comm exam 3

2. Which of the following best represents the concept of homelessness as crisis poverty? a. Man with chronic alcoholism and drug abuse living in a halfway house b. Recently unemployed man evicted from his apartment c. Teenager living on the streets and abusing drugs d. Woman with schizophrenia who is living in a shelter

ANS: B Crisis poverty is a conception of homelessness that views the homeless as people whose lives are generally marked by hardship and struggle. For this group, homelessness is often transient or episodic. Their homelessness may result from lack of employment opportunities, lack of education, obsolete job skills, and/or domestic violence.

8. Community-oriented nurses practice in a variety of settings and therefore, have the greatest opportunity to advance a major national health objective for children by: a. increasing the access to care. b. justifying the cost of care. c. promoting healthy lifestyles. d. providing anticipatory guidance.

ANS: A A major goal of the Healthy People 2020 objectives is improving access to health care for children, specifically access to preventive services and immunization. Community-oriented nurses have the exciting opportunity to focus on this goal. They practice in a variety of settings, including community health centers, school-based clinics, and home health programs. As the nation struggles to deal with the issue of access to care, solutions will probably include expanding the role of nurses and the settings for practice. The nursing process and knowledge of the factors unique to children provide a framework for care. Although all of the activities mentioned above are aspects of the community-oriented nurse's role, increasing the access to care for this population will have the greatest impact in reaching our national objectives for the health status of this population.

6. When conducting an environmental risk assessment, the nurse explores the economic risk and social risk of the family. To capture social risk assessment data, the nurse can best use which of the following? a. Community assessment and ecomap b. Genogram and ecomap c. Genogram and history d. Double ABC-X model

ANS: A An assessment of environmental risk typically includes information about the relationships that the family has with others such as relatives and neighbors and their connections with other social units, the flow of energy in those relationships, and the characteristics of the neighborhood and community in which the family lives. This information can be obtained through the use of assessment tools such as an ecomap and community assessment.

2. The developmental theory of human ecology emphasizes the complex relationship between a growing child and their immediate environment that helps the child to learn to: a. accommodate. b. achieve ego identity. c. create mental schemes. d. differentiate.

ANS: A Bronfenbrenner's human ecology theory emphasizes the complex relationship between the growing child and their environment. The most important environment is the family environment but children also interact with their schools, community, and society. Children learn to accommodate to their environment and alter themselves based on environmental interactions, therefore children do not develop in isolation but in relation to their environments.

4. To detect the presence of the leading cause of disease burden for women in the United States, a screening program for women would include: a. blood pressure screening, mammography, and dietary assessment. b. testing for HIV/AIDS and sexually transmitted diseases. c. pap smear, screening for smoking, and assessment for exposure to violence. d. questions about a family history of depression, employment status, and chronic diseases.

ANS: A Chronic disease has become a public health problem of great proportions with the most common and costly chronic diseases being heart disease, diabetes, stroke, cancer, and arthritis. Chronic disease is the leading cause of preventable deaths, disability, and decreased quality of life. Heart disease is the leading cause of death for both men and women. Uncontrolled hypertension leads to heart attack, stroke, kidney damage, and a host of other complications and only two-thirds of people with hypertension are aware that have high blood pressure because there are no associated symptoms. Cancer is the second leading cause of death in the United States. Early screening and detection, promotion of healthy lifestyles, expanding access to services, and improving cancer treatments will help reduce the burden of cancer and disparities. Screening activities (secondary prevention) make a difference in death rates and early detection can promote a cure, whereas late detection typically ensures a poor prognosis. Overweight and obesity are topics addressed numerous times in Healthy People 2020 because of their link to many chronic health diseases (risk factor for diabetes and heart disease). A dietary assessment, along with physical and psychological assessments, helps nurses to identify women at-risk for appropriate referrals.

7. The Family and Medical Leave Act (FMLA) of 1993 addressed many issues to support and strengthen the families in our nation without producing an adverse effect on the majority of business employers. Its most significant impact on families was that it: a. enabled individuals to have both a family and a career. b. called for paid adoption leave. c. provided eldercare services. d. provided life insurance benefits.

ANS: A FMLA allows covered employees to take up to 12 weeks of unpaid leave of absence each year for certain family and medical reasons such as their own serious medical illness; the illness of a child, spouse, or parent; and the birth or adoption of a child. Employees' medical benefits remain intact during the unpaid leave, and they are guaranteed that their old position or a similar one will be available to them once they return to work. The most significant impact of FMLA was to ensure that an individual could have both a family and a career and would not have to choose between the two. Americans could now meet the needs of their families while maintaining employment. All women became eligible for unpaid maternity leave on the birth of a child. Many states have legislated longer leave time and more benefits than the minimum required under FMLA for employees in their states. Seven years after the enactment of FMLA, a survey was conducted to understand the impact of such a family policy. Findings from the survey indicated that FMLA had no adverse effect on over two-thirds of business employers and that employees are taking advantage of the FMLA-mandated benefits in increasing numbers.

8. Two of the most significant barriers to practicing family nursing are the narrow definition of family used by health care professionals and social policy makers and: a. lack of consensus on what constitutes a healthy family. b. medical and nursing diagnosis systems. c. nursing's historical ties with the medical model. d. lack of exposure of practicing nurses to family concepts.

ANS: A Family nursing is practiced in all settings. Family nursing consists of nurses and families working together to improve the success of the family and its members in adapting to normative and situational transitions and responding to health and illness. The diverse and changing definitions of "family" present a challenge to society's notion of what constitutes healthy families. Healthy and vital families are essential to the world's future, because families serve as the basic social unit of society.

2. Nurses must be aware of the incidence of incest, its signs and symptoms, and the psychological and physical trauma it causes. One fact relevant to comprehensive nursing assessment is that incest: a. occurs in all races, religious groups, and socioeconomic classes. b. often occurs in father-son relationships. c. occurs only in father-daughter relationships. d. never occurs in stepparent-child relationships.

ANS: A Father-daughter incest is the type of incest reported most frequently, and stepfathers are considered the most common perpetrators of father-daughter incest. Very little is known about female perpetrators, but mothers do engage in child sexual abuse. Incest occurs in all races, religious groups, and socioeconomic classes. Nurses must be aware of this fact to conduct comprehensive assessments that take into account the incidence of incest, signs and symptoms, and the psychological and physical trauma it causes.

5. The community health nurse visits the home of a pregnant teen who lives with her parents, one older brother, and two preteen sisters. The best strategy for meeting the objectives of Healthy People 2020 would be for the nurse to offer which of the following for the entire family? a. Anticipatory guidance addressing sexuality issues b. Assessment for financial assistance c. Assessment of family dynamics d. Environmental assessment addressing suitability for child rearing

ANS: A Healthy People 2020 seeks to reduce pregnancies among teenagers, decrease the number of adolescents engaging in sexual intercourse before age 15 years, increase the number of adolescents who have never engaged in sexual intercourse, increase the use of barrier methods and other contraceptive methods among sexually active teens, and increase the number of young adults who have received formal instruction on reproductive issues before turning age 18 years. In addition, providing anticipatory guidance to the entire family can model open discussions about sexually related issues in a manner that increases parent-teen dialogue. All of the activities listed above are appropriate interventions by the nurse during a home visit. Anticipatory guidance regarding sexuality issues directly addresses the Healthy People 2020 objectives related to family planning.

4. A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

6. A recent movie release portrays a female drug user living with her abusive boyfriend, who has two children by different women, in a rundown inner city neighborhood with high levels of poverty and unemployment. This portrayal best describes the influence of which class of factors on societal responses to poverty and homelessness? a. Cultural b. Environmental c. Political d. Social

ANS: A Individual perceptions of poverty and poor persons are rooted in social, political, cultural, and environmental factors. Societal responses to poverty and homeless persons (what actions are taken to assist them) are deeply rooted in history, and that history has helped to shape cultural attitudes. Cultural attitudes affect, and are affected by, the discourses in various media. Portrayals of poor people as lazy and shiftless folk, desperate persons, criminals, and slackers living off of public assistance influence what we believe to be true about poor persons.

