vaccination is known as: a. natural immunity. b. resistance. c. acquired immunity. d. herd immunity.

Passive immunization

Immunization by a transfer of a specific antibody from an immunized person to one who is not immunized

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

In health care facilities and clinical laboratories, the occupational health nurse needs to be aware of the worker groups that are at risk for exposure to biological agents. Besides the health care workers, worker groups at risk for exposure to biological infectious agents may include which of the following? a. Clerical staff b. Maintenance personnel c. Receptionists d. Chaplains

In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families? a. Acute care inpatient settings b. Community clinics and physicians' offices c. Emergency departments and psychiatric units d. In homes during home health visits

This phase is where rapport is established...

In-home phase

Federal poverty level

Income level for a certain family size that the federal government uses to define poverty.

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: A. adolescents. B. injection drug users. C. older adults. D. pregnant women.

Nosocomial infections

Infections acquired during hospitalization or developed within a hospital setting.Nosocomial infections may involve clients, health care workers, visitors, or anyone who has contact with a hospital

epidemiologic triangle

Infectious agent, host, and environment

This phase in the home visit process clarifies the purpose and why you are going to see this...

Initiation phase

Case Management

Interchangeable term with care management. A client service including the following activities; screening, assessment, care planning, arranging for, and coordinating service delivery, monitoring, reassessment, evaluation, and discharge. Case management is a process that enhances continuity and appropriateness of care. It is most often used with clients whose health problems are actually or potentially chronic and complex.

homicide

Killing of one human being by another.

Quality improvement organization

Mandated to improve the quality and efficiency of Medicare-funded services

BDE

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.) A. Decreases appetite B. May lead to tolerance C. Is highly toxic D. Has little quality control E. Is a safe therapeutic agent

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 a disadvantage to the use of Methadone? A. Methadone is inexpensive. B. Methadone carries a risk of overdose. C. Methadone prevents relapse. D. Methadone is long acting and effective orally.

Quality Assurance

Monitoring the activities of client care to determine the degree of excellence attained in the implementation of the activities

describe the source of program evaluation.. epidemiologic data

Morbidity and mortality data Incidence and prevalence rates

______ _________ are often the only source of health-related data available for small geographic areas.

Mortality Data

define SMART goals

Must be specific/ action/ single purpose & outcome To be truly effective, the program plan should begin with a general program goal and move on to specific objectives that will help meet the program goal.

types of cancers found in a state and the locations of the cancer risks and health problems in the state.

National program of cancer registries

violence

Nonaccidental acts, interpersonal or intrapersonal, that result in physical or psychological injury to one or more of the people involved.

Vectors

Nonhuman organisms, often insects, that either mechanically or biologically play a role in the transmission of an infectious agent from source to host

Nonprofit home health agencies can be reimbursed for home health services through Medicare, Medicaid, and private insurance companies. A major difference between an official agency and a voluntary or private agency is that official agencies receive additional: a. client payments. b. charity support. c. public funding. d. third-party payments.

Nurses come to home health from a variety of educational and practice settings. Based on educational level, nurses are prepared to practice at various levels. To ensure the public of competence and quality in a highly competitive health care environment, it may become necessary for nurses to seek which of the following? a. Accreditation b. Advanced degrees c. Certification d. Specialization

sexual assault nurse examiner

Nurses trained in sexual assault examination who perform the physical examination in the emergency department to gather evidence (e.g., hair samples, skin fragments beneath the victim's fingernails, evidence from pelvic examinations using colposcopy) for criminal prosecution of sexual assault.

forensic nursing

Nursing care individuals and communities receive in response to injury in situations where health and law intersect.

What is summative evaluation?

Occurs at the end of a specific time or course of study, usually applies a single grade or score to represent a student's preformance

emotional neglect

Omission of the basic nurturing, acceptance, and caring essential for healthy personal development.

physical abuse

One or more episodes of physical aggression, often resulting in serious physical damage to the internal organs, bones, central nervous system, or sense organs.

Advocate

One who works to protect the rights of the client while supporting the client's responsibility for self-determination. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that will result in improved public health services for these populations. An example would be a nurse who serves on a local coalition for uninsured people and works toward the development of a plan for sharing the provision of free or low-cost health care by local health care organizations and providers.

Vertical transmission

Passing the infection from parent to offspring via sperm, placenta, milk, or contact, in the vaginal canal at birth

Disadvantaged

People who lack adequate resources that other people may take for granted.

What is formative evaluation?

Periodic reevaluation based on midtests administered during the training, usually at regular intervals

Horizontal transmission

Person-to-person spread of infection through one or more of the following routes: direct or indirect contact, common vehicle, airborne, or vector-borne

Child neglect

Physical or emotional neglect. Physical neglect refers to the failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect refers to the omission of basic nurturing, acceptance, and caring essential for healthy personal development.

spouse abuse

Physical, emotional, or sexual mistreatment of a partner or former partner.

This phase is where the nurse documents, and plans for interventions...

Post-visit phase

This phase in the home visit process is the phase where a phone call is made and an appointment is scheduled...

Pre-visit phase

A family genogram made to assess health risks is what type of prevention...

Primary

Risk

Probability of some event or outcome occurring within a specified period of time.

Sporadic

Problems with an irregular pattern with occasional cases found at irregular intervals

Protecting the nation's food supply from contamination by all the virulent microbes is complex, costly, and time consuming. However, much foodborne illness, regardless of causal organisms, can be prevented through simple changes in: a. food preparation, handling, and storage. b. importation regulations. c. pesticide usage. d. animal breeding practices.

Public health programs are designed with the goal of improving a population's health status. Which of the following apply to public health? Select all that apply. a. It is a branch of medicine. b. It is funded at a local level. c. It is health status monitored at the state level. d. It is implemented at the federal level. e. It is an organized community approach.

Determinants of health

Range of personal, social, economic, and environmental factors that influence health status.

Knowledge

Recognize that nursing and other health profession students are parts of systems and intervention process that affect outcomes for clients and families

Poverty

Refers to having insufficient financial resources to meet basic living expenses. These expenses include cost of food, shelter, clothing, transportation, and medical care.

