Community Exam 4
Community and public health nurses (PHNs) practicing in rural locales consistently note which of the following characteristics of their practice environments? a. Broad scope of practice, independence and autonomy, and opportunity for community involvement b. Expanding scope of practice, plentiful resources, and increased opportunity for less formal interactions c. Lack of autonomy and independence, along with greater flexibility than in an urban practice d. Narrower scope of practice and focus than in an urban practice
ANS: A Characteristics of nursing practice in rural environments include broad, diverse, and/or intergenerational scope of practice, greater independence, public status and autonomy, and a greater opportunity for community involvement than in many urban practice environments.
A truck driver says, "At first I was just using 'meth' at parties, but now I think about it all the time and how am I going to get some." The term that best describes this individual's use behavior is: a. drug addiction. b. drug dependence. c. recreational drug use. d. substance abuse.
ANS: A Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with using a drug (compulsive use) and securing its supply, and a strong tendency to relapse if the drug is removed. Frequently addicts are physically dependent on the drug, but there appears to be an added psychological component that is responsible for the intense cravings and subsequent relapse.
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.
The minimum requirements for entry into home care practice should be: a. baccalaureate in nursing. b. baccalaureate in nursing and clinical nurse specialist (CNS) certification. c. master's in nursing. d. master's in nursing and CNS certification.
ANS: A Nurses come to home care from a variety of educational and practice backgrounds. Home care nurses should be educated to function at a high level of competency so that they can be relied on not only by their professional colleagues but also by the community. A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting, including home care.
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.
When determining whether a geographic area is rural or urban, the nurse should recognize that: a. rural and urban areas by their nature occur on a continuum. b. rural regions have fewer than six persons per square mile. c. rural residents feel isolated. d. rural areas are recreational, retirement, and resort communities.
ANS: A Rural and urban residencies are not opposing lifestyles. Rather, they occur on a rural-urban continuum ranging from living on a remote farm, to living in a village or small town, to residing in a larger town or city, to living in a large metropolitan area with a core inner city. Although some communities may seem geographically remote, the residents who live there may not feel isolated. For the affluent, the term rural may bring to mind recreational, retirement, and resort communities in the mountains, seashore, or lake country. For the less affluent, it may mean an impoverished Indian reservation or migrant labor camp. Therefore rural may be a state of mind.
A very toxic psychoactive drug that is a stimulant, causes tolerance to develop within hours, and has dangerous health impacts for those in the vicinity during use is: a. alcohol. b. crack cocaine. c. nicotine. d. volatile solvents.
ANS: C Nicotine is a stimulant to which the body quickly develops a tolerance. For regular smokers, tolerance develops within hours, compared with days for heroin or months for alcohol. Smoke is damaging when inhaled directly. Sidestream smoke, also called secondhand smoke, contains greater concentrations of toxic and carcinogenic compounds than mainstream or firsthand smoke.
An occupational health nurse establishes a local business-sponsored smoking cessation clinic that incorporates the use of nicotine replacement therapy, behavioral treatments, and support groups. This strategy best exemplifies: a. population-focused tertiary prevention. b. individual-focused primary prevention. c. primary prevention education. d. secondary early detection.
ANS: A Tertiary prevention related to substance abuse focuses on the development of programs to help reduce or end substance abuse. Nurses can be active in smoking prevention programs for individuals as well as in community efforts to help people quit smoking. Fewer than 10% of those who try to quit smoking on their own are able to stop for a year. Interventions that include medications (nicotine replacement therapy) and behavioral treatments appear most promising. The most effective way to get people to stop smoking and prevent relapse is through multiple interventions and continuous reinforcement, and most smokers must make several attempts at cessation before they are successful.
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.
The Omaha System was initially designed to address the concerns of nurses practicing in the community in the following areas: (Select all that apply.) a. Documentation b. Information management c. Nursing practice d. Telehealth e. Specialty certification
ANS: A, B, C The Omaha System was initially developed to operationalize the nursing process and provide a practical, easily understood, computer-compatible guide for daily use in community settings and is the only American Nurses Association (ANA)-recognized terminology developed inductively by and for nurses who practice in the community. As early as 1970, the nurses, other staff, and administrators of the Visiting Nurse Association (VNA) of Omaha, NE, began addressing nursing practice, documentation, and information management concerns.