6. Teens are at higher risk for becoming pregnant because of the presence of multidimensional factors that include such things as adolescent immaturity, low levels of contraceptive use, and: a. early age of initiation of sexual activity, sexual victimization, and peer pressure. b. parenting styles, family structure, and paternity issues. c. partner pressure, discouragement of abortion, and poor nutrition. d. poor nutrition, preterm delivery, and late-term prenatal care.

ANS: A Many adults have difficulty understanding why young people would jeopardize their careers and personal potential by becoming pregnant during their teen years. Adolescents, however, do not view the world in the same way that adults do. Teens may feel invincible and therefore do not recognize any risk related to their behaviors or anticipate the consequences. They may not think that the negative outcomes of which they are warned could occur and believe that they are unique and different and that everything will work out fine. Pregnant teens often express the unrealistic attitude that they can do it all: school, work, parenting, and socializing. In addition, the earlier the age at which sexual activity begins (sexual debut), the less likely it is that a birth control method will be used. Inconsistent use of birth control can reflect a teen's willingness to take risks, dissatisfaction with available birth control methods, and ambivalence about becoming pregnant. Peer and partner pressure also places teens at greater risk when their friends are sexually active. Sexual victimization, family structure, and parenting styles have a significant impact. Adolescents raised in single-parent families are more likely to report sexual experiences. Parents who are extremely demanding and controlling or neglectful and who have low expectations are least successful in instilling parental values in their children.

2. When planning a program for pregnant adolescents, the nurse should be aware that pregnant adolescents who decide to have a child experience an increased risk for: a. reduced lifetime earning potential. b. eating disorders. c. genetic diseases in their infants. d. weight gain.

ANS: A Many teenagers who become pregnant are caught in a cycle of poverty, school failure, and limited life options. A disproportionate number of teens who give birth are poor (more than 75%), have limited educational achievements, and see few advantages in delaying pregnancy because they do not expect that their circumstances will improve at a later time.

5. In comparison with women, men: a. incur more work-related injuries. b. experience lower survival rates in the first year after myocardial infarction. c. metabolize alcohol more efficiently. d. more actively initiate preventive health care interventions.

ANS: A Men are often employed in dangerous jobs and incur more work-related injuries than women. Men do not participate in health care to the same level as women, apparently because of the traditional masculine gender role learned through socialization. Men are socialized to ignore pain, be self-reliant, and be achievement oriented. Large numbers of men do not receive the health screenings intended to prevent and identify disease.

9. When working with battered women, the nurse needs to know that research suggests that the response to abuse is a process that moves from: a. commitment to the relationship to leaving to start a new life. b. emotional degradation to financial dependence to dominance. c. heated argument to hitting to battering. d. self-blame to fear to terror.

ANS: A Nursing research suggests that the response to battering is a process that occurs over time in which the victim's emotional and behavioral reactions change. At first there is a great need to minimize the seriousness of the abuse, ascribe external blame, accept the partner's remorse, blame oneself, experience a moral conflict about leaving, hide the violence, placate the partner, and lose the sense of self, until finally concern about children or personal fear of death tips the balance to a decision to leave the abusive relationship.

8. Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

ANS: A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

9. A cultural belief and an environmental factor that may increase the risk of potential pesticide exposure for some migrant workers are: a. hot-cold balance and housing. b. cuarentena and distance from health care services. c. need to achieve high productivity and transportation challenges. d. disease causality and proximity to the farm fields.

ANS: A Some migrant workers may not shower when they return from the fields as a result of cultural beliefs about being exposed to cooler water while feeling hot from working. Inadequate housing that lacks showers and/or adequate laundry machines also prevent farmworkers from washing pesticides off themselves and their clothing in a timely manner. This exposes the farmworker and the entire family to the risk of pesticide exposure.

3. Parents of a 12 year old have started the Weight Watchers program and are concerned about the appropriateness of their eating plan for the preteen's nutritional needs. The preteen's weight is within accepted guidelines for the given height. Which of the following would be the most appropriate guidance? a. A nutritional plan that includes whole foods, fruits, vegetables, lean protein and dairy sources, whole wheat breads, and legumes is healthy for the whole family. b. An extremely low-carbohydrate diet would be more effective to avoid obesity. c. Preteens naturally limit their own intake of unnecessary foods. d. The Weight Watchers plan is appropriate, but children can benefit from having convenient prepackaged processed snack foods to eat as soon as they come home from

ANS: A The entire family benefits from a nutritional plan that includes whole foods, fruits, vegetables, lean protein and dairy, whole wheat products, and legumes. Decreasing consumption of processed foods and simple carbohydrates is beneficial. Adding exercise the whole family can do together is also very important.

8. When working with the poor or homeless, to develop effective nursing interventions the nurse should evaluate clients and populations in the context of: a. environment. b. improvement in the quality of services. c. human dignity. d. nursing theories.

ANS: A The foundation of nursing theories is the assumption that human beings have inherent dignity and worth. Nursing is based on valuing individuals, promoting health, respecting and restoring dignity, and improving the quality of life of individuals, families, and aggregates. Conflicts in values, beliefs, and perceptions often arise when nurses work with persons from different social, cultural, and economic backgrounds. A lack of agreement between the professional's and the client's perceptions of need can lead to conflict. As a result of this conflict, clients may fail to follow the prescribed treatment protocol. The nurse may then inaccurately interpret the client's behavior as resistance, lack of cooperation, or noncompliance. Nurses should evaluate clients and populations in the context of the environment to develop effective nursing interventions. Care must be multidimensional and should include consideration of biological, psychological, social, political, cultural, environmental, economic, and spiritual factors.

6. A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

8. To improve the health of frail elderly, community-based nursing programs will need to address: a. racial/ethnic and sociological disparities. b. culture, ethnicity, and race. c. media and marketing initiatives that target elderly concerns regarding quality of life and degree of disability. d. national vital statistics on morbidity and mortality.

ANS: A The prevalence of frailty in the older population poses a major public health dilemma since the majority of this group will reside in a community setting, placing new demands on health care systems, family caregivers, and community resources. To improve the health of frail elderly, community-based nursing programs will need to address racial/ethnic and socioeconomic disparities.

8. Violent crimes in the United States include rape, robbery, homicide, and assault. Although rates are decreasing, the long-term consequences of victimization reveal troubling trends that best support the realization that violence must be addressed as which of the following? a. Community and public health problem b. Legal and political concern c. Medical and health care concern d. Nursing concern

ANS: A Violence should be considered a community and public health problem because violence results in significant mortality and morbidity, contributing to health care costs; exposure to violence as either a victim or witness can predict violent behavior in the future (violence begets violence); health care professionals have been slow to develop a response to violence; community factors contribute to violence; and evidence-based interventions have demonstrated that violence can be decreased or prevented and the community's capacity to respond to violence can be increased.

7. A nurse case manager identifies a potential health outcomes concern for a 1 year old with special needs living in an impoverished neighborhood, because this child is at increased risk for: a. developmental delays. b. ear infections. c. frequent colds and infections. d. irritability.

ANS: A Young children (0-5 years of age) are at highest risk for the most harmful effects of poverty. Good nutrition during the first years of life is crucial for normal cognitive development. Unfortunately, many children live in poverty during their early childhood years. The brain is directly affected by environmental stimulation during a critical time that extends from the prenatal period through early childhood. Among the risk factors that impede cognitive development in young children are inadequate nutrition, maternal substance abuse, maternal depression, environmental hazards, trauma, and abuse. Unfortunately, poor children often have greater exposure to risk factors such as these. Poverty increases the likelihood of chronic diseases, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron-deficiency anemia, and elevated blood lead levels.

1. Which of the following are factors that significantly influence the health status of children in the United States? (Select all that apply.) a. Access to health care b. Education c. Infant mortality among minority groups d. Poverty status e. Risk-taking behavior

ANS: A, B, C, D, E Children living in poverty or low-income families endure inadequate housing, inadequate nutrition, poor environmental conditions, and increased exposure to violence and crime. Minority children are overrepresented in these groups. Government programs have attempted to address the diminished access to health care, including basic preventive services and episodic illness services, for underserved children. Even though overall infant mortality is decreasing, the mortality rate for minority infants is twice that for white infants. Risk-taking behavior combined with other behaviors like experimentation with alcohol, smoking, and drugs; violent crime; and gang activity impacts the health status of the nation's children. The number of children and adolescents who are behind in their education, not in school, detached from their families, and runaways continues to rise. The result is young adults who are ill prepared to assume their role in society and lead healthy and productive lifestyles.