Social determinants of health

Reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work, and age.

Vulnerability

Results from the interaction of internal and external factors that cause a person to be susceptible to poor health.

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. A. Crisis intervention B. Gaps in continuum of mental health services C. Sufficient number of mental health services D. Tolerance for destructive coping behaviors E. Trust in the health care professionals

Use a behavioral health risk survey to identify the factors leading to health problems such as obesity...

Secondary

abde

Secondary prevention activities are the largest responsibility of the school nurse and may include which of the following? Select all that apply. a. Establishing an emergency plan when a child or staff member needs immediate care b. Giving medications to children during the school day c. Participating in developing an individual education plan (IEP) for students with long-term health needs d. Screening for vision, hearing, height and weight, oral health, TB, and scoliosis e. Teaching standard precautions to all staff

Risk management

Seeks to reduce the agency's liability because of the grievances brought against them

Disenfranchisement

Sense of social isolation; a feeling of isolation from mainstream society.

Advocacy

Set of actions undertaken on behalf of another while supporting the other's right to self-determination; activities for the purpose of protecting the rights of others while supporting the client's responsibility for self-determination; involves informing, supporting, and affirming a client's self-determination in health care decisions.

incest

Sexual abuse among family members, typically a parent and a child.

rape

Sexual intercourse forced on an unwilling person by threat of bodily injury or loss of life.

what're some questions to ask for program evaluation?

Shows whether the program is meeting its purpose

Since 2000, home health agencies have been paid by the federal government based on which type of reimbursement? a. Diagnostic-related groups b. Distributive care c. Episodic care d. Prospective payment system

B D

Six students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that apply.) a. The first student asks for a salad with chicken strips and dressing on the side. b. The second student asks for a hamburger, very rare. c. The third student orders a tuna salad sandwich with extra mayonnaise. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast.

Wrap-around services

Social and economic services provided, either directly or through referrals, in addition to available comprehensive health services. In this way, social and economic services that will help ensure the effectiveness of health services are "wrapped around" health services.

Society bears the burden of infectious disease. That burden includes the effects of morbidity and mortality as well as the staggering: A. economic burden. B. fear burden. C. incidence burden. D. vulnerability burden.

Natural immunity

Species-determined innate resistance to an infectious agent

Universal precautions

Strategy to prevent exposure to pathogens transmitted through blood and other body fluids by requiring blood and body fluids from all clients to be handled as if they were infected with such pathogens

D The most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. Because the students are engaging in tobacco use, this is the most important topic to address with them at this time. If the students were not engaging in this behavior the other topics of commonly used drugs on campus, just "saying no", and overcoming peer pressure may have been just as appropriate.

Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to "just say no" when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d.The fact that tobacco smoking causes more deaths than any other behavior in the United States

This phase is where the nurse and client plan for future visits...

Termination phase

Developing a contract with family to change nutritional patterns to reduce further complications is what type of prevention...

Tertiary

A. Legal options for treatment choices in the event the person becomes incapacitated.

The Patient Self-Determination Act of 1991 requires that providers receiving Medicare and Medicaid funds give clients written information regarding: A. Legal options for treatment choices in the event the person becomes incapacitated. B. Patient rights. C. The cost of services. D. Patient privacy.

B D

The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Which of the following best describes why the nurse doesn't just prescribe antibiotics as the client repeatedly requests? (Select all that apply.) a. Antibiotics are expensive, whereas the support measures would be almost free of cost. b. Viral diseases are not affected by antibiotics. c. Clinics cannot afford to continually give antibiotics to anyone who asks for them. d. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs.

The board of directors is examining various submitted reports concerning its home health agency. Which of the following reports represents an example of benchmarking? a. A report by the administrator regarding how the home health agency's performance compares with that of other local and national home health agencies b. A report by the chief financial officer regarding a cost-benefit analysis related to technological advances c. A report by the chief nursing officer regarding client outcomes d. A report by the medical director regarding implementation of evidence-based practice into standards of care

The broad practice of public health requires a set of skills, knowledge, and attitudes in all disciplines. The baccalaureate level of entry for nursing is currently endorsed to achieve the core competencies of public health because of: a. core public health competencies typically being learned in the workplace. b. encouragement for nurses with an associate's degree to seek further degrees. c. financial planning and management skills learned at the master's level. d. rapid change and limited resources in public health.

Family structure

The characteristics of the individual members (gender, age, number) who constitute the family unit

B. Diabetic patient with lower extremity wound.

The community health nurse is aware that African-American adults are more likely to be admitted to the hospital for which of the following conditions? A. Newly diagnosed HIV infection B. Diabetic patient with lower extremity wound C. Testicular cancer D. Psychiatric disorders

The difference between the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) can best be described as which of the following? a. NIOSH enforces workplace safety, and OSHA educates about occupational injury and illness prevention. b. NIOSH monitors work-related injury/illness incidence, prevalence, and prevention, and OSHA governs financial compensation under Workers' Compensation. c. OSHA is part of the Department of Labor, and NIOSH is part of the National Institutes of Health. d. OSHA sets the workplace safety standards, and NIOSH examines potential hazards of new work technologies and practices.

Credentialing

The formal recognition of a person as a professional with technical competence or of an agency that has met minimum standards of performance

The future of school nursing is very strong and will be further enhanced by the future trend in which of the following? a. Development of an HIV/AIDS health curriculum b. Enhanced use of picture boards c. Improving the air quality of school buildings d. Telehealth and telecounseling

The greatest risk for experiencing work-related accidents with subsequent injuries is to which of the following? a. New workers with less than 1 year of experience on the current job b. Older workers with 2 years of experience on the job c. Women over 50 years of age with 3 years of experience on the current job d. Workers with safe, low-level exposure on the job

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: A. assess for recreational drug use. B. destroy the myth of good drugs versus bad drugs. C. encourage children to "just say no." D. refer to an addiction treatment program.