The ANA Standards of Home Health Nursing Practice is composed of two parts: Standards of Care, which follow the six steps of the nursing process, and Standards of Professional Performance, which include which of the following? (Select all that apply.) a. Quality of care b. Performance appraisal c. Collegiality d. Outcome identification e. Resource use
ANS: A, B, C, E The ANA scope and standards publications, including those for Home Health Nursing and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance. Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, critical thinking skills, education, collegiality, ethics, collaboration, research, and resource use.
Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression? (Select all that apply.) a. Delays in seeking mental health services b. High rate of poverty c. Gaps in the continuum of mental health services d. Sufficient number of mental health services e. Tolerance for destructive coping mechanisms
ANS: A, B, C, E There appears to be more persistent, endemic depression among rural residents. Factors that relate to this level of depression are the high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.
When using the health measure of death rates for working adults, the nurse could expect to find the highest death rates in which areas? a. Large metropolitan areas b. Most rural and highly populated urban areas c. Most rural and suburban areas d. Small suburban and all urban areas
ANS: B Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults are found in the most rural areas. Residents of rural areas have the highest rates of death as a result of unintentional injuries in general and because of motor vehicles injuries in particular. Homicide rates are the highest in the central counties of large metropolitan areas.
Nurses practicing in rural communities often observe that protecting client confidentiality is a unique challenge because: a. nurses' family members expect nurses to share client information when something serious is happening to a community member. b. nurses in rural areas are well known to their service populations and are often approached by their clients in social and other settings with requests for counsel and advice. c. professional nurses in rural areas often work in more than one role in the community, which reduces their professional credibility. d. rural residents do not expect nurses to keep client information confidential because "everyone knows everyone" and his or her family.
ANS: B Nurses practicing in rural areas are obligated to maintain client confidentiality just as they would in an urban setting. However, nurses are often asked for health information and advice in nonclinical settings. Nurses must be especially sensitive and exercise creativity to maintain client confidentiality when approached in public settings.
A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach? a. Assessment b. Case management c. Geriatrics d. Tertiary prevention
ANS: B Nurses working in rural areas, including those working with migrant workers, have opportunities to use community-oriented nursing skills. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models for addressing some of these deficits and reducing rural health disparities.
To promote quality improvement, the documented plan of care for an elderly home care patient should include which of the following? a. Listing of community resources available to meet the patient's needs b. Expected patient outcomes for each identified problem or diagnosis c. Formulated nursing diagnosis d. Objective physical assessment data
ANS: B Setting short- and long-term goals provides criteria for evaluation, and increases continuity of care and the potential for improved outcomes.
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.
A community-oriented nurse newly assigned to a rural community learns that the characteristics of rural and small town life include: a. consistent employment, formalized professional interactions, and openness to people new to the community. b. informal social and professional relationships, acquaintance of residents with most other members of the community, work of many residents in high-risk occupations, and often a lack of openness to newcomers. c. lack of anonymity, fractured family systems, role of churches as socialization centers, and mistrust of newcomers. d. tendency of residents to work in safety-oriented occupations, preference for autonomy rather than working as a community, and work in agriculture-related factories.
ANS: B The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").
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.
A client acknowledges that his cocaine use is damaging his career and marriage, but the client has not investigated local treatment options. The nurse encourages the client to weigh the pros and cons of the drug problem and think about the solution to the problem, because the nurse recognizes that the client is in the change stage of: a. action. b. contemplation. c. precontemplation. d. preparation.
ANS: B The role of the nurse in assessing individuals is to determine their readiness for change in acknowledging a problem and seeking treatment and recovery. The stages of change are precontemplation, contemplation, preparation, action, and maintenance. The strategies used by the nurse depend on the specific stage of change the client is in. At the contemplation stage of change, the individual is aware that a problem exists and is seriously thinking of overcoming it, but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the advantages and disadvantages of the problem and consider the solution to the problem.
