LP 11: Mental Health Nursing; Vulnerable Populations
poor definition
-Acute vs chronic (persistent) -Absolute vs relative -2018= $25k/annually family of 4
Marginalization (social peripheralization)
-Live on margins/edge of society -Based on real or perceived difference -Intentional or unintentional
Cancer Alley
-Louisiana had the 2nd highest death rate from cancer in the U.S. -National average is 206 deaths per 100,000 -Louisiana rate is 237.3 deaths per 100,000 r/t toxic release inventory -The population of cancer alley is primarily African-American and low income.
List of the regional and national organizations that serve vulnerable populations
-NAMI -Medicaid -Migrant Health Center-(Migrant Health Act) -Department of Veteran Affairs -American Disability Association (Americans with Disabilities Act)
Poor (Health Concerns)
-Overcrowded environment -Work in high-risk jobs -Inadequate diet -Chronic illness, infant mortality -Education -Less access to health care (insurance, transportation)
Migrant workers risk factors
-Temporary housing -Crowded -Pesticide treated field
Poverty levels
-U.S. 15% -WI 13% -Wis Rapids 18% Milwaukee 29%
Disabled Characteristics/Risk Factors
-physical (arthritis), communication, mental
Migrant workers definition
-principal employment=agriculture on a seasonal basis -Travel from location to location
Individuals with Disabilities Education Act (IDEA)
A special education law that requires schools to educate students with disabilities in least restrictive environments to the greatest extent of their abilities using plans tailored to the individual needs of the students.
Which of the following are factors that may contribute to vulnerability? A: exercise habits B: crime C: Peeling lead paint D: social isolation E: illiteracy
A, B, C, D, E Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problems
A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: A: Child abuse B: Depression C: Intimate partner abuse D: Parent's resentment of the preteen
A: Child abuse To help abusive families, nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence. As children, abusers were often beaten or saw siblings or parents beaten. They learned that violence is a way to manage conflict. Both men and women who witnessed abuse as children were more likely to abuse their children. Financial solvency and support tended to decrease the incidence of child abuse.
A multisystem approach to community disease control would include interventions such as: A: Community action programs B: Control of vectors C: Improved surveillance systems D: Legislation E: Provision of chemotherapy
A: Community action programs B: Control of vectors C: Improved surveillance systems D: Legislation E: Provision of chemotherapy The multisystem approach to communicable disease control has the following goals: (1) improve host resistance to infectious agents and other environmental hazards, (2) improve the safety of the environment, (3) improve the public health system, and (4) facilitate social and political changes to ensure better health for all people. All of the interventions above are examples of the activities that would meet these goals.
Society bears the burden of infectious disease. That burden includes the effects of morbidity and mortality as well as the staggering: A: Economic burden B: Fear burden C: Incidence burden D: Vulnerability burden
A: Economic burden Infectious diseases are expensive. Foodborne illnesses alone are estimated to cost $77.7 billion annually in the United States.
Health care-acquired infections (HAIs) are those acquired during hospitalization or developed within a hospital setting. Which of these statements is true regarding HAIs? A: Hand hygiene before approaching every client is critical in the hospital setting. B: HAIs involve patients in the surgical areas C: Infection control practitioners are responsible for decreasing infections D: There are few HAIs in the hospital setting
A: Hand hygiene before approaching every client is critical in the hospital setting. HAIs may involve clients, health care workers, visitors, or anyone who has contact with a hospital. Invasive diagnostic and surgical procedures, broad-spectrum antibiotics, and immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to exposure to virulent infectious agents from other clients and indigenous hospital flora from health care staff. In this setting, the simple act of performing hand hygiene before approaching every client becomes critical. Although progress has been made in preventing some infection types, work needs to be done. About one in 25 hospital patients has at least one HAI on any given day. Infection control practitioners play a key role in infection control programs.
A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population? A: Migrant farm workers B: Seasonal farm workers C: Underinsured D: Undocumented aliens
A: Migrant farm workers A migrant farm worker is a person whose principal employment is in agriculture on a seasonal basis, who has been employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode. Seasonal farm workers work cyclically in agriculture but do not migrate.
Many behaviors place individuals of all ages, genders, ethnicities, or any other factors at greater risk for sexually transmitted diseases (STDs). The nurse should include primary prevention interventions in all client encounters through the discussion of: A: Safer sex B: Standard precautions C: STD testing D: Partner notification
A: Safer sex Sexual abstinence is the best way to prevent STDs. However, for many people, sexual abstinence is not realistic; therefore, teaching about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal and oral sex with a condom. Nurses should not base assessments or knowledge on age, gender, ethnicity, or any other factors and should discuss safe sex in all client encounters.