The home health nurse completes an initial assessment on a recently admitted home health client. The nurse should now analyze the assessment data and complete what step in the nursing process that is consistent with the standards of home health practice? a. Diagnosis b. Implementation c. Outcome identification d. Planning

A. Adapting and coping responses.

The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges: a. adapting and coping responses. b. intellectual capacity. c. socioeconomic status. d. spiritual awareness.

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: A. bars frequented by migrant workers. B. farm fields employing migrant workers. C. housing for migrant workers. D. restaurants frequented by migrant workers.

Charter

The mechanism by which a state governmental agency grants corporate status to institutions with or without rights to award degrees

The model of care delivered in the home setting which focuses on symptom management at the end of life is known as: a. hospice care. b. palliative care. c. personal care. d. transitional care.

A. Injuries and accidents

The most important causes of preventable disease, disability, and death among children are: a. injuries and accidents. b. maintaining a healthful diet. c. physical activity. d. cardiovascular health.

The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned that the student will be required to be home-schooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? a. "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." b. "I realize that this will be a difficult adjustment, but home-schooling has improved over recent decades and the Internet will allow your child to connect with friends." c. "Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue." d. "Your child may remain in school as long as he can manage the course requirements and doesn't flunk out."

Outcome

The net change or result that occurs as a result of health care

The nurse in community health prepares a community assessment for the local planning commission and presents data that indicate an increase in violence among young children and teens within the community. The nurse projects the cost of care related to violence in ED visits, treatment of stabbing and gunshot wounds, and rehabilitation. The nurse also produces information on school absenteeism, graduation rates, and teenage rape and pregnancy. The planning commission creates a task force to explore the community outlets for child and teen recreation and the current community education programs available to families and students related to violence prevention, negotiation, and mediation. This can best be described as an example of: a. disparities in health care. b. outreach work. c. power of partnerships. d. social issues.

The nurse in community health serves as a bridge between the at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

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: A. drug dependence. B. drug addiction. C. substance abuse. D. opiate addiction.

The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented? a. Both secondary and tertiary prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

The occupational health nurse is aware that several employees from the accounting/finance departments are complaining about exhaustion, anxiety, and heartburn and notes an increase in absenteeism for these departments. On further exploration, the nurse learns that a new chief financial officer (CFO) has been in place for 1 month. The new CFO is demanding higher productivity and turnaround with expectations of working overtime and weekends to "get the job done" ahead of deadlines. The occupational health nurse, using the epidemiologic model, recognizes this as a psychological agent that can best be described as which of the following? a. Employment conditions b. Nonfatal violence c. Organizational culture d. Shift work

The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe? a. Comfort level of the PPE b. Effectiveness of the nurse's teaching c. Knowledge level of the employee d. Psychosocial norms of the setting

The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion? a. To provide an example to other employees to ensure future cooperation with safety measures b. To enforce an economic penalty for not obeying nurse's instructions regarding safety measures c. To ensure that all employees keep their positions during an economic downturn d. To continue employment and income with limited duty as a rehabilitation effort after an injury

The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? a. "I'll get the names to you and the involved teachers immediately." b. "Let me get the parents' consent, and then I'll get you the names." c. "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." d. "Why don't we coordinate a school-wide program on preventing accidents instead"

The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an applicant would most likely result in the applicant not being hired? A. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." B. "I prefer to work in teams because no single person has too much responsibility because the burden is shared." C. "Teamwork is better than work done by individuals because teamwork incorporates different perspectives." D. "Whether teamwork is better than work done by individuals depends on the nature of the work being performed."

The role/activity of the nurse in community health that was most important during the disasters of September 11, 2001, and the subsequent anthrax bioterrorism attack involved: a. assessment. b. client-level teaching. c. enhanced surveillance activities. d. free and low-cost immunization.

The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

The school nurse at the intermediate level arranges for a presentation by the trauma educator at the local regional medical center. Bicycle and helmet safety will be the primary topic at the school's open house. This is an example of which of the following school nurse roles? a. Community outreach b. Counselor c. Consultant d. Case manager

The school nurse has arranged for volunteers to help check each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

D. Social skills instruction to resist pressure to smoke.

The school nurse is interested in providing an antismoking program in a local middle school and is aware that programs are more effective for this age group when they focus on short-term versus long-term effects of smoking. Besides including health risks and cosmetic effects, the nurse should also consider: A. behavior modification techniques. B. effects on the environment. C. laws regarding tobacco sales to minors. D. social skills instruction to resist pressure to smoke.

define planning

The selecting and carrying out of a series of actions to achieve stated goals

There is great concern in the nurse's community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? a. Ask the state department of health for assistance b. Demand that everyone over age 65 become immunized immediately c. Encourage immunization of all children under 12 d. Have an educational campaign to remove any containers of standing water

A Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. Because of the high rate of alcohol involvement in injuries seen in trauma centers, an alcohol blood level would be most important. A cardiac workup, pregnancy test, or STD test would not be the priority.

Three women were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? a. Alcohol blood level b. Cardiac workup c. Pregnancy test d. STD tests

To achieve the major goals of Healthy People 2020, increasing quality and years of healthy life and eliminating health disparities, the partnership between federal, state, and local agencies is critical, and local community coalitions are encouraged because the: a. federal government is ultimately responsible for the health status of the nation. b. public demands that the government protect the people. c. public health departments do not have the resources to accomplish these goals independently. d. state health department would require a universal approach to achieving objectives.

To reach the desired goal of maximizing the full immunization rates for preventable communicable disease and increasing herd immunity levels, it is crucial for the nurse to: A. assume that the primary care physician has provided all appropriate immunizations. B. check an individual's immunization status at each and every visit. C. support parents who are reluctant to immunize their children. D. understand the difficulties in obtaining and maintaining immunization schedules.

A. Caregivers of older persons with health problems.

Universal Precautions is a policy for all health care settings, where potential contact with blood or other body fluids exists, and requires that health care workers always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying strategy for this policy requires that: a. blood and body fluids of all clients be handled as if infected. b. health care workers effectively use hand hygiene. c. health care settings are reservoirs of infection. d. effective infection control surveillance programs are in place.