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

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

1. Disaster-related nursing is an evolving specialty. Nurses have unique skills that can be applied in which of the following aspects of disaster management? (Select all that apply.) a. Completion of the American Red Cross disaster management course and registration as a disaster responder b. Clinical management of blast lung injury c. Engagement of the BioWatch system d. Monitoring of the environment to contain infectious disease e. Planning and organization of mass prophylaxis and vaccine campaigns

ANS: A, B, D, E Nurses have skills in assessment, planning, implementation, evaluation, education, priority setting, collaboration, and provision of health care services to address both preventive and acute care needs. These skills sets are important in the four stages of disaster-related work prevention (planning/drill participation), preparedness, (course work/registration), response (clinical expertise), and recovery (monitoring). BioWatch is a system of sensors that test the air in several major metropolitan areas for biological agents that terrorists might use. This technology-based early warning system is distinctly different from BioSense, which is a public health surveillance initiative that is intended to serve as a biosurveillance program for early detection and quantification of a bioterrorism event or disease outbreak. Nursing skill sets lend themselves to participation in BioSense

4. One of the most significant household changes in the second half of the twentieth century in North America was the increase in men and women living together without marrying. Effects of this trend on the children of cohabitating couples include: a. increased chance of exposure to second-hand smoke. b. decreased chance of parental separation. c. more behavioral and cognitive problems. d. more stable living conditions.

ANS: A, C Cohabitating couples in the United States live together for shorter periods of time than cohabiting couples in other countries. Parental separation is five times greater for children born to cohabiting than married parents. The unstable living arrangements for children born outside of marriage remain an important question relative the well-being of these children. The number of transitions is associated with negative child well-being. Many of these children experience about three transition relationships from birth to 3 years of age. The research shows that children in cohabitating relationship have more behavioral and cognitive problems. Researchers also found that cohabitating-parent families spend a greater share of their budgets on alcohol and tobacco than do married, divorced, and never-married single-parent families.

1. Diabetes mortality rates continue to rise for all ethnic and socioeconomic groups, but evidence shows that which of the following are true? (Select all that apply.) a. Addressing the diabetic epidemic involves more than a focus on individual factors. b. Community-based education programs have done little to address the problem. c. Complications and mortality rates are highest among low-income and minority groups. d. Selection of healthy food options is both an availability issue and an education issue. e. Standard of living does not affect decision making.

ANS: A, C, D Diabetes is a serious public health problem and is epidemic in the United States. One in 12 adults in the United States has diabetes, and for every three people who have been diagnosed with diabetes, there is another who does not know he or she has it. Research supports the importance of also addressing social and economic factors related to health and well-being when treating diabetes. These social determinants of health include the characteristics of clients' communities, such as income distribution, educational level, and segregation. This broader perspective also includes attention to policies that affect the availability of healthy foods.

2. A community-oriented nurse is developing goals for a community health center's senior center. The goals should focus on which of the following? (Select all that apply.) a. Meeting social and recreation needs b. Helping elders accept the inevitability of the debilitation of aging c. Maximizing functional status and minimizing functional decline d. Implementing secondary and tertiary prevention measures

ANS: A, C, D Senior centers were developed in the 1940s to provide social and recreational activities. Now many centers are multipurpose, offering recreation, education, counseling, therapies, hot meals, and case management, as well as health screening and education. Nurses caring for elder populations strive to help maximize functional status and minimize functional decline. Senior centers are effective platforms for nurses to provide interventions related to primary, secondary, and tertiary prevention, health promotion and maintenance, and disease prevention. Senior centers are multipurpose and provide safe, stimulating recreational opportunities. Many of the changes traditionally associated with aging can be delayed or prevented by positive health practices and proactive intervention.

7. Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

ANS: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. 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.

1. The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

ANS: B A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

7. Adolescents who feel competent as parents have enhanced self-esteem, which, in turn, positively influences their relationship with their child and response to the child's cues signaling basic needs or distress. It is important for the nurse to initiate parenting education for both parents as early as possible to increase the teens' understanding of their child's growth, development, and needs in order to reduce the risk for: a. academic behavior problems in the future. b. abusive parenting. c. limited verbal communication with the infant. d. negative parenting feedback.

ANS: B Abusive parenting is more likely to occur when the parents have limited knowledge about normal child development. It may also be more likely to occur among parents who cannot adequately empathize with a child's needs. The frustration caused by this failure may be exhibited as abusive behavior toward a child. Teens who show greater psychological distress or lack social support should also be assessed for child abuse risk by the nurse. Limited verbal communication and eye contact with the child, displays of frustration, and ambivalence are indicators of limited knowledge regarding infant growth and development.

2. The nurse case manager in a migrant farmworker clinic assesses this vulnerable population from the perspective of occupational and environmental risks related to: a. contaminated water, applied chemicals, and unfamiliar farm equipment. b. naturally occurring plant substances, pesticides, and fear of injury reporting. c. traffic accidents, weather, lack of worker supervision, and inadequate sewage. d. weather, pesticides, and strict enforcement of occupational regulations.

ANS: B Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.

8. Factors that are associated with decreased sexual risk behaviors in teens include higher levels of parental education and: a. age-restricted discussion of sexual issues. b. good family health practices. c. strict parental rules on behaviors. d. membership in the white majority versus other racial groups.

ANS: B Family structure can influence adolescent sexual behavior and pregnancy. Adolescents raised in single-parent families are more likely to report sexual experiences and to have become sexually active at a young age than those raised in two-parent families. "Two-parent family" does not necessarily mean a "traditional" family structure. Other factors, such as parental higher education, family communication, and good family health practices, are also associated with decreased sexual risk behaviors.

2. Counseling regarding hormone replacement therapy (HRT) should include the following information: a. menopause is a result of hormone deficiency, and therefore HRT is appropriate for all women to treat all symptoms. b. HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medication. c. research concludes that HRT does prevent heart disease in menopausal women. d. HRT should be considered for prevention of osteoporosis in all women.

ANS: B For decades, many U.S. women used HRT, even though HRT remained untested by rigorous scientific study. A clinical trial launched in 1991, the Women's Health Initiative, set out to test specific effects HRT had on women's health, especially its effect on heart disease and osteoporosis. Researchers concluded that HRT did not prevent heart disease and that to prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol intake, maintain a healthy body weight, and be physically active. Scientists also concluded that HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medications.

5. A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are: a. natives of Guatemala. b. natives of Mexico. c. natives of Panama. d. newly arrived from Haiti.

ANS: B Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel). Symptoms and folk treatments may vary depending on the individual's or family's place of origin in Mexico. When experiencing a folk illness, the traditional Mexican individual would prefer to seek care from a folk healer. The more common healers are curanderos, herbalists, and espiritualistas. The most common herbs used by the folk healers are chamomile (manzanilla), peppermint (yerba buena), aloe vera, nopales (cactus), and epazote. The nurse needs to ask clients what herbs and other remedies they have tried to help with their symptoms. Use of some herbs with prescribed medication may be contraindicated, and the nurse needs to include that information in client counseling. Any client counseling should incorporate awareness of and sensitivity to the client's culture.

1. To develop a baseline for a presentation at the local women's club about the status of women's health in the community, a community-oriented nurse researches national vital statistics to establish the leading cause of women's deaths in the United States. In the United States, the leading cause of death for women is: a. cancer. b. heart disease. c. stroke. d. infectious disease.

ANS: B Heart disease is the leading cause of death for both men and women. The lifetime risk for stroke is higher in women (~1 in 5) than men (~1 in 6). Since women live longer than men and strokes increase with age, more women are likely to die from stroke than men. Cancer is the second leading cause of death in the United States surpassed only by heart disease.

2. One challenge in working with families for healthy outcomes when the following capacity-building practice model occurs when the nurse steps aside in: a. defining the problem. b. designing family interventions. c. evaluating the plan. d. pre-encountering data collection.

ANS: B In a capacity-building model of practice, nurses assume the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates actions for and with the family. When designing family interventions, nurses will be challenged to help families identify the primary problem confronting them (prioritizing) and stepping aside; accepting the family's priorities as they work in partnership with the family to keep their interventions simple, specific, timely, and realistic.

1. A community health nurse is applying for funding to help reduce the incidence of the most common cause of childhood morbidity and mortality in the community. The requested grant should seek to: a. educate the community about the dangers of lead paint for young children. b. teach elementary school children how to choose and use a helmet for biking. c. teach kindergarten children how and when to wash their hands. d. teach kindergarten children how to brush their teeth.

ANS: B Injuries and accidents are the most important cause of disease, disability, and death among children in all age groups. School-age children have the lowest injury death rate. Developmentally, however, at this age it is difficult to judge speed and distance. Therefore this group is at risk for pedestrian and bicycle injuries. Universal use of bicycle helmets would prevent deaths and severe injuries. Peer pressure often inhibits the use of protective equipment such as helmets and limb pads.

1. A nurse is assessing a family's ability to provide home care for their 6 year old, who is a quadriplegic as a result of an automobile accident. The nurse teaches the parents body mechanics and transfer techniques. The nurse also determines the parents' physical ability to safely lift the child. The nurse's actions relate to which of the five interacting variables of Neuman's Systems Model? a. Developmental b. Physiological c. Psychological d. Sociocultural e. Spiritual

ANS: B Neuman's Systems Model, a wellness-oriented model, defines family health in terms of system stability as characterized by five interacting sets of factors: physiological, psychological, sociocultural, developmental, and spiritual. The nurse draws on family strengths and resources to keep the system stable while it adjusts to stress in the face of change. The nurse is answering the question, "Are the parents physically able to transfer the child from bed to wheelchair and from wheelchair to car or shower seat?" This question assesses the physiological variable of family health.

1. A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. The most effective strategy to consider when networking with homeless individuals, families, or populations is to: a. form a community partnership to establish a clinic for homeless persons. b. create a trusting environment and establish a therapeutic relationship. c. collaborate with the local United Way to obtain funding for primary care services. d. dialogue with local clergy to address the unmet primary care need for homeless persons.

ANS: B Nurses need to be able to work with poor and homeless clients to promote, maintain, and restore health. Nurses must be prepared to look at the whole picture: the person, the family, and the community interacting with the environment. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

5. During an assessment of a family of four, the nurse completes a genogram. This assessment tool is effective in identifying: a. behavioral health risk. b. biological health risk. c. nonnormative life events. d. normative age-related risk.

ANS: B One of the most effective techniques for assessing patterns of health and illness in families is construction of a genogram covering three generations of family history. Major illnesses can be listed and patterns can be quickly identified to provide a guide for the health interviewer.

6. A nurse takes the time to read and understand the community's disaster plans and participates in mock disaster drills as a leader of the triage team. The nurse obtained disaster management training through the local Red Cross chapter and registered with the state as a disaster management nurse. The best description of the nurse's activities is: a. American Red Cross disaster training. b. community preparedness. c. personal preparedness. d. professional preparedness.

ANS: B Preparedness takes place at three levels: personal, professional, and community. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Preparedness also involves the development of the knowledge one needs to respond to specific types of incidents (chemical, biological, radiological, nuclear, and explosive events, and those involving weapons of mass destruction): how to treat those injured by each, how to use personal protective equipment, and how to work safely near dangerous materials. Nurses who seek greater participation or desire more in-depth understanding of disaster management can become involved with any number of community organizations that are part of the official response team. After receiving formal disaster training nurses can register with national and state registries to provide disaster response when needed. The importance of being adequately trained and properly associated with an official response organization to ensure an orderly, effective, and efficient response cannot be overstated.

5. Professional nursing organizations recommend that all women be routinely screened for domestic violence when they: a. come to the emergency department with physical trauma. b. come to any health care setting. c. repeatedly visit their primary care provider with symptoms of depression or anxiety. d. report increased financial stress in the home.

ANS: B Studies indicate that only a small percentage of battered women in emergency departments and other health care settings are identified as such and treated for the abuse, despite the significant prevalence of domestic violence. Battered women seek treatment in a number of ways and may be unaware of the relationship between their symptoms and the violence in their lives. Professional nursing associations (e.g., American Nurses Association; Emergency Nurses Association; Association of Women's Health, Obstetric and Neonatal Nurses; American College of Nurse-Midwives) recommend that all women be routinely screened for domestic violence each time they come to a health care setting. For the battered woman and the staff to begin to make the connection between her life situation and the presenting complaints, the nurse must ask direct questions in a supportive, open, and concerned manner.

2. The nurse continues the assessment of a family's ability to provide home care for their 6 year old, who is a quadriplegic as a result of an automobile accident, noting that the parents are in good physical health with no genetic or lifestyle risks, live in a safe neighborhood with caring neighbors, are dealing with grief and stress as they adjust to their child's injury, and are concerned that their insurance benefits may not adequately cover their child's expenses. The family's current health risk appraisal identifies the following risks: a. Biological and life-event risks b. Economic and life-event risks c. Life-event and social risks d. Social risks and biological risks

ANS: B The family is facing a nonnormative life-event risk: their child's sudden significant permanent injury. They are also facing an economic risk, because their financial resources, including their insurance coverage and personal finances, may not be adequate to meet their needs. Currently, they do not have a biological risk in terms of genetics or lifestyle patterns. They also are not facing a social risk such as racial discrimination, pollution, or living in a high crime area.

8. An extensive train derailment occurs in the suburbs of a large metropolitan area. First responders determine that although no fatalities occurred, the derailed cars contain a noxious gas that diffuses readily into the air. The event easily overwhelms the capability of the local responders and hazmat teams are required. The local office of emergency management would coordinate through the emergency operation center to request assistance through which of the following? a. Environmental Protection Agency (EPA) b. Mutual aid agreement c. NIMS d. National Response Plan

ANS: B The first level of disaster response occurs at the locality, with mobilization of entities such as the fire department, law enforcement, public health agencies, and voluntary organizations like the Red Cross. If the disaster warrants significant local attention and overwhelms the capacity of the local responders, then the county or city office of emergency management will coordinate activities through the emergency operation center. Generally localities within a county are signatories to a regional or statewide mutual aid agreement. This agreement provides that the signatories will assist one another with needed personnel, equipment, services, and supplies. Mutual aid agreements are established between facilities and other emergency responding entities within localities, jurisdiction(s), and states; between states; and across borders to ensure seamless service in responding to disaster events, whether caused by people or by nature. When state resources and capabilities are overwhelmed, the governor may request federal assistance under a presidential declaration of disaster or emergency.

3. When the community health nurse displays pertinent family information in a family tree format, the family can see the family structure, its members and their relationships over at least three generations and provides a visual source for planning family interventions. This approach also assists the nurse in making clinical judgments relevant to family structure and history. This type of family assessment instrument is referred to as: a. ecomap. b. genogram. c. family developmental task. d. family diagnosis.

ANS: B The genogram displays pertinent family information in a family tree format that shows family members and their relationships over at least three generations. The genogram shows family history and patterns of health-related information, which is a rich source of information for planning interventions. The identified client and his or her family are highlighted on the genogram. Genograms enhance nurses' abilities to make clinical judgments and connect them to family structure and history.

5. A nurse working in a clinic in an inner city with high poverty and unemployment rates recognizes the need for programs for women because impoverished women are at higher risk for: a. decreased access to social services. b. poorer health status. c. exposure to environmental toxins. d. poorer academic success.

ANS: B The relationship between poverty and health is significant. Poverty presents a formidable obstacle to positive health across the life span. Those in lower income groups have poorer health status, and those with poor health have decreased ability to work and improve their socioeconomic status.

9. An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

6. In following the principles of nursing interventions with violent families, nurses should: a. avoid provoking the perpetrator by initially suggesting that the victim leave the relationship. b. indicate zero tolerance for any further violence, degradation, or exploitation of family members. c. provide assurances that the family's confidentiality will not be violated. d. threaten to report child abuse to the authorities.