A client diagnosed with human papillomavirus (HPV) states to the nurse, "I'm not concerned; I know the lesions disappear after a while." The nurse should counsel the client on which of the following? A: The link between HPV and cervical cancer B: The fact that HPV is a reportable disease C: The removal of warts does not eradicate the virus D: The serious complications for men E: The lack of a cure
A: The link between HPV and cervical cancer C: The removal of warts does not eradicate the virus E: The lack of a cure The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. Pap smears are important because they allow for microscopic examination of cells to detect HPV and tumors. The tumors can often be surgically removed if found early. HPV is exacerbated during pregnancy and in immune-related disorders; it may infect a fetus, and there is no cure.
In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: A: absolutely honest about what will be reported and what the family can expect B: authoritarian in approaching the problem C: cautious in reporting unconfirmed reports of violence D: sincere in concern for the victims
A: absolutely honest about what will be reported and what the family can expect The principles of giving care to families who have experienced violence include the following: intolerance of the violence, respect and caring for all family members, safety as the first priority, absolute honesty, and empowerment. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach.
A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: A: advocacy B: culturally competent care C: partnership D: social justice
A: advocacy Advocacy refers to those actions one undertakes on behalf of another. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that lead to improved public health services for these populations
An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: A: agent-host-environment interaction B: circadian rhythms C: herd immunity D: resistance
A: agent-host-environment interaction The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of the factors may result in disease transmission.
For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize drug addiction can be successfully treated, anyone may develop drug dependence, and: A: any psychoactive drug can be abused B: illegal drugs are the category of abused drugs C: prescription drugs rarely cause dependence D: over-the-counter (OTC) drugs are "good drugs."
A: any psychoactive drug can be abused A health care approach to ATOD problems is the harm reduction model. This is a new public health model that nurses can use to treat individuals, families, and communities. To develop a therapeutic attitude, the nurse must realize that any psychoactive drug can be abused, anyone may develop drug dependence, and drug addiction can be successfully treated.
A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: A: carrying heavy books B: changing to home education C: decreasing fluid intake to avoid nausea D: keeping up her grades
A: carrying heavy books If teens return to school, it is important for the nurse to discuss these needs: (1) using the bathroom frequently, (2) carrying and drinking more fluids or snacks to relieve nausea, (3) climbing stairs and carrying heavy book bags, and (4) fitting comfortably behind stationary desks.
A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? A: cultural B: environmental C: political D: social
A: cultural Cultural attitudes are the beliefs and perspectives that a society values. Perspectives about individual responsibility for health and well-being are influenced by the prevailing cultural attitudes. The media communicate thoughts and attitudes through literature, film, art, television, and newspapers.
Vulnerable populations may be exposed to more than one hazard at a time. This is known as: A: cumulative B: disenfranchised populations C: resilience D: undeserved populations
A: cumulative risk Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Risks come from environmental hazards (e.g., lead exposure from lead-based paint from peeling walls or that which has been used in toy manufacturing or melamine added to milk supplies), social hazards (e.g., crime, violence), personal behavior (e.g., diet, exercise habits, smoking), or biological or genetic makeup (e.g., congenital addiction, compromised immune status).
A client is back for his follow-up appointment and says to the nurse, "I know. I know. I drink too much, but the job is so stressful that I need to find a way to unwind at the end of the day. You would too!" The nurse should recognize that this is a primary symptom of addiction known as: A: denial B: social drug use patterns C: setting variable D: coping
A: denial The role of the nurse in secondary prevention is to accurately assess the client to identify substance abuse and plan appropriate interventions. A progression in drug-use patterns and related problems warns about the possibility of addiction. Denial is a primary symptom of addiction and can be demonstrated by the following: lying about use; minimizing use patterns; blaming or rationalizing; intellectualizing; changing the subject; using anger or humor; and "going with the flow" (agreeing that a problem exists, stating behavior will change, but not demonstrating any behavior change).
A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: A: developmental delays B: ear infections C: frequent colds and infections D: irritability
A: developmental delays Young children are at highest risk for the effects of poverty, especially lack of adequate nutrition and brain development, exposure to environmental toxins, trauma, abuse, and lower quality daily care (Children's Defense Fund, 2014).
The nurse is evaluating a new home health client for ongoing management at home following back surgery for a traumatic injury. The client has been receiving a morphine-based drug for long-term pain management over the past 6 months. The nurse's assessment should include a plan for addressing the client's: A: drug dependence B: drug addiction C: substance abuse D: opiate addiction
A: drug dependence Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. This is a physiological change in the central nervous system; therefore, the drug must be continued to prevent withdrawal symptoms. The morphine should be gradually tapered rather than abruptly stopped to prevent withdrawal symptoms.