Sentinel method

Uses outcome measures to evaluate the quality of care; based on epidemiological principles.

Attitudes

Vale own and others' contributions to outcomes in local community settings

BCD

What did events after September 11, 2001, clearly demonstrate (Select all that apply.) A. A strong public health structure ready to respond effectively to a crisis B. Public health's need for additional funding and resources C. The unrecognized importance of nurses in lowering health care costs D. Lack of adequate vaccines to meet community's needs

When meeting with a client and family, the home health nurse says, "We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve." In which of the following phases of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning

When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas? A. Large metropolitan areas B. Most rural and highly populated urban areas C. Most rural and suburban areas D. Small suburban and all urban areas

ACD

Which of the following activities are addressed by most public health departments on the federal, state, and local levels (Select all that apply.) A. Collecting and analyzing various health statistics B. Fining or terminating business at any facility that engages in unsafe commercial practices C. Identifying and planning for high-risk populations D. Planning for and responding to emergencies

abc

Which of the following activities are included in the Centers for Disease Control and Prevention's school health program (Select all that apply.) a. Ensuring a healthy school environment b. Assisting teachers with education related to health c. Encouraging nutritious school meals d. Giving immunizations to students, staff, teachers, and their families

B Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications. Beer, cigarettes, and mixed alcoholic beverages are not as culturally acceptable as caffeine, as there are regulations that limit the age that these products can be used

Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) d. Mixed alcoholic beverages

A. A 16-year-old who is living on his own (not with his parents) B. A pregnant adolescent C. An adolescent in an emergency situation

B The harm reduction model is a public health approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. Substance abuse education is only one part of the harm reduction model. Using an approach of punishment and the criminal justice system has not been found to be effective based on research

Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education

Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers (Select all that apply.) a. To fulfill their ethical and moral responsibility b. To avoid the cost of liability suits, workers' compensation, etc. c. To maintain good public relations d. To meet legislated standards and avoid significant penalties for noncompliance

Which of the following aspects of a home health agency would most likely be examined during the accreditation process (Select all that apply.) a. Cost of each service rendered b. Credentials of each employee c. Organizational structure d. Outcomes of care

D. Reluctance to visit physicians.

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

Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early twentieth century? A. PHNs contributed without receiving any salary for doing so. B. PHNs created new settings where health care could be given. C. PHNs gave care to powerless groups. D. PHNs worked outside any organized health care system.

Which of the following best describes one of the outcomes of the incentives and pressures for cost control and improved health outcomes? a. Expansion in alternative health care agencies b. Improvements in client teaching materials c. Public pressure to improve health professionals' education d. Development and increased use of telehealth technology

Which of the following best describes services that are offered at a school-based health center? a. Employee care at a discounted cost at the school b. Care to others in the community c. Sex education, birth control, family planning, and care throughout pregnancy d. Referral and networking with other health care services in the community

Which of the following best describes the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases

A. HRT does not prevent heart disease.

Which of the following best describes the mission of OSHA? a. To create an inspection system to avoid preventable loss of life b. To ensure safe and healthful working conditions c. To establish rules for employee safety d. To share factory illness and injury rates with the public

Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years? A. Advances in hospital care and procedures B. Advances in medicine and medical research C. Advances in nursing practice D. Advances in public health

Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car, and wearing a helmet when biking or skateboarding? a. Because children won't know if someone doesn't tell them b. Because injuries are the leading cause of death in children and most injuries are preventable c. Because it is a dangerous world and someone has to warn children about the dangers d. Because teaching is easy and more fun than passing out bandages and documenting care

Which of the following best describes the role of nursing in community health? A. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities B. Health care provision offered in primary and secondary institutions or in the client's home C. Provision of health care services in institutions located in the community but outside the hospital D. Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement

Which of the following best describes when the home health nurse must document required Outcome and Assessment Information Set (OASIS-B1) data? a. Before any episode of hospitalization b. After each home health visit c. For all incidences of error or mistake in care d. On first admission to home health care

B. Early detection programs with referral to ongoing access to a care provider

Which of the following best describes where health care dollars in the United States should be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up

Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) a. About 25% of all U.S. residents live in rural settings. b. People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c. Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d. A high prevalence of poverty exists among rural families.

Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her family than to meet the needs of a dying adult? a. Children don't understand what it means to die. b. A child's death is harder for anyone to accept. c. Society does not expect death to occur in children. d. Families are not prepared to deal with death.

Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? a. Teacher shortages have required nurses to be increasingly involved in teaching life skills. b. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. c. States are requiring nurses to screen and to teach life skills. d. Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children.

Which of the following best explains why the federal government is beginning to fund school-based health centers (Select all that apply.) a. These centers help young children avoid becoming addicted to drugs while still in elementary school. b. Attendance and learning are higher in schools with health clinics. c. These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. d. Many children have no other source of health care services.

Which of the following best explains why the home health nurse would essentially repeat the same information given to the client by the nurse in the hospital? a. Clients find it difficult to learn in the midst of the stress of the acute care setting and often don't remember what the hospital nurse taught. b. Hearing something from a different person, using different words and examples, can help ensure that learning is retained. c. Home health nurses often don't know what hospital-based nurses have already taught. d. Learning depends on receiving information more than once.

Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia

C. Has a father or brother who has had prostate cancer.

A. A 1-year-old

Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager

Which of the following clients over 65 years of age meets the criteria for Medicare reimbursement for home health nursing? a. The client who needs assistance with bathing and meal preparation b. The client who needs assistance with house cleaning and meal preparation c. The client who needs sitter services because she wanders from home and becomes lost d. The client whose family members need to learn how to care for his wound

Which of the following comments was most likely stated by a home health nurse? a. "Every time I see a client, it costs $80." b. "Health care costs are killing our economy." c. "I can't believe how much clients are charged for things." d. "Medicaid costs are such a large portion of our state's budget."

