Chapter 23 - Poverty, Homelessness, Mental Illness, Teen Pregnancy

A

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.

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. Distributing literature is an ineffective intervention as community members would need to read the literature that has been provided. Based on the growth and development of youth, they are unlikely to be able to truly understand the larger scope of youth violence. Recommending increased funding for prosecution and jail does not provide any measure to prevent the problem from occurring

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

B

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.

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. In order to respond therapeutically to the mother, the nurse should not use the words absolutely (which implies that there may not be a problem with the son at all) or crazy (which is not a positive word to describe the son's behavior).

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

D

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.

A

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.

D

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.

C 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. Elevated blood pressure, positive STD test, and seeking prenatal care late in the pregnancy are all concerns for the nurse. However, most concerning would be homelessness, as homelessness presents many challenges for the women during and after the pregnancy

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

B, D Suggestions for promoting interaction between an adult and a baby include smiling and making eye contact. Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). The mother should be taught to use a distance of 8 to 10 inches from the infant and should not blow on the infant's face. The mother should soothe the baby and try to provide comfort before trying to let the infant "cry it out."

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

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 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

A 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. All of these statements are true; however, it is crucial to consider all pregnant teenagers as high-risk obstetric clients. Limited self care, lack of prenatal care, and limited financial resources are all contributors to the potential for all teen pregancies to be considered high risk

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.

C Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. 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. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

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.

B 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. Teaching about body changes an proper care of babies and parenting would address short-term health outcomes. Monitoring teens to detect early problems in pregnancy addresses a short-term health outcomes as well.

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.

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 incorrect responses address how to address the issue of poverty or concerns of the nurse but do not address increasing the nurse's self-awareness.

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?

B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills. Thus, it is most likely that he was unable to meet his basic needs through his current employer. If he had already eaten his meal, it would be unusual to get additional food out of garbarge, rather he should be able to afford to purchase additional food if he was able to purchase his meal. The young adult would most likely not be pulling out half-eaten food if he was looking specifically for a friend's meal. There is no reason to assume that he was part of a fraternity.

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

A Accessibility refers to the ability of clients to obtain needed health care services. 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. All of these options lead to opportunities for improvement in health, either directly or indirectly, but distributing flyers, refering homeless clients, and soliciting donations does not address the issue of accessibility

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.

A

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

B Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy. 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. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care.

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

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. Homeless children may have delayed communication, more mental health problems, and histories of abuse. The priority of the nurse should be to address the potential absenteeism. Being clumsy is not related to living in poverty. Receiving screenings, such as a vision screening, is many times not a priority for those living in poverty. However, this would not be the key concern of the nurse. It is possible that this child could be bullied; however, there are also children who do not live in poverty who experience bullying as well.

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

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. Homeless children may have delayed communication, more mental health problems, and histories of abuse. Because the student is attending school, the student should be eligible for free lunches and should be provided adequate food. There is nothing that suggests that this child is unable to see and poverty is not indicative of vision problems. It is possible that this chld is being mistreated, and this may be something to speak with the teacher about; however, developmental delays would be of greater concern to the nurse than mistreatment.

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

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. Having friends suggest that the pregnancy will just go away is not a common reason why pregnant teens do not seek prenatal care; it is more likely that the teen herself is thinking that the pregnancy will just go away. Being told that a condom was used doesn't make it so. The girl should know whether a condom was used or not without relying on verbal statements

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.

B According to the Federal Register in January 2016, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $24,300. According to the Federal Register in January 2016, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $16,020 for a family of two, $32,580 for a family of 6, and $40,890 for a family of 8.

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. $16,020 b. $24,300 c. $32,580 d. $40,89

A

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.

C, D

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.

D

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

B 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. Although the nurse might assess for any and all of these options, however, the primary goal of a postpartum visit would be to assess knowledge regarding normal growth and development. A teenager mother's knowledge about her own growth and development and how much assistance she is receiving from her own mother and the baby's father would be secondary concerns

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

C

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.

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. If the wound is not kept clean, it is unlikely that antibiotics will be able to prevent an infection, and the antibiotics will not promote wound healing. Handing out bandaging supplies does not address being able to wash the wound on a regular basis. Monitoring of the wound will not assist in wound healing.

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

B Men over age 85 are in the highest risk category for suicide. Adolescents under age 20, females 25 to 45 years of age, and women over age 65 are all not part of the highest risk category for suicide.

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

C Major depressive depression is the leading cause of disability for Americans between the ages of 15 and 44 years. Accidents, arthritis, and workplace injuries are not the leading causes of disability for Americans between the ages of 15 and 44 years

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

B Families with children are the fastest-growing segment of the homeless population with the highest rates being found in rural areas. Adolescents, persons and crisis, and single men are not the fastest-growing segments of the homeless population

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

B In 2014, the poverty rate for children under 18 was 21.2%, which was higher than all other age groups. In 2014, the poverty rate for people between the ages 18 and 63 was 13.5 percent, and for people over 65 years, the rate was 10 percent. The textbook does not list a specific percent for those between the ages of 18 and 25.

Which of the following populations experiences the highest incidence of poverty? a. Those between the ages of 18 and 64 b. Those under the age of 18 c. Those over the age of 65 d. Those between the ages of 18 and 25

B

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

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. It is likely that most homeless people do not seek preventive care, thus, it is not that they require increased services, but they are less likely to seek these preventive services. Homeless clients are likely to not be seen in the clinic setting. Homeless people may spread contagious diseases, but this does not explain why providing health care to this population is expensive.

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.