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.
Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. Which of the following are facts about marijuana of which the nurse should be aware? (Select all that apply.) a. It decreases appetite. b. Tolerance and physical dependence can develop. c. It is highly toxic. d. It can be a safe therapeutic agent. e. It may be contaminated.
ANS: B, D, E Compared with other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. Because of its status as an illicit drug, however, there is little quality control, and a user may consume contaminated marijuana that may cause problems. Both tolerance and physical dependence can develop; however, withdrawal is benign. Side effects include dry and reddened eyes, increased appetite, dry mouth, drowsiness, and mild tachycardia. Adverse effects include anxiety, disorientation, and paranoia.
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.
A client receiving morphine on a regular basis for pain management must be gradually weaned off the drug to avoid withdrawal symptoms. This best illustrates the state of neuroadaptation known as: a. biopsychosocial effects. b. drug addiction. c. drug dependence. d. substance abuse.
ANS: C Drug dependence is a state of neuroadaptation—a physiological change in the central nervous system—caused by the long-term administration of a drug. In drug dependence, continued use of the drug becomes necessary to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use and procurement of a drug and a strong tendency to relapse if the drug is removed. Although addicts frequently are physically dependent on a drug, there is also a psychological component that causes the intense cravings and relapse. In general, anyone can develop drug dependence as a result of regular administration of drugs that alter the central nervous system; however, only 7-15% of the drug-using population will develop a drug addiction.
Primary prevention programs for adolescents at risk for ATOD problems should focus on: a. encouraging competitiveness and success in aggressive sports. b. encouraging focus on short-term solutions rather than long-term planning. c. screening and treating psychiatric disorders and influencing social norms. d. teaching adolescents to "just say no."
ANS: C Family-related factors such as genetics, family stress, parenting styles, and child victimization appear to be the variables with the greatest influence on substance abuse among adolescents. The presence of a psychiatric disorder (especially a mood disorder) and behavioral problems is also associated with substance abuse among adolescents; peer pressure is a less influential factor. Effective social influence-based prevention programs should focus on effective screening and treatment of psychiatric disorders and modification of social norms to reduce adolescents' social motivation to begin using ATOD.
The shift of home care away from its charitable and public health-oriented roots toward current models in use can be attributed to: a. consolidation of voluntary and official home health agencies. b. expansion of home care to include community health needs. c. integration of home care into benefit programs. d. passage of the Medicare prospective payment system.
ANS: C Home care began changing from its charitable and public health-oriented beginnings when it was added to benefit plans by payers, starting with the Metropolitan Life Insurance Company in the early 1900s; Medicare included it as a benefit for enrollees in 1965. Inclusion of home care benefits began to change the nature of the services provided. Services were focused on individuals with specific functional and health problems who could not be cared for elsewhere, and the care provided became more technical, opening the door for population-focused home care, transitional care, home-based primary care, traditional home health care, and hospice care
In home health care, the use of performance improvement programs, evidence-based practice guidelines, and appropriate communication, documentation, and telehealth technologies are strategies to address the issue of: a. agency accreditation. b. professional performance standards. c. malpractice risk reduction. d. regulatory compliance.
ANS: C Home health and hospice nurses are at risk for malpractice claims related to the complexity of care, failure to adhere to standards of practice, and other errors. Nurses and their employers need to be proactive by taking responsibility for personal and agency actions. A focus on communication with clients, families, and the health care team; commitment to providing quality care; documentation refresher sessions; performance improvement programs; use of evidence-based practice guidelines; and appropriate use of information technology and telehealth are strategies that can help reduce risks.
A rural health nurse who is planning programs to address the population's needs should recognize that, in general, rural populations: a. engage in physical activity during leisure time. b. engage in preventive health behaviors. c. perceive their overall health as less favorable. d. use seat belts.