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

Which of the following conditions of the rural environment provides increased opportunities for teaching? a. Increased interaction among residents due to neighbors visiting neighbors on the family farms b. Involvement in rural community activities provides more contact with community residents than in urban areas c. Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention d. Increased illnesses and injuries of rural residents require that they see nurses more often

Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered

Which of the following describes how occupational health nursing differs from other nursing specialties (Select all that apply.) a. It is autonomous, because the occupational nurse works independently. b. The major focus is on the environment. c. Nurses focus on health promotion and disease prevention. d. Nursing care is given in the community.

Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC NOC c. Nursing Diagnosis Taxonomy d. The Omaha System

Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for extensive documentation? a. Advances in medical technology and pharmacology b. Increased number of lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s

Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace (Select all that apply.) a. All chemicals are inherently dangerous to humans. b. Chemicals are often used when natural substances are equally effective. c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown.

D. Poverty

Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty

Which of the following factors is causing nursing to change so quickly? A. Economic issues B. Increases in medical and nursing knowledge C. Legislative issues D. Technology changes

Which of the following federal agencies is most influential in public health activities? A. The Agency for Healthcare, Research, and Quality B. Centers for Disease Control and Prevention C. Department of Health and Human Services D. Food and Drug Administration

Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation? a. New workers employed less than 1 year b. Older workers with chronic illnesses c. Older workers with diminished hearing d. Women in their childbearing years

Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB? a. Housekeeping staff b. Medical staff c. Nursing staff d. Ward clerks

Which of the following infectious disease interventions best represents the use of secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual partners. b. Clients with HIV infection are given medications to improve immunological response. c. Health care workers are encouraged to receive annual vaccinations for influenza. d. Health care workers are required to have a tuberculosis skin test or chest x-ray.

Which of the following interventions regarding worker safety would be the least effective? a. Using job rotation and workplace monitoring b. Designing equipment so that employee exposure to hazards is minimized c. Having employees use safety measures and personal protective equipment d. Designing the environment to encourage employees to follow workplace procedures

A. Assess schools and day care centers for environmental "friendliness" C. Develop home and environmental assessment guides.

Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two boards of experts. b. Continuity of care is enhanced. c. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation. d. They are eligible for tax exemptions through affiliated agencies.

Which of the following is a primary requirement for a client to be eligible for home health nursing and Medicare reimbursement of services? a. Must be homebound b. Must be living in a medically underserved area c. Must be indigent d. Must be insured or eligible for Medicare or Medicaid

Which of the following is a unique characteristic of the role of the occupational health nurse? a. Adapts to the needs of the agency and specific groups of workers b. Works as a solo clinician and/or independent contractor c. Is interdisciplinary in nature d. Specializes in health promotion and education

B Marijuana is the most widely used illicit drug in the United States. It is not highly toxic except for possible damage to the respiratory tract from smoking. It may reduce pain but is currently illegal with national efforts at total prohibition. It does not quickly lead to dependence, and withdrawal symptoms are mild.

Which of the following is an accurate concern about the use of marijuana? a. Marijuana has painful withdrawal symptoms. b. Marijuana may damage the respiratory tract. c. Marijuana can often reduce pain but physicians refuse to prescribe it. d. Marijuana quickly leads to psychological and physiological dependence.

Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? a. Complementary and alternative therapies such as acupuncture b. Computer and technology use c. Psychoanalytical techniques d. Self-defense techniques

B. Motor vehicle accidents.

Which of the following is of the greatest concern for the nurse who works with high school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex

A. Breastfeeding only

Which of the following is the leading cause of children being absent from school because of a chronic illness? a. Allergies b. Asthma c. Diabetes d. Upper respiratory infections

Which of the following is the most common disabling condition when measured by days away from work? a. Bruises b. Cuts and lacerations c. Mental illnesses d. Sprains and strains

Which of the following is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever

Which of the following is the most common vector-borne disease worldwide? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever

Which of the following is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population

Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

Which of the following is the primary focus of hospice care? a. Curing or controlling the client's chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves

Which of the following is the primary reason that large companies are becoming more involved in their employees' personal health and well-being? a. It is an ethical and moral responsibility. b. It improves public relations within the community. c. It allows managers to better understand their employees. d. It provides a cost savings to the company.

Which of the following is the underlying science or area of study on which public health is based? A. Biostatistics B. Epidemiology C. Medicine D. Social sciences

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a. Areas where people share dressing or bathing facilities b. Daycare centers and schools c. Long-term care facilities d. Senior citizen centers

Which of the following practices in the home is most crucial? a. Using good handwashing procedures b. Obtaining a puncture-resistant container for family to use for needles c. Putting all contaminated material directly into a trash bag d. Washing all surfaces with disinfectant

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States? a. Answering parents' questions about the safety and importance of vaccines today b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. "No shots, no school" legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge

Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associate's degree in nursing and RN licensure d. Eligibility for certification as a home health nurse

C. A young man repeatedly steals money from his grandmother.

B Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting and effective when taken orally, it does not produce a "high," it is inexpensive, and it has few known side effects. The main effect of this medication is that it decreases the craving for heroin; it is not a drug that clients come to prefer nor does it prevent further dependence on drugs

Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment.

B. Fewer health services are offered to men. C. Men often put work ahead of their health needs. E. Men often incur more work related injuries than women.

Which of the following statements are true regarding the health-related vulnerabilities of men? Select all that apply. a. More males die at birth. b. Fewer health services are offered to men. c. Men often put work ahead of their health needs. d. More males die from suicide. e. Men often incur more work related injuries than women.

Which of the following statements best describes how workers' compensation legislation has changed employer behavior? a. Employers have improved safety of working conditions because safety data is now public information. b. Companies have improved safety of working conditions because worker's compensation insurance premiums are now based on previous claims. c. Employers were legally required to implement safety changes. d. Companies have become more involved in the legislative process.

Which of the following statements best describes the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client's environment. c. Reimbursement for home health care varies from that of care provided in institutions. d. The focus of acute client care is on community health.

Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? a. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. b. Most nurses prefer to be employed in hospitals giving direct care. c. Most school districts are unable to afford a nurse in every school. d. School districts and taxpayers see no need for nurses in schools.

acd

Which of the following supplies or equipment should a nurse have available in the school health office (Select all that apply.) a. Cervical spine collars b. Complete emergency kit that fulfills American Hospital Association requirements c. Epinephrine autoinjector kit d. Material for splints

C D

Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox? (Select all that apply.) a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever.

Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies

D. Social networks that give support and meaning to life.

Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? a. Tell all staff to call 911 if the nurse is not in the building. b. Arrange to always be available, even if only by phone. c. Create and share an emergency plan with all teachers and staff. d. Wear a pager so that the nurse can come as soon as humanly possible.

Which of the following would most likely be one of the first steps taken in employer disaster planning? a. All employees are invited to attend sessions on disaster planning. b. Employers stress the importance of disaster drills and encourage active participation. c. Exhaustive inventory of chemicals and industrial hazards is completed. d. Written disaster plans are distributed to each employee and each worksite.

C. Most women with bulimia are concerned with the shape and weight of their body.

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: A. adult immunization rates. B. chronic respiratory illness rates. C. maternal/infant morbidity rates. D. obesity rates.

parish nursing

a community-based and population-focused professional nursing practice with faith communities to promote whole person health to its parishioners, usually focused on primary prevention

wellness committee

a health cabinet supporting healthy spiritually fulfilling lives; made up of a nurse and members of the congregation

parish nurse coordinator

a parish nurse who has completed a certificate program designed to develope the nurse as a coordinator of a parish nursing service

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.DIF: Cognitive Level: KnowledgeREF: Pages 470-471

Child abuse

active forms of maltreatment of children

health ministries

activities and programs in faith comunities directed at improving the health and well-being of individuals, families, and comunities across the life span

A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: advocacy. culturally competent care. partnership. social justice.

advocacy. Advocacy refers to those actions one undertakes on behalf of another. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that lead to improved public health services for these populations.DIF: Cognitive Level: ApplicationREF: Page 380

neighborhood nurse

also known as block nurse, the nurse responds to a defined community or locality

define program, or what're examples

an organized approach to meet the assessed needs of individuals, families, groups, or communities by reducing or eliminating one or more health problems For example, immunization programs Health-risk screening programs for industrial workers/ Family-planning programs ; Broadly-based community programs: Community school health programs/ home health program

define evaluation

as the methods used to determine whether a service is needed and likely to be used, whether it is conducted as planned, and whether it actually helps people in need

the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants

biological terrorism

is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing

chemical terroism

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: Child abuse depression intimate partner abuse parent's resentment of the preteen

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.DIF: Cognitive Level: ApplicationREF: Pages 460-461

refers to a group exposed to a common noxious influence such as the release of noxious gases (e.g., ricin in the Japanese subway system several years ago and more recently in a water system in the United States)

common source

holistic health centers

comprehensive health teams that include family and clergy and encourage personal responsibility for health and preventive health practices

program management consists of what? like what steps?

consists of assessing, planning, implementing, and evaluating a program to reduce or eliminate health problems

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

crime rates levels of unemployment Identification of risk factors is an important part of primary prevention used by nurses who work with clients in a variety of settings. Although abuse cannot be predicted with certainty, several factors influence the onset and support the continuation of abusive patterns. Assessing for violence in a community context is completed by observing community characteristics inclusive of 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.DIF: Cognitive Level: ComprehensionREF: Page 470 (Box 25-3)

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

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).DIF: Cognitive Level: KnowledgeREF: Page 375

9. The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe?

d. Psychosocial norms of the setting\The employee will only be safe if the employee uses the PPE. If the employee doesn't use the PPE or uses only part of the equipment, then the employee will be at risk. The primary determination of whether the PPE is used correctly and used all the time is the psychosocial norms of the setting. If others are careless in PPE use, then such carelessness is the norm. If everyone is extremely careful to use their PPE, then that is the norm in that setting.

Data also come from ________ _____________ s and administrative data such as ________ ________ ________ ________

death certificates discharge reports billing records

The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: confront the daughter when she arrives to pick the father up. discuss the findings with the caregivers to determine the cause of the injuries. educate the staff about indications of elder abuse. 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 so that proper plans for interventions can be made.DIF: Cognitive Level: KnowledgeREF: Page 467

faith communities

distinct groups of people acknowledging specific faith traditions and gathering in churches, cathedrals, synagogues or mosques

foodborne botulism in Alaska.

endemic

if there is a persistent (usual) presence with a low to moderate number of cases of the disease or event. The endemic levels of a disease or an event in a population provide the baseline for establishing a public health pr

endemic

means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period.

epidemic

The parish nurse partners with the wellness committee and volunteers to plan programs and consider health-related concerns withing what?

faith communiies

pastoral care staff

faith community leaders including clergy, nurses, and educational and youth ministry staff

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. family secrets. father-daughter incest. impaired family functioning.

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.DIF: Cognitive Level: ApplicationREF: Page 465

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: direct financial subsidies for children. funds to insure currently uninsured children. outreach efforts to enroll eligible children in Medicaid. prospective payments for child services.

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 reductionsDIF: Cognitive Level: ApplicationREF: Page 379

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. health care costs. juvenile delinquency. population density.

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.DIF: Cognitive Level: ApplicationREF: Pages 453-454

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: disenfranchisement. health disparities. loss of independence. resilience.

health disparities. Vulnerable populations often are more likely than the general population to suffer from health disparities (i.e., wide variations in health services and health status among certain population groups). The less than adequate care experienced by these groups can be defined by age, gender, race or ethnicity, education or income, disability, geography, or sexual orientation. 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.DIF: Cognitive Level: ApplicationREF: Pages 375-376

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

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.DIF: Cognitive Level: KnowledgeREF: Page 381-382

in a population implies a highly prevalent problem that is commonly acquired early in life. The prevalence of this problem decreases as age increases

holoendemic

Parish nurses carry out their practice in groups or individually and make visits to?

homes, hospitals and nursing homes

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. homicide. possessive behavior. spontaneous abortion.