Protecting the nation's food supply from contamination by all the virulent microbes is complex, costly, and time consuming. However, much foodborne illness, regardless of causal organisms, can be prevented through simple changes in: A: food preparation, handling and storage B: importation regulations C: pesticide usage D: animal breeding practices
A: food preparation, handling and storage Because safe food preparation measures are so important in preventing foodborne disease, Healthy People 2020 includes an objective geared toward food safety, and the the World Health Organization (WHO) has developed Five Keys to Safer Food. Many foodborne illnesses, regardless of causal organism, can be prevented by simple changes in food preparation, handling, and storage to destroy or denature contaminants and prevent their further spread.
For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: A: limitations in following treatment protocols B: limited number of transient treatment facilities C: transition to persistent poverty D: use and abuse of tobacco, alcohol, and illicit drugs
A: limitations in following treatment protocols Homeless people are exposed to the elements, crowded and unsanitary living conditions, malnutrition, lack of sleep and stress. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens.
When determining whether a geographic area is rural or urban, the nurse should recognize that: A: rural and urban areas, by relative nature, occur on a continuum B: rural regions have fewer than six persons per square mile C: rural residents feel isolated D: rural areas are recreational, retirement, or resort communities
A: rural and urban areas, by relative nature, occur on a continuum Rural and urban residencies are not opposing lifestyles. Rather, they are a rural-urban continuum ranging from living on a remote farm, to a village or small town, to a larger town or city, and to a large metropolitan area with a core inner city.
Disabled definition
Any restriction on or lack of ability to perform an activity in a normal manner or within the normal range, which results from a physical or psychological limitation
A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill? A: Assessment B: Case management C: Geriatrics D: Tertiary prevention
B: Case management Nurses working in rural areas, including those working with migrant farmworkers, have opportunities to use many skills of nursing in community health. 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 to address some of those deficits and resolve rural health disparities.
The community health nurse performs an assessment of violence by observing which of the following community characteristics? A: Presence of social support networks B: Crime rates C: Levels of unemployment D: Presence of physical disabilities in individuals E: Presence of family violence
B: Crime rates C: Levels of unemployment Identification of risk factors is an important part of primary prevention used by nurses who work with clients in a variety of settings: crime rates, unemployment levels, lack of neighborhood resource and support systems, and a lack of community cohesiveness. Individual factors include the presence of physical disability and familial factors are those related to violence and other family factors.
A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? A: Emotional abuse B: Emotional neglect C: Physical abuse D: Physical neglect
B: Emotional neglect Neglect is more difficult to assess than is abuse. Emotional neglect is the omission of basic nurturing, acceptance, and caring essential for healthy personal development. These children are largely ignored or in many cases treated as a nonperson. It is difficult for a neglected child to feel a great deal of self-worth because the parents have not demonstrated that they value the child. Astute observations of children, their homes, and the way they relate to their caregivers can provide clues of neglect.
Rural residents appear to have a more persistent, endemic level of depression. The factors that may contribute to this level of depression may be related to which of the following? A: Crisis intervention B: Gaps in continuum of mental health services C: Sufficient number of mental health services D: Tolerance for destructive coping behaviors E: Trust in the health care professionals
B: Gaps in continuum of mental health services D: Tolerance for destructive coping behaviors There appears to be a more persistent, endemic level of depression among rural residents. Factors that relate to this level of depression are 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.
All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: A: Fleeing to a shelter B: Homicide C: Possessive behavior D: Spontaneous abortion
B: Homicide The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the greater potential for homicide, the effects on the children in the household, and the more serious long-term emotional and physical consequences.
Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. The nurse should be aware that marijuana has which of the following characteristics? A: decreases appetite B: May lead to tolerance C: is highly toxic D: Has little quality control. E: Is a safe therapeutic agent
B: May lead to tolerance D: Has little quality control. E: Is a safe therapeutic agent Compared with the other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. However, because of its illegal status, there is little quality control, and a user may consume contaminated marijuana that may cause problems. Tolerance can develop, as well as physical dependence; however, withdrawal is benign.
A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: A: Developmental disorders B: Mental health problems C: Parental neglect D: Violence potential
B: Mental health problems Children are at risk for disruption of normal development by biological, environmental, and psychosocial factors that impair their mental health, interfere with their education and social interactions, and keep them from realizing their full potential as adults. Children can develop depression or behavior problems in response to an actual or potential loss.
Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is another advantage to the use of Methadone? A: Methadone is a cure for heroin addiction B: Methadone has few known side effects C: Methadone produces a "high" similar to heroin D: Methadone is short-acting
B: Methadone has few known side effects Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other opioids thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long acting and effective orally, does not produce a "high," is inexpensive, and has few known side effects. The oral use of methadone offers a solution to the danger of the spread of HIV infection and other blood-borne infections that commonly occur among needle-sharing addicts. Although not recognized as a cure for heroin (or other opiate) addiction, methadone maintenance is a harm reduction intervention because it reduces deviant behavior and introduces addicted persons to the health care system (Volkow et al, 2014).