ANS: C In general, people in rural areas have a poorer perception of their overall health and functional status than those in urban areas.
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.
Hospice care would be an appropriate option to discuss with which of the following patients? a. Patient with stage II lung cancer who is undergoing chemotherapy b. Patient with early Alzheimer's disease whose caregiver needs respite care c. Patient with metastatic breast cancer who has discontinued chemotherapy and radiation treatment d. Patient with severe debilitating osteoporosis
ANS: C The criterion for entry into hospice care is that the disease process or condition has progressed to the point that further treatment cannot cure and death within 6 months would not be unexpected. This does not mean that the patient will die within the next 6 months, only that if death occurred, it would not have been unexpected. Hospice care services can be provided in the home and/or institutional setting. Multidisciplinary teams have the knowledge, skill, compassion, and experience to address the unique needs of the patient at the end of life as well as the needs of his or her family.
Some health care organizations, like the American Nurses' Association, American Public Health Association (APHA), and several state nurses' associations, passed formal resolutions to support the use of medicinal marijuana based on its low level of toxicity, dependence, or addiction, and therapeutic safety and benefits especially in the control of pain. These resolutions have impacted changes in state legislation but to date, despite formal petition in 2002 to remove cannabis from the Drug Enforcement Agency's (DEA) Schedule I of Controlled Substances, and an extensive review and report by the Department of Health and Human Services (DHHS) in 2010, a DEA final ruling has not been received. This collective action by health care organizations to influence policymakers to put the emphasis on health care instead of law enforcement can best be described as: a. assessment. b. advocacy. c. education. d. surveillance.
ANS: C The greatest challenge for nurses and nursing is to influence policy makers to put the emphasis on health care instead of law enforcement in addressing ATOD problems, which are a major health care problem in this country. Through evidence-based practice nurses can demonstrate the effectiveness of health promotion, disease prevention, and drug-education programs. Nurses can also provide accurate information about the effects of psychoactive drugs, guidelines for their use, and the negative impacts of taking a law enforcement approach to ATOD problems. In this case, working to ensure public access to the appropriate therapeutic/medicinal use of marijuana under the supervision of a physician is advocating for the availability of a safe and effective therapeutic agent for client treatment.
Medicare regulations, professional organizations, and state licensing boards dictate the responsibilities and functions of health professionals in providing home care, and a variety of specialized services can be included in home care either through direct care service, staff education, or consultation. Because of this need for various knowledge, skills, and perspectives, successful functioning in the provision of services requires: a. certified advance practice home health nurses. b. integration of home health aide and homemaker roles. c. interprofessional teams. d. physician certification of the medical problem and plan of care.
ANS: C The responsibilities and functions of health professionals in home care are determined by Medicare regulations, professional organizations, and state licensing boards. Many specialized services can be provided in home care, such as enterostomal therapy, podiatric care, pharmaceutical therapy, nutritional counseling, intravenous therapy, respiratory therapy, and psychiatric or mental health services. Many of these services can be provided on a consulting basis, either through staff education or through direct provision of services. This requires the use of an interprofessional team model, so that the specialized knowledge, skills, and perspectives of each team member can be integrated and will be implemented and reinforced by those in all involved disciplines to achieve successful patient outcomes.
A community health nurse is prioritizing health-promotion activities with the local rural community. An understanding of the health status and health risks of the rural community would lead the nurse to give priority to: a. aerobic exercise classes and an exercise class for seniors with arthritis. b. English as a second language program using health promotion literature as reading materials. c. mentoring program to increase adult literacy. d. motor vehicle and farm accident prevention project and prenatal care outreach program.
ANS: D All of the health-promotion activities mentioned would be helpful for a rural community. However, health-promotion activities should be prioritized according to the most common causes of morbidity and mortality for the population served. Rural residents are at increased risk of injury and death secondary to motor vehicle accident and farm-related occupational injuries. Rural residents also have increased rates of infant and maternal morbidity and mortality.