ANS: B The five principles of providing care to families who are experiencing violence include intolerance for violence, respect and care for all family members, safety as a first priority, absolute honesty, and empowerment. Nurses must clearly indicate that any further violence, degradation, and exploitation of family members will not be tolerated, but that all family members are respected, valued human beings. However, everyone must understand that the safety of every family member is the first priority. In all states, nurses are required by law to report child abuse, even when it is only suspected, and in most states they must also report elder abuse and felony assaults. Referral to protective service agencies should be viewed as enlisting another source of help. Absolute honesty about what will be reported to officials, what the family can expect, what the nurse is entering into the records, and what the nurse is feeling is essential.

5. A community health nurse is working with a single parent with a special needs child and a child with asthma. The maternal grandmother lives with the family and was recently diagnosed with diabetes. The nurse understands the importance of including the grandmother in her assessment and interventions because families are: a. resistant to outside intervention or involvement. b. involved in the health care of their members. c. unable to manage the stress of complex health needs. d. restricted in their ability to identify interventions.

ANS: B Health care decisions are made within the family, the basic social unit of society. Families are involved in the health care of their members and therefore, are significant participants in the health care team, because they are an ever-present force over the lifetime of care.

1. Contracting with families represents a shared effort by the client(s) and the community health nurse to increase healthful choices. This method of shared effort and active equal involvement of the nurse and family is appropriate for which types of families? (Select all that apply.) a. All families b. Families capable of taking responsibility c. Families oriented toward self-care d. Families seeking ambitious goals e. Families with poor coping skills

ANS: B, C Contracting may not be effective when the nurse is working with families from cultures that expect health care providers to give directive guidance and feedback. Families from cultures outside the United States, as well as some families in the United States, may expect their health care provider to "tell them what to do." Part of the initial nursing assessment should include discussing with family members their expectations and value system before initiating a contract. Also, families must have the competencies and capabilities to participate and take responsibility, must have realistic expectations, and must be willing to renegotiate. Contracting is therefore not for all families

1. The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps

ANS: B, C, D Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policymakers at local, state, and national levels are necessary actions that nurses are prepared to undertake.

1. A nurse is evaluating the outcome of a family with children's action plan to address the incorporation of caregiving needs of the paternal grandfather. Although evaluation includes many tasks, the critical thinking process includes: (Select all that apply.) a. conducting a summative evaluation meeting. b. determining the timeliness of the plan outcome. c. identifying changes in the family story. d. identifying nurse-related barriers. e. making the transition of nurse to family dependence.

ANS: B, C, D Termination, transition, and summative evaluation are tasks of the evaluation process; however, the critical thinking process of evaluation must address whether the plan worked, was it timely, does it need to be revised, whether family barriers or nurse-related barriers existed that interfered with the plan, or figure out if the family story changed. Family barriers include family apathy and indecision. Nurse-related barriers include nurse imposed ideas; negative labeling; overlooking family strengths; and neglecting cultural or gender implications.

1. When conducting a nursing assessment of a child, the nurse should be aware that indicators of potential or actual child abuse may include which of the following? (Select all that apply.) a. Cognitive impairment b. Unusual fear of the nurse and others c. Injuries not mentioned in history d. Seems to need to take care of the parent e. Evidence of general poor care

ANS: B, C, D, E A national survey estimated that in 2011, 742,000 unique reports of children and adolescents who were subjected to neglect, medical neglect, physical and sexual abuse, and emotional maltreatment. Of these children, 78% were victims of neglect; 18% were victims of physical abuse, 10% were sexually abused, and 8% were psychologically maltreated. The remaining 2% were medically neglected. This is probably a conservative figure, since only the most severe cases are reported. Careful assessments through both observation and discussion can help in determining the presence of indicators that require further investigation. When conducting a nursing assessment of the child, the nurse should be aware of indicators of potential or actual abuse in the child as well as indicators in the family and its environment.

1. A nurse planning a primary intervention program for adolescent pregnancy reviews trends in adolescent pregnancy, births, abortions, and adoption and notes that comparisons with other developed countries indicates which of the following? (Select all that apply.) a. Adolescent pregnancy rates continue to rise because of unreliable contraceptive methods. b. Use of contraceptives is improving among teens in the United States. c. Decreases in pregnancy among teens ages 15-17 have been attributed to reduced sexual activity. d. Female students are more likely to initiate sexual activity before the age of 13 years. e. Changes in parental notification or consent requirements for minors impacted rates of teen abortions.

ANS: B, C, E Pregnancy and birthrates increased steadily among teens of all ages from 1986 to 1991 and declined among teens of all ages and ethnicities from 1991 to 2005. Decreases in pregnancy among teens ages 15-17 have been attributed to reduced sexual activity (one-fourth of the reduction) and to improved contraceptive use (three-fourths of the reduction). For teens ages 18-19 the reduction is entirely attributed to increased contraceptive use with evidence showing that the use of long- acting reversible contraceptives tripled among this age group from 2007 to 2009. In 2008, 26% of pregnancies of teenagers were ended by elective abortion, a decrease from 46% of teen pregnancies in 1986.

1. Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

2. Family health can be defined as a dynamic relative state of well-being that involves the biological, psychological, sociological, cultural, and spiritual aspects of the family system. This approach to family health is consistent with which of the following principles? (Select all that apply.) a. Assessment of the individual's health does not reveal 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 the family's functioning e. Individual family members and the family system as a whole are assessed simultaneously

ANS: B, D, E The biological/psychological/sociological/spiritual approach to family health considers individual members as well as the family unit as a whole. An individual's health (along a wellness-illness continuum) affects the functioning of the entire family, and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.

2. The interrelationship among individual health, family health, and community health is accurately described by which of the following statements? (Select all that apply.) a. Community is the context for influencing only family health habits. b. Family health habits are developed based on the availability and accessibility of health services. c. Family is a social unit within the community; therefore family influences societal norms more than the health of the individual. d. Health values and beliefs are developed within the family. e. Individual health behaviors are carried out within the family, community, and societal environment.

ANS: B, D, E To achieve the national health objectives for improving the health of the general population, an emphasis must be placed on health promotion and risk reduction. Reducing the risks to segments of the population is a direct way of improving the health of the general population because of the interrelatedness of individual health, family health, and community health. The family is an important environment affecting individual health, because it is within the context of the family that individuals develop health values, health habits, and health-risk preferences. Yet the family is also a social unit within a community and society. In the context of community norms, family health habits are developed based on the availability and accessibility of health services. Societal norms, such as the acceptability of smoking, alcohol abuse, or other risky behaviors, influence the development of family and individual health habits. Individuals, on the other hand, carry out their health behaviors within the context of the family and the community. This complex interrelatedness establishes how individual, family, and community health influence and are influenced by one another. Although posing challenges, this interrelatedness can also bring opportunities by allowing interventions provided at one level to influence the other levels.

7. Community-level factors that influence violence and human abuse are: a. bullying, gangs, and corporal punishment. b. job boredom and unemployment rate. c. population density, sense of cohesiveness, and diversity. d. poverty, recreational facilities, and access to health care

ANS: C A community's population, resources, and facilities can influence violence and human abuse. Density, poverty, and diversity are population-level factors that affect the incidence of violence and are related to issues such as overcrowding, lack of economic opportunity, racial tension, and overt racism. A community sense of cohesiveness may reduce crime, provide support, and promote harmony. Community resources and facilities provided to residents offer socially acceptable outlets for a variety of feelings, including aggression, but their presence alone does not prevent violence or crime.

3. The definition of a migrant farmworker includes which of the following? a. Farmer who helps his neighbors on their farms after his own crop fails b. High school student who works part time at his uncle's rose farm c. Teenager who moved with his family ten times in 2 years to work different crops d. Woman who works in the crop fields in the summer and at a grocery store in thewinter

ANS: C According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day. A seasonal farmworker returns to his permanent residence, worked in agriculture for at least 25 days or parts of days and did not work year round only in agriculture.

6. Although all men are at risk for developing prostate cancer, those at greatest risk are men who: a. have erectile dysfunction. b. fail to undergo prostate-specific antigen testing or digital rectal screening. c. are African American. d. have multiple sex partners.