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. As a woman tries to leave the abusive relationship, the risk for homicide increases, creating a catch-22 scenario. A nurse encountering evidence of severe abuse needs to consider the safety of the woman and her children as the priority.DIF: Cognitive Level: ApplicationREF: Page 465

high cholera in asians and pacific islanders

hyerendemic

there is a persistently (usually) high number of cases.

hyperendemic

Persons assulted with physical and emotional illness and brokenness that are able to call upon their faith beliefs and religious traditons are better able to do what?

increase their coping skills and realize spiritual growth

Additional legal concerns for the parish nurse are?

institutional contractual agreements Records manaagement release of infromation volunteer liability

Parish nursing includes the physical, psychological, social and spiritual dimensions of its clients into its practiice however it focuses on what aspect of nursing care?

intentional and compassionate care which stems from the spiritual dimension of all humankind

cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions.

intermittent or continous source

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: complicated to address. costly to serve. invisible to the community. resilient to the community.

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.DIF: Cognitive Level: ApplicationREF: Page 376

why is planing and evaluation important to program management

it is vital to the survival of the nursing discipline in health care delivery.

The parish nurse is required to be :

knowledgeable about lines of authority and channels of communication in the congregation and in the colaborative institutions well acquainted with the personnel committees of the congregation An advocate for well-being to highlight justice issues in local and national legislation A contributor of information to policymakers about the implications for health and well-being for the parish and the local and global communities An active participant in political activities that contribute to spiritual growth and healthy functioning

public health surveillance can be used to facilitate the following (CDC, 2014): • Estimate the _________ of a problem (disease or event) • Determine the _______ __________ of an illness or symptoms • Portray the _______ _________ of a disease • Detect ______ and define a _________ • Generate __________ and stimulate _________ • Evaluate ________ _________ • Monitor changes in ___________ __________ • Detect __________ in health practices • Facilitate _____________

magnitude geographic distribution natural distribution epidemics problem hypothesis research control measures infections agents changes planning

s "when a victim of a common source epidemic has person-to-person contact with others and spreads the disease, further propagating the health problem"

mixed outbreak

a good example of a process in place to detect morbidity data is

national program of cancer registries

describe the aspects of program evaluation, relevance

need for the program

parish nurses

nurses who respond to health and wellness needs within the faith context of populations of faith communities and are partners with the church in fulfilling the mission of the health ministry

program management process is similar to the

nursing proces

"Program" meets the needs of what?

organized approach to meet the assessed needs of individual, families, groups, or communities for health

a epidemic is often called a

outbreak

refers to the epidemic spread of the problem over several countries or continents (e.g., severe acute respiratory syndro

pandemic

institutional model

parish nurse arrangement in a larger partnership undr contract with hospitals, medical centers, long-term care facilities, or educational institutions

congreational model

parish nurse arrangement in an individual community of aith in which the nurs is accountable to the congregation and its governing body

congregants

people who gather as part of faith community of the congregation of a church

all persons exposed become ill at the same time, during one incubation period.

point source

describe the aspects of program evaluation, adequacy

program addresses the extent of the need

does not have a common source and spreads gradually from person to person over more than one incubation period, such as the spread of tuberculosis from one person to another.

propagated outbreaks

Response to bioterrorism or large-scale infectious disease outbreak may require the use of emergency public health measures such as:

quarantine, isolation, closing public places, seizing property, mandatory vaccination, travel restrictions, disposal of the decreased

describe the aspects of program evaluation, efficiency

relationship between program outcomes and the resources spent

Partnerships

relationships between individuals, groups, or organizations in which the parties are working together to achieve a joint goal; often used synonymously with coalitions and alliances, although partnerships usually have focused goals such as jointly provideing a specific program; involve shared power

problems are those with an irregular pattern with occasional cases found at irregular intervals.

sporadic

Parish nursing services emphasize on what?

srengths of individuals, families, and communities

ways to protect HCP from exposure

standard precautions , disposable non sterile gowns and gloves with hand washing following removal and use of a face shield.

Clinicians, health care agencies, and laboratories report cases to

state health departments

healing

strengthening the inner spiritual connectedness and choosing healthy lifestyles

describe the aspects of program evaluation, effectiveness +impact

summative evaluation: client and provider satisfaction with program activities for health outcomes Effectiveness: ability to meet program objectives and the results of program efforts Impact: long-term changes in the client population

Family nursing diagnosis

the central issue of concern with the family; this directs the interventions

Legal resources for the arish nurse or faith community nurse include:

the faith community's legal consultant the faith community's national position statements statements of the HMA and IPNRC

polity

the policy, governances, expectations, and mission of a specific faith community

The nurse must personally and professionallly abide by the parameters of the nurse practice act of the jurisdiction and maintain an active license of whhat?

the state

The revised scope of standards of the Faith Community Nursing: Scope and Standards of Practice describes?

the who, what, where, when, why, and how of te practice of faith community nursing

describe the aspects of program evaluation, progress

tracking of program activities to meet program objectives

holistic care

understanding the body, mind and spirit relationship of persons in an enviornment that is always changing

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: conduct a comprehensive assessment and formulate a plan for treatment. establish a long-term trust relationship to prevent disappointment. schedule appointments for appropriate immunizations for the children. use every opportunity to teach about preventive health care.

use every opportunity to teach about preventive health care. Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also 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 of environmental hazards and violence and assurance of safe food and water.DIF: Cognitive Level: ComprehensionREF: Page 384

Assault

violent physical or verbal attack.

