Community Quiz Week 12

Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.)

A. An adolescent in an emergency situation B. A pregnant adolescent C. A 16-year-old who is living on his own (not with his parents) Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the "mature minors doctrine." This allows youths 15 years of age and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated. If an adolescent has a diagnosis that has a serious prognosis, parental consent will be neededed as this is not a situation that involves emergency care, substance abuse, pregnancy, and birth control.

A nurse has just met the parents of a 10-year-old child who has been diagnosed with a congenital heart defect. When interviewing the parents, which of the following would be a priority question for the nurse to ask?

A. Does your child have a medical home? The use of a medical home, in which one provider or clinic has all of the child's records, is important for this population. Communication among all providers who are working with this child is essential in order for the child to achieve optimal health and functioning. Learning needs, nutritional needs, and peer relationships are important for a 10 year old child. However, without having the coordination and consistency of a medical home to coordinate medical care these other things may be insignficant.

A nurse is implementing Wagner's Chronic Care Model (CCM). Which of the following actions would the nurse most likely take?

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

A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling?

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

A nurse is providing preconceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend?

A. Folic acid Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects. A recommendation was made that women capable of or planning a pregnancy take 400 mcg of folic acid daily (USDHHS, 2010). Iron, calcium, and vitamin C are not used as routine prenatal supplements.

A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse?

A. Monitoring blood glucose levels closely and modifying diet accordingly Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes. Developing lifestyle improvement programs for women at risk for diabetes is an example of secondary prevention as this group is at risk for developing the problem. Presenting lifestyle management at women's conferences is an example of primary prevention, preventing the disease before it occurs. Screening glucose levels is an example of secondary prevention, as all screening tests are secondary prevention.

Which of the following behaviors results in men being less healthy than women?

A. Reluctance to visit physicians A major obstacle to improving men's health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of US men see a doctor, nurse practitioner, or physician assistant compared with 74% of women (AHRQ, 2010). Hobbies, employment, and preference on how to spend money may influence a man's decision to seek medical care. However, these have not been identified as major obstacles in comparance to overall reluctance to seek care.

A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving?

A. Review the family's learning and other accomplishments of the visit During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The incorrectoptions listed occur during the pre-visit phase.

A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take?

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

A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used?

A. Tertiary prevention Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability. Primary prevention and health promotion both address the use of interventions before the disease occurs and to reduce the risk of developing the disease. Secondary prevention is aimed at detecting the disease early through screening programs and early intervention for at risk individuals.

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" Which of the following provides the best rationale for the nurse asking this question?

A. To assess the family's environment and social resources and risks The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap. An ecomap does not assess extended family relationships or financial assets. An ecomap is not used as a communication method.

A nurse is caring for a child who has been diagnosed with a chronic health condition. Which of the following conditions would the child most likely have?

B. Autism Spectrum Disorder (ASD) Common chronic conditions seen in children are autism spectrum disorder (ASD), spina bifida, cerebral palsy, asthma, ADHD, diabetes, cystic fibrosis, neuromuscular disorders, seizure disorders, congenital heart disease, cancer, hemophilia, brochopulmonary dysplagia, juvenile rheumatoid arthritis, and AIDS. Heart disease, emphysema, hypertension, chronic bronchitis, and adult rheumatoid arthritis are common chronic health conditions of adults, not children.

Which of the following is the best way to ensure good nutrition in infants?

B. Breastfeeding only Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity. Feeding brand-name foods, homemade cereals, and supplementing with formula are not the best ways to ensure good nutrition in infants. Breastfeeding is the best option to ensure good nutrition.

Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.)

B. Develop home and environmental assessment guides. C. Assess schools and day care centers for environmental "friendliness." Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day-care centers for lack of asthma triggers. Sharing nutritional information is not related to the care of asthma patients. It is not necessary that all school personnel know how to use rescue inhalers, rather those who are in direct contact with the child with asthma.

Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates?

B. Early detection programs with referral to ongoing access to a care provider Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider. Education for women about breast cancer is not as effective as early detection programs. Screening must be completed which is accomplished through secondary, not primary prevention. Tertiary care does not occur until after diagnosis has occurred and this is too late.

A nurse is providing nutrition counseling to the parents of a 4-year-old. Which of the following recommendations is the nurse most likely to provide?

C. It is recommended that the child consume approximately four cups of fruits and vegetables daily. It is recommended that children of 4 to 8 years old consume 1.5-2.5 cups of vegetables and 1-2 cups of fruits on a daily basis. It is recommended that children 4 to 8 years old consume 4-6 ounces of grains on a daily basis. It is recommended that children 4 to 8 years old consume 2 cups of dairy on a daily basis. It is recommended that children 4 to 8 years old consume 3-5.5 ounces of proteins on a daily basis.

Which statement about eating disorders is correct?

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

A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement?

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

A nurse is conducting a screening for type 2 diabetes for children attending a local school. In addition to an elevated BMI, which of the following risk factors should the nurse consider?

D. Family history of type 2 diabetes Screening for type 2 diabetes mellitus is recommended for children with a BMI from the 85th to 95th percentile with two or more for the following risk factors: family history of type 2 diabetes in a first or second degree relative; Native American, African American, latino, Asian American or Pacific Islander descent; signs of insulin resistance or conditions associated with insulin resistance; or maternal history of diabetes or GDM during the child's gestation. Native American, African American, latino, Asian American or Pasific Islander descent is a risk factor, not Caucasian descent. Elevated birthweight and poverty have not been identified by the American Diabetes Association as significant risk factors that indicate the need for additional screening.

Which of the following factors has the largest impact on health disparities among all populations?

D. Poverty Poverty is a strong and underlying current factor that affects all special groups. Ethnicity, education level, and lifestyle choices do not have as large of an impact on health disparities than income level related to poverty.