ANS: C According to the National Cancer Institute, approximately 15% of men will be diagnosed with prostate cancer in their lifetime. It is the most common non-skin cancer and the second leading cause of cancer deaths in the United States. African American men have higher rates of prostate cancer compared to all races. Prostate cancer is linked to changes in the DNA of a prostate cancer cell and high levels of male hormones, but the exact cause of prostate cancer is unknown.

7. A new primary health clinic is established in a predominantly African American neighborhood to address the top causes of mortality in the local adult population. The nurse at the clinic uses a community-focused nursing process to plan interventions aimed at reducing the incidence of: a. cardiovascular accident, lung cancer, and alcoholism. b. depression, alcohol abuse, and obesity. c. heart disease, stroke, and homicide. d. mental illness, drug and alcohol abuse, and heart disease.

ANS: C African Americans in 2009 had the highest death rates from heart disease and stroke compared with other racial and ethnic populations. They also had the highest death rates from homicide, with rates among African American males highest across all age groups among males (Centers for Disease Control and Prevention (CDC) Health Disparities and Inequalities Report, 2013).

3. At the request of a local senior women's group, a nurse is developing an osteoporosis primary prevention program. An appropriate strategy for the program would be to: a. design a nurse-directed program instead of a peer-directed program. b. encourage exercise and consideration of HRT. c. promote diets rich in calcium and vitamin D and daily weight-bearing exercise. d. promote swimming and supplementation with calcium and vitamin D.

ANS: C Among women older than age 50 years in the United States, approximately one in two will experience an osteoporosis-related fracture at some point in their lifetime. Primary prevention measures include consumption of a diet rich in calcium and vitamin D, and supplementation with calcium and vitamin D only if needed. Weight-bearing exercise is also important in maintaining bone density. Weight-bearing exercise includes activities such as walking, running, stair climbing, and weight lifting. Swimming is not a weight-bearing exercise. Limiting alcohol consumption and avoiding smoking are also important. Community-oriented nursing includes empowerment of community members as peer educators and change agents.

3. A nurse contacts a family to arrange an initial home visit. The nurse explains the source of the referral and the purpose of the visit. The husband expresses his concerns about the need for a home visit but agrees to a date and time for the home visit. The nurse reviews the agency's family record and the referral. The nurse has completed which phase(s) of the home visit? a. Initiation phase b. Initiation and postvisit phase c. Initiation and previsit phase d. Previsit phase

ANS: C Home visits allow a more accurate assessment of the family structure, the natural or home environment, and behavior in that environment than do clinic visits. The nurse has completed the initiation phase and the previsit phase. The initiation phase includes clarifying the referral source and the purpose of the visit, and sharing this information with the family. The previsit phase includes initiating contact, establishing shared perceptions, determining the family's willingness to participate, reviewing the record, and scheduling the home visit.

4. Within the impoverished older adult population, the most vulnerable group may be: a. elderly couples living in poverty with serious chronic illnesses. b. elderly men with alcoholism and limited incomes. c. homeless older adults. d. newly widowed, low-income elderly women.

ANS: C Homeless older adults are the most vulnerable of the impoverished older adult population. They have long lived in poverty, have fewer supportive relationships, and are likely to have become homeless as a result of catastrophic events. Life expectancy for homeless older adults is significantly lower than that for older housed adults. Permanent physical deformities, often secondary to poor or absent medical care, are common among homeless older adults. Homeless older adults suffer from untreated chronic conditions, including tuberculosis, hypertension, arthritis, cardiovascular disease, injuries, malnutrition, poor oral health, and hypothermia. As with younger homeless persons, older adults who are homeless must focus their energy on survival, which leaves little time for health promotion activities.

5. A school nurse is working with a parents and teachers organization to improve the health status of students in an urban lower socioeconomic community that has a high concentration of Hispanic and African American individuals. Given the demographics of the community, the nurse is aware that these children will be at highest risk for: a. asthma. b. attention deficit disorder. c. obesity. d. poisoning.

ANS: C Lower socioeconomic groups and those living in urban settings have been shown to have higher rates of obesity. Low food security associated with low income or poverty and the built environment of low-income urban settings (food landscape, food deserts, unsafe neighborhoods, and lack of playgrounds and parks) contribute to the development of obesity.

6. An undocumented migrant farmworker has been diagnosed with 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 6-12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.

ANS: C Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.

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

ANS: C Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.

5. After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

4. In caring for a rape victim/survivor, the nurse should be aware that the client will initially exhibit: a. anger and fear with repeated recounting of the sequence of events during the assault. b. crying, shouting, and hysteria followed by helplessness and self-blame. c. different responses that vary from client to client and may include emotional withdrawal, silence, and/or repeated verbal description of the event. d. symptoms of early onset posttraumatic stress disorder.

ANS: C People react to rape differently, depending on personality, past experiences, background, and support received after the trauma. Some survivors cry, shout, or discuss the experience. Others withdraw and fear discussing the attack. A noncritical atmosphere should be created in which survivors are encouraged to talk about what happened and to express their feelings and fears. The nurse needs to engage in nonjudgmental listening.

9. The nurse is following a pregnant teen who attends the local high school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy and assist in keeping the teen in school. The nurse's interventions will involve the teen and the staff and teachers at the local high school. These interventions should address specific needs related to: a. adequate hydration and screening for depression. b. desk space and desk location in the classroom. c. frequency of bathroom breaks and modifications to bookbag weight. d. use of the stairs and consumption of high-carbohydrate sodas for snacks.

ANS: C Per federal regulations (1975), the schooling and educational needs of the pregnant teen must be met. The potential for a closely spaced second birth may be lessened by the teen's return to school. The nurse can coordinate with the school to tailor efforts to keep the student in school. The nurse should also discuss self-care activities with the student and make related needs known to the school's teachers and staff. Specific areas to be addressed include the need to use the bathroom frequently, the need to carry and drink more fluids or snacks to relieve nausea, the need to avoid climbing stairs and carrying heavy book bags, and problems fitting comfortably behind stationary desks.

3. Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

ANS: C Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

4. For the pregnant adolescent, the factors that pose the greatest nutritional challenge are: a. chronological age and fetal growth. b. family support and teen attitude. c. lifestyle, growth, and development. d. need to limit weight gain and increase exercise.

ANS: C Teen lifestyles generally do not promote overall good nutrition. Teen diets tend to rely on processed snacks high in fat, calories, sugar, and sodium. The pregnancy may occur concurrently with the adolescent growth spurt, so that a significant increase in caloric nutrients is required. Nutritional needs are impacted by the teen's gynecological age. School meals cannot be assumed to be balanced and nutritionally appropriate for pregnant teens.

8. A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. An evidence-based strategy that would be effective for this mobile population is educating: a. advocacy groups for migrant farmworkers. b. local policymakers. c. migrant lay health workers. d. workers seeking care at the migrant health clinic.

ANS: C The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.

4. A nurse is working with a disaster medical assistance team as it responds to a disaster. A new team member excitedly insists that its personnel can exceed their 12-hour shifts and do not need breaks. The best intervention on the part of the nurse is to: a. arrange for the team member to be transferred to another unit. b. arrange for the team member to leave duty, return home, and talk with his or her pastor. c. educate the rescuer about necessary stress-management techniques and offer to pair up with the individual so that each can monitor the other's stress level. d. help the team member to call home to speak with his or her family.

ANS: C The nurse needs to be aware that rescue workers are repeatedly exposed to stress and, despite their training in managing such situations, have a higher than normal risk of developing post-traumatic stress syndromes. The nurse can assist the new team member by educating the rescuer about the importance of stress-management and self-management techniques. The nurse could pair up with the new team member so that they could monitor each other's stress responses and could provide guidance in adhering to stress management techniques.

4. The migrant clinic's mobile van program provides health education through lay health workers; screening for pesticide illness, tuberculosis (TB), and diabetes; pregnancy testing; and treatment for some acute and chronic illnesses typically seen in this vulnerable population. In dealing with this population's beliefs about disease causality, this program demonstrates the application of the health promotion and disease prevention principle of: a. advocacy. b. cultural competency. c. outreach. d. primary prevention.