Americans rely heavily on prescription drugs and over-the-counter drugs to relieve or mask anxiety, tension, fatigue, and physical and emotional pain. Attitudes toward ATOD problems in our society today are influenced by this "quick fix" attitude, as well as by the myth that: a. alcoholism is a disease. b. any drug can be abused. c. biopsychosocial factors affect addiction. d. there are good drugs and bad drugs.
ANS: D Attitudes are developed through cultural learning and personal experiences. Attitudes toward ATOD problems are influenced by the way society inappropriately categorizes drugs as either good or bad. In the United States, "good" drugs are over-the-counter drugs or those prescribed by a health care provider as medicine, yet this makes them no less problematic or addictive. "Bad" drugs are illegal drugs, and people who use these drugs are considered criminals, regardless of whether or not the drug use has caused problems. Americans rely heavily on the "quick fix" and take pills to deal with their problems or negative feelings. Although alcoholism and drug addiction have been recognized as a disease, many people, including health care providers, have failed to change their attitudes and accept alcoholics and addicts as ill persons in need of health care.
A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, nonmetropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding? a. Client who lives next to a ranch in a town of 1200 people b. 70-year-old client residing in an assisted living facility in a rural area c. Apple grower who lives in a 100-square-mile county with a population of 19,900 d. Soybean grower and his wife who live in a 400-square-mile county with a population of 39,501
ANS: D Farm residency denotes living outside "city limits" and involvement in agriculture. Frontier regions have fewer than six persons per square mile; rural communities have fewer than 20,000 residents or fewer than 99 persons per square mile. Nonmetropolitan statistical areas are regions without a central city of 50,000 or more citizens. The soybean grower and his wife make their living in agriculture (farm resident), and the county where they live has fewer than 99 persons per square mile (rural).
A home health nurse is charged with identifying opportunities for health promotion and illness primary prevention. The activity that bests demonstrate this focus is: a. collaborating with the chaplain to address the spiritual needs of a hospice patient. b. educating a school nurse on the care regime of a returning student newly diagnosed with asthma. c. referring a newly diagnosed diabetic patient to the nutritionist for dietary teaching. d. tracking the immunization status of patients.
ANS: D Immunizations prevent disease, a function of primary prevention. Patients requiring home health care may be more at risk of complications of diseases like influenza and pneumonia. Keeping immunizations current is a critical aspect of health promotion and illness primary prevention for these patients. Home health nursing involves the same primary prevention focus in the care of aggregates as does other community-oriented nursing. It also requires a focus on secondary and tertiary prevention in the care of individuals in collaboration with the family and other caregivers.
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.
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.
A community assessment reveals a high incidence of alcohol-related chronic liver disease and cirrhosis in the local community. A primary prevention harm-reduction program would focus on: a. detoxification, addiction treatment, and codependency. b. drug education, drug treatment, and recovery. c. polysubstance abuse, assessment of recreational drug use, and drug testing. d. promotion of a healthy lifestyle and resilience factors, and drug education.
ANS: D The harm reduction approach to alcohol, tobacco, and other drug (ATOD) problems focuses on health promotion and disease prevention. Primary prevention for ATOD problems includes the promotion of healthy lifestyles and resiliency factors, and education about drugs and guidelines for their use. Nurses are ideally prepared to use health promotion strategies such as encouraging healthy alternatives to indiscriminate, careless, and often dangerous drug use practices and providing education about drugs to decrease harm from irresponsible or unsafe drug use.
The incentives and pressures for cost control and improved health outcomes have promoted the development of technologies that are simpler, more reliable, and: a. more acceptable to the patient. b. more expensive. c. more complex. d. efficient.
ANS: D The increased availability of telehealth coincides with trends described in this and other chapters in this book: an aging population, increased chronic illness and costs, and changes in health care reimbursement. Home health, palliative, and hospice providers face the challenge of managing increasingly complex clients in a highly constrained fiscal environment where patterns of care and reimbursement are based on client need and agency efficiency. Telehealth has emerged as a viable and acceptable way to supplement the delivery of health care economically.