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.DIF: Cognitive Level: ApplicationREF: Page 376

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. disadvantaged populations. vulnerability. vulnerable populations.

vulnerable populations. Vulnerable populations are those groups who have an increased risk to develop adverse 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.DIF: Cognitive Level: ApplicationREF: Page 375

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: competition. unemployment. survivor guilt. work-related stress.

work-related stress. Productive and paid work is an expectation in mainstream American society. Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.DIF: Cognitive Level: ApplicationREF: Pages 454-455

Outbreak

A change (increase) in a disease and/or an event from expected levels to levels that are clearly in excess of expected levels

Family nursing assessment

A comprehensive family data collection process used to identify the major problems facing the family

Endemic

A disease and/or event that is found to be present (occurring) in a population in which there is a persistent (usual) presence with low to moderate disease/event cases

Family health

A dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of the family system

Family nursing process

A dynamic, organized method of critically thinking about a family

Holoendemic

A highly prevalent problem found in a population commonly acquired early in life. the prevalence of this problem decreases as ae increases

National Notifiable Disease Surveillance System (NNDSS)

A voluntary system monitored by the centers for disease control and prevention that includes 52 infectious diseases or conditions with case definitions that are considered important to the public's health

Pandemic

A worldwide outbreak of an epidemic disease

Disease

An indication of a physiological dysfunction or a pathological reaction to an infection

Biological terrorism

An intentional release of viruses, bacteria, or their toxins for the purpose of harming or killing

6. A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. I wouldnt sit next to someone with HIV. b. Having unprotected sex with someone who is infected spreads HIV. c. Sharing needles when shooting up drugs spreads HIV. d. Transfusions of blood products that are contaminated can spread HIV.

ANS: A HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. Worldwide, the largest number of HIV infections result from heterosexual transmission.

10. A male client visits the clinic office complaining of a yellow, green discharge from his penis. Which of the following STDs has the client most likely contracted? a. Gonorrhea b. Syphilis c. Herpes simplex virus 2 d. Human papillomavirus

ANS: A The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility.

13. Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

ANS: A Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

8. Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the clients name, address, or contact information? a. Client doesnt actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test and collection agencies will not be able to harass them. d. Client wants to be sure care providers dont share results with their family.

ANS: B An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination.

12. Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs b. It can cause problems in infants born to infected mothers c. It is not frequently seen in the United States d. It is so difficult and expensive to treat

ANS: B Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers, although it is rather easily treated with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

9. A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a. Side effects of PrEP include extreme lethargy and joint pain. b. PrEP has been shown to be effective in preventing transmission of the disease from sharing needles. c. The effectiveness of PrEP will depend on your adherence to the medication regimen. d. PrEP will prevent you from contracting HIV and Hepatitis B.

ANS: C Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b).

7. In the United States, which demographic group has the highest risk for HIV infection? a. African-American homosexual men b. Hispanic IV drug abusers c. White homosexual men d. White lesbians

ANS: C The largest number of new HIV infections in 2009 (11,400) were in white men who had sex with other men (MSM), and this was followed by black MSM (10,800).

2. Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear results will be positive. b. They avoid the problem (maybe it will go away). c. They dont recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

ANS: C When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV.

4. A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test. b. A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure. c. A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood. d. A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml.

ANS: D AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

5. The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis

ANS: D HIV-infected persons who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB.

11. A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching

ANS: D Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

3. A client was clearly very relieved when an HIV test came back negative. Thank goodness. Ive had sex several times without a condom, and when one of my friends said he was sick, I think I panicked. Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV-free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks. All persons who have an STD test should be counseled about risk-reduction activities before and after the test is done.

Anthrax

An acute disease caused by the spore-forming bacterium, Bacillus anthracis

Functional families

Family units that provide autonomy and are responsive to the particular interests and needs of individual family members

Elimination

Focuses on removing a disease from a large geographic area such as a country or region of the world

Surveillance

Systematic and ongoing observation and collection of data concerning disease occurrence to describe phenomena and detect changes in frequency or distribution

Syndronic surveillance systems

Systems developed to monitor illness syndromes or events, such as increased numbers of medication purchases, trips to physicians or emergency departments, or orders for cultures or x-rays, as well as rising levels of school or work absenteeism, which may indicate that an epidemic is developing hours or days before disease clusters are recognized or specific diagnoses are made and reported to public health agencies

Resistance

The ability of the host to withstand infection

Endemic

The constant presence of an infectious disease within a specific geographic area

Chemical terrorism

The intentional release of hazardous chemicals into the environment for the purpose of harming or killing

Eradication

The irreversible termination of all transmission of infection by extermination of the infectious agents worldwide

epidemic

The occurrence of an infectious agent or disease within a specific geographic area in greater numbers than would normal be expected

Disease surveillance

The ongoing systematic collection, analysis, interpretation, and dissemination of specific health data for use in public health

Acquired immunity

The resistance acquired by a host as a result of previous natural exposure to an infectious agent; it may be induced by passive or active immunization

Infection

The state produced by the invasion of a host by an infectious agent. such infection may or may not produce clinical signs

Family demographics

The study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through the number, timing, and sequence or the events

Communicable period

The time or times when an infectious agent may be transferred from an infected source directly or indirectly to a new host

Incubation period

Time interval beginning with the invasion by an infectious agent and continuing until the organism multiplies to sufficient numbers to produce a host reaction and clinical symptoms

Common vehicle

Transportation of the infectious agent from an infected host to a susceptible host via water, food, milk, blood, serum, or plasma

Family

Two or more individuals who depend on one another for emotional, physical, and/or financial support. Members of a family are self-defined

MHMD-11

increase depression screening by PCP

NWS-4

increase the proportion of Americans who have access to a food retail outlet that sells a variety of foods that are encouraged by the dietary guidelines for Americans

FP-13

increase the proportion of adolescents who talk to a parent or guardian about reproductive health topics before they are 18

MICH-31

increase the proportion of children with special health care needs who receive their care in family-centered, comprehensive, coordinated systems

MICH-30

increase the proportion of children, including those with a special need who have a medical home

EMC-2

increase the proportion of parents who use positive parenting and communicate with their HCP about positive parentin

FN-12

increase the proportion of sexually active women who receive instruction on reproductive health before they are 18

Child abuse - primary prevention

proved programs in child development for families at risk for child abuse, such as single-parent households

Child abuse - tertiary prevention

provide family therapy for abusive families; remove children from the home

Child abuse - secondary prevention

provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems

OA-9

reduce the proportion of unpaid caregivers of older adults who report an unmet need for caregiver support services.

IVP-39

reduce violence by current or former intimate partners

Pandemic

refers to the epidemic spread of the problem over several countries or continents (such as the SARS outbreak)

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