ANS: C The same principles of health promotion and prevention apply to migrant farmworkers as to the rest of the U.S. population. However, health promotion and disease prevention as presented by nurses may be difficult concepts for migrant workers to embrace because of their beliefs regarding disease causality, their irregular and episodic contact with the health system, and their lower educational level. Health promotion begins by informing the farmworker family about health topics and the resources available to improve health. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers.

1. In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle, especially their current: a. communicable diseases. b. educational level. c. housing arrangements. d. pesticide exposure.

ANS: C The way of life of migrant farmworkers and their families is stressful. They often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.

4. A parent is concerned that her child should not receive a diphtheria-pertussis-tetanus immunization inoculation because of a runny nose. The child is afebrile and otherwise asymptomatic. The most appropriate intervention for the nurse is to: a. defer the immunization to avoid masking the symptoms of the illness. b. defer the immunization until the child's next well-child examination. c. educate the parent regarding the safety of immunization during a minor acute illness. d. reschedule the immunization after the sinus drainage has cleared.

ANS: C There are relatively few contraindications to giving immunization inoculations. Parental fears about vaccinations prevent children from getting immunized, which puts the child and others at risk. Consult the websites of the U.S. Public Health Service and the American Academy of Pediatrics for updates regarding immunization guidelines and contraindications.

2. In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

ANS: C Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

9. To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses must first: a. apply epidemiologic principles for prevention. b. develop resource expertise in the community. c. examine their personal beliefs, values, and experiences. d. understand the federal criteria and guidelines for poverty.

ANS: C To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses need to understand poverty as a concept with historical, social, political, economic, biological, psychological, and spiritual dimensions. Understanding the concepts of poverty and homelessness begins with an examination of one's own beliefs, values, and personal experience.

6. In implementing an antismoking program in the local middle school, a school nurse is aware that programs are more effective when they are consistent with the developmental stage of the target age group. Besides including information about immediate health risks and cosmetic effects, the nurse should also consider: a. teaching behavior modification techniques. b. describing effects on the environment. c. outlining laws regarding tobacco sales to minors. d. teaching the social skills to resist peer pressure.

ANS: D Antismoking programs directed toward children and teenagers are more successful if the focus is on short-term effects rather than long-term effects. Developmentally, children and teenagers cannot visualize the future to imagine the consequences of smoking. The focus should be on immediate health risks and cosmetic effects, stress-reducing techniques, resistance to advertising pressure, and, most importantly, the social skills to resist peer pressure.

9. A nurse wishes to become actively involved in disaster management and is extremely interested in providing first aid and delivering aggregate health promotion, disease prevention, and emotional support. It would be ideal for the nurse to train and volunteer as which of the following? a. Community emergency response team member b. Disaster medical assistance team member c. Member of the Medical Reserve Corps d. Red Cross shelter manager

ANS: D Creation and operation of shelters are generally the responsibility of the local Red Cross chapter, although the military may be charged with setting up "tent cities" or mobile home parks for large groups of people needing temporary shelter. Because nurses are comfortable performing tasks such as aggregate health promotion, disease prevention, and provision of emotional support, they make ideal shelter managers and team members. The Red Cross provides training in shelter support and use of appropriate protocols.

3. Deinstitutionalization of chronically ill individuals from publicly funded psychiatric hospitals had the unintended consequence of: a. moving clients to readily available community-based care. b. shortening hospital stays in mental health facilities. c. increasing the funding for community-based services. d. increasing the number of homeless persons.

ANS: D Deinstitutionalization of chronically mentally ill individuals from public psychiatric hospitals increased the number of homeless persons. The intent was to move clients from public psychiatric hospitals to community-based treatment centers. However, adequate community-based services were not funded. Few of the intended community mental health centers were ever built.

7. After a mock disaster drill, the nurse participates in a "hot wash" of the exercise in which participants from all units speak about successes, problem solving, failures, and unanticipated challenges or obstacles faced during the mock disaster drill. This activity best addresses the public health workforce competency of: a. describing the agency chain of command. b. identifying the limits of one's own knowledge, skill, and authority. c. recognizing unusual events that might indicate an emergency. d. writing after-action reports, updating implementation plans, and implementing changes.

ANS: D Federal agencies and professional organizations have outlined competencies for public health professionals at all points of the disaster management cycle. One competency speaks to the ability to evaluate drills, exercises, or actual events. As valuable components of preparedness, mass casualty drills and exercises can help rescuers develop the necessary coordination, skills, and confidence to operate effectively and efficiently across disciplines and agencies. Special emphasis is placed on the after-action reporting once the exercise is over, which ultimately allows improvement of the overall all-hazards disaster response plan. Such sessions may be referred to as debriefings, hot washes, or postings. Participation in these sessions develops the critical skill of evaluation that allows for process improvement.

7. Nurses should assess environmental health hazards at each health care visit because of the direct impact of the environment on the health of children. The most appropriate interventions would include: a. community assessments and referrals for treatment. b. lobbying efforts and education for public policy changes. c. neighborhood screening programs and education. d. referrals for treatment and counseling for risk reduction.

ANS: D Growth, size, and behaviors place children at greater risk for damage from toxins in the environment. Many factors can adversely affect the health of children and teenagers, such as exposure to lead, pesticides, and substandard air in tightly built houses; children's growing tissues and developing organ systems, smaller size, and increased opportunity to be in outdoor spaces; respiratory illnesses; and the effects of low income, including substandard housing, poor nutritional status, and exposure to the higher levels of contaminants found in low-income neighborhoods. It is critical to assess environmental health hazards during health care visits to intervene effectively with referrals for treatment and counseling of families on risk reduction strategies. At the community level, nurses can also participate in community-oriented strategies such as community assessments, lobbying for policy change, neighborhood screening programs, and community education programs.

4. During a home visit, a nurse teaches a husband who is recovering from a stroke and his wife how to modify their home environment to prevent falls. This education represents: a. primary prevention. b. secondary prevention. c. secondary and tertiary prevention. d. tertiary prevention.

ANS: D Health-risk reduction is based on the assumption that decreasing the number of risks or the magnitude of risk will result in a lower probability of an undesired event. After a stroke, clients are often unstable when ambulating. Tertiary prevention includes assessing the home to prevent further complications from preventable injuries.

8. Government programs that support family health through the promotion of healthy lifestyles affect the health of individuals, family health, and overall community health. The best example of a government-sponsored program that can promote health and prevent illness for middle-income, subsistence-level families is: a. Medicaid. b. Medicare. c. nongovernmental organization. d. Women, Infants, and Children (WIC).

ANS: D Not all families have access to health insurance. For families at the poverty level, programs such as Medicaid are available to pay for illness care as well as health promotion and risk reduction/prevention. An increasing number of middle-income individuals are without health benefits. These people often do not have enough income to purchase health care but earn too much money to qualify for public assistance programs. These families may have access to illness care services but typically do not have access to preventive care. Such families are at a subsistence level and do not have the purchasing power for preventive care or nutritious foods like fruits and vegetables. Nutritious diets are important to preventing illness and promoting health. The WIC program of the U.S. Department of Agriculture is a government-sponsored nutrition program. Women, infants, and children from families living at a subsistence level may meet the eligibility criteria for this nutrition program. Women who participate in WIC programs during pregnancy have healthier babies. Infants and children who participate in the WIC program are more linked to the health care system than children who are not WIC participants. Children who participate in the WIC program receive both preventive and curative care more often than children who do not participate in the program.

3. In conducting a nursing assessment of new parents the nurse should be aware of the warning signs of actual or potential abuse, including: a. history of adolescent depression and suicidal thoughts. b. intermittent religious affiliations. c. lack of legal marital status. d. verbal aggressiveness or detachment.

ANS: D Nurses are in key positions to predict and deal with abusive tendencies. By understanding the factors contributing to the development of abusive behaviors, nurses can identify abuse-prone families and target specific interventions to eliminate or minimize the risk for abuse through primary prevention strategies.

1. The most effective primary prevention intervention to reduce the incidence of child abuse is: a. adolescent role playing of the realities of parenting. b. education of grandparents on the risk factors and indicators of child abuse. c. provision of parenting classes for college students. d. provision of parenting and conflict-management classes for survivors of child abuse.

ANS: D Parents who were themselves abused or witnessed abuse or other types of family violence are at markedly higher risk of abusing their own children. Primary prevention of abuse includes strengthening individuals and families so they can cope more effectively with multiple life stressors and demands, and reducing the destructive elements in the community that support and encourage violence. Strengthening parenting skills and teaching successful conflict resolution are specific areas to target to provide new learning and correct earlier childhood influences.

3. The challenges faced by a pregnant teen when attempting to establish paternity may be impacted by: a. beliefs that impregnating a women proves masculinity. b. demands for involvement in the child's birth. c. denial of paternity because of associated financial obligations. d. involvement of the legal system to acknowledge paternity.

ANS: D Paternity, or fatherhood, is legally established at the time of the birth for a teen who is married. However, it is more difficult to establish paternity for unmarried couples. Some of the difficulty lies in the complexity of the specific state systems for young men to acknowledge paternity. In some states, a young man may have to work with the judicial system outside of the hospital after the birth, and if he is younger than age 18 years, he may need to involve his parents. Some young couples do not attempt to establish paternity and prefer a verbal promise of assistance for the teen mother and child. Although a verbal commitment may be acceptable when the child is born, the mother may become more inclined to pursue the establishment of paternity later when the relationship ends or when reasons arise related to the financial, social, or emotional needs of the child. Young women who receive state or federal assistance (e.g., Aid to Dependent Children, Medicaid) may be asked to name the child's father so that the judicial process can be used to establish paternity.

1. A high school teen tells the school nurse that she wants to become pregnant. The most appropriate nursing action is to: a. clarify the intent and inform the teen's parent(s) of the potential to influence her behaviors. b. discourage the teen's interest in pregnancy when she has a full life ahead of her. c. encourage the teen to use contraception if she intends to be sexually active. d. provide preconception counseling and emphasize the need to achieve good health.

ANS: D Teens need to know that their concerns are heard. Health care providers may have their own opinions about what teenagers need and may fail to take the chief complaint offered in an interview seriously. A desire for pregnancy expressed by a teen should be discussed in depth even if the nurse feels uncomfortable providing information to a teen about how to conceive. During the interview, the nurse can provide preconception counseling and emphasize the need to achieve good health and to establish a health-promoting lifestyle before pregnancy. Health risks to the mother, as well as to fetal development, can be discussed. Not only does information presented in this way demonstrate that the nurse has heard what the teen is saying but it also allows the nurse to provide useful information that may encourage the teen to examine her plans carefully, seriously, and maturely.

1. A nurse is assigned to provide community outreach to a small town that was partially destroyed by a tornado 3 years earlier and has been rebuilt. The first client is a family who lost their home and their best friend in the tornado. The best intervention would include: a. assessment of the family's home environment to rule out safety issues. b. avoidance of discussion of the disaster of 3 years ago. c. consideration that the family will have worked through the emotional aftermath by now. d. support of the family in preparing a personal disaster response plan.

ANS: D The approach of relief activities needs to shift from short-term aid to long-term support. Promoting individual, family, and community preparedness increases safety in the event of disaster and can help children and adults feel empowered. This builds on the resilience of the individual, family, and/or community. Individuals and families still need to be assessed for indications of mental distress (case finding) and referred to a mental health professional if the need exists. Open discussions of the family's response to the slow process of recovery or long-term results of living under adverse conditions can uncover lingering mental distress or exacerbations of chronic conditions that require attention. During the initial stages of recovery environmental safety issues should have been addressed.

1. When applying the bioecologic systems theory to families, a major assumption of this model is: a. families experience disequilibrium when they transition from one stage to another stage. b. focusing on the interaction of the system with other systems rather than the individual. c. maintaining stability through adaptation to internal and external stressors. d. what happens outside the family is as equally important as what happens inside the family.

ANS: D The bioecologic systems theory of Bronfenbrenner is designed around the principles of nature and nurture and those principles can be applied to families. The family is at the center of the concentric circles representing microsystems, mesosystems, exosystems, macrosystems, and chronosystems. One assumption of this model is that what happens outside the family is equally as important as what happens inside the family, providing a more holistic view of interactions between family and society, but not addressing how families cope or adapt to the interactions with these systems. The other statements apply to family development/lifecycle theory and family systems theory.

7. One major challenge in the development of social policies that affect families is related to: a. absence of any federal family policies. b. indirect negative effects on families. c. attempts at welfare reform. d. ongoing debate as to what constitutes a family.

ANS: D The challenges of social policy for families are numerous. Given the ongoing debate as to what constitutes a family, social policy may specify a definition that is inconsistent with the family's own definition, such as same-sex partnerships and/or marriage, legal definition of a parent, reproductive and fertility issue (surrogacy rights), care of older adults, health care proxy, teen request for confidential services.

5. The major factor that has led to sharply increased insurance payouts following disasters in the United States in recent decades has been: a. El Niño. b. geography. c. technology. d. human development.

ANS: D The cost in more developed countries is higher because of the extent of material possessions and complex infrastructures, including technology. In the United States, increases in population and development in areas vulnerable to natural disasters, especially coastal areas, have led to sharply increased insurance payouts.

3. The emergency support functions of the National Response Framework (NRF) and the National Incident Management System (NIMS) provide: a. authority to step in and take control of state, local, and voluntary organizations during disasters. b. command and control for American Red Cross and Disaster Medical Assistance teams. c. oversight of federal and state response operations, with minimal interaction with other organizations. d. written approach, protocol, and common language for responders from federal agencies and other voluntary organizations.

ANS: D The first level of disaster response is carried out by the locality (office of emergency management). Through mutual aid agreements, localities can arrange for additional support from surrounding communities (emergency operations center). When the response needs exceed the capability of the localities and state-level resources or capabilities, then the governor may request assistance under a presidential declaration of disaster or emergency. The way the federal government offers assistance is through the NRF. The NRF was written to approach a domestic incident in a unified, well-coordinated manner that enables all responding entities to work together more effectively and efficiently. All member organizations of the responding teams, including all relevant branches of the federal government, are assigned functions that are listed in the plan as emergency support functions. When large disasters require the services of a variety of emergency responding units with personnel coming from different parts of the country, the challenge of working together in unison may require the use of the NIMS, which provides all responders with a protocol and common language for working together. The importance of interoperable communication equipment is stressed by the NIMS.

2. The highest priority for a nurse who is among the first responders to a disaster is: a. arranging for shelter for disaster providers. b. beginning community assessment as soon as possible to ensure a rapid recovery. c. beginning surveillance and planning needed health education for disaster survivors. d. immediately developing plans for effective triage and client management.

ANS: D The first priority when responding to a disaster is to immediately plan for, coordinate, and carry out effective triage. Disaster response includes community assessment, surveillance, health education, and coordination of shelter arrangements. However, the first task is to provide care for life-threatening injuries and conditions.

9. To work effectively with a child and family, a nurse must understand the cognitive abilities of children at each stage of development. Cognitive development leads to: a. achievement of ego identity and mastery of the previous stage. b. developmental milestones in the quality of the parent-child relationship. c. internal psychosocial developmental crisis points. d. increasing problem solving behavior.

ANS: D The work of Jean Piaget is widely used to understand the process of cognitive development. According to Piaget, learning results from active manipulation of objects and information by the mental processing of events. The child creates mental schemes or thought patterns to understand encounters. Development occurs as the schemes increase in scope and complexity. Piaget identified four stages of cognitive development that represent increasing problem solving ability. Psychosocial development, including ego identity and parent-child relationships, are not part of Piaget's cognitive development model.

6. The nurse working with the family of a child recently diagnosed with juvenile diabetes asks the parents about any changes in their relationship since the child's diagnosis. This family nursing approach can best be described as treating the family as a: a. client. b. component of society. c. context. d. system.

ANS: D When the family is approached as a system, the focus is on the family unit and the family is viewed as an integrated system in which the whole is more than the sum of its parts. The interactions among family members become the target for nursing interventions. The systems approach always assumes that when something happens to one family member, the other members of the family system are affected, and vice versa. This includes interactions among parents and children as well as interactions between parents.