When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas? A: Large metropolitan areas B: Most rural and highly populated urban areas C: Most rural and suburban areas D: Small suburban and all urban areas
B: Most rural and highly populated urban areas 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 occur in the most rural counties. Residents of rural areas have the highest death rates resulting from unintentional injuries in general and motor vehicle injuries in particular.
The primary prevention of hepatitis C virus (HCV) includes: A: counseling and follow-up of infected clients B: screening of blood products C: routine testing for health care workers. D: testing of high-risk individuals
B: Screening of blood products Primary prevention of HCV infection includes screening blood products and donor organs and tissue; risk-reduction counseling and services, including obtaining the sexual and injection drug use history; and infection control practices.
To reach the desired goal of maximizing the full immunization rates for preventable communicable disease and increasing herd immunity levels, it is crucial for the nurse to: A: assume that the primary-care physician has provided all appropriate immunizations B: check an individual's immunization status at each and every visit C: support parents who are reluctant to immunize their children D: understand the difficulties in obtaining and maintaining immunization schedules
B: check an individual's immunization status at each and every visit Many interventions at the primary level, such as federally supplied vaccines and "no shots, no school" immunization laws, are population based because of public health mandate. Nurses deliver many childhood immunizations in public and community health settings, check immunization records in daycare facilities, and monitor immunization records in schools. Nurses often provide the teaching necessary to prevent communicable diseases.
A nurse in community health is following an older woman who complains frequently of migraine headaches, backaches, and GI disturbances. During a recent visit, the woman states that her adult son now lives with her. He was recently let go from his job. He enjoys hanging out with his old buddies. When he feels better, he will look for a new job. Despite the added burden she really enjoys having her son around again. The nurse should explore this further to determine whether the family is: A: abusive B: codependent C: coping D: estranged
B: codependent Drug addiction is often a family disease. People in close relationship with the addict often develop unhealthy coping mechanisms to continue the relationship. This is known as codependency, a stress-induced preoccupation with the addicted person's life, leading to extreme and excessive concern with the addict. Codependents try to meet the addict's needs at the expense of their own. Codependency may underlie medical complaints and emotional stress seen by health care providers such as ulcers, skin disorders, migraine headaches, chronic colds, and backaches.
The harm reduction approach to substance abuse focuses on health promotion and disease prevention. A primary prevention strategy that can be used by the nurse to address substance abuse under this approach is to: A: assess for recreational drug use B: destroy the myth of good drugs vs bad drugs C: encourage children to "just say no." D: refer to an addiction treatment program
B: destroy the myth of good drugs vs bad drugs Nurses are experts in medication administration and understand the potential dangers of indiscriminate drug use and the inherent inability of drugs to cure problems. Nurses can influence the health of clients by destroying the "good drugs versus bad drugs" myth. This means: (1) teaching clients that no drug is completely safe and that any drug can be abused and (2) helping persons learn how to make informed decisions about their drug use to minimize potential harm.
The nurse at the adult daycare center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: A: confront the daughter when she arrives to pick the father up B: discuss the findings with the caregivers to determine the cause of the injuries C: educate the staff about indications of elder abuse D: make a referral to the primary-care provider for follow-up
B: discuss the findings with the caregivers to determine the cause of the injuries Rough handling by caregivers can lead to bruises and bleeding into body tissues because of the fragility of older adult clients' skin and vascular systems. It is often difficult to determine whether the injuries of older adults result from abuse, falls, or other natural causes. Careful assessment through both observation and discussion can help determine the cause of injuries.
An eighth-grade athlete is brought to the clinic with complaints of palpitations and insomnia. The nurse should consider the possible use of: A: marijuana B: energy drinks C: MDMA (Ecstasy). D: PCP (phencyclidine)
B: energy drinks There is a growing public health issue related to the use of energy drinks by children, adolescents, and young adults. Energy drinks are beverages that contain caffeine, taurine, vitamins, herbal supplements, and sugar or sweeteners and are marketed to improve energy, weight loss, stamina, athletic performance, and concentration. The main ingredient, caffeine, causes coronary and cerebral vasoconstriction, relaxes smooth muscle, stimulates skeletal muscle, has cardiac effects, and reduces insulin sensitivity.
A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family's children may qualify for enrollment in the State Children's Health Insurance Program (SCHIP). The nurse's intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides: A: direct financial subsidies for children B: funds to insure currently uninsured children C: outreach efforts to enroll eligible children in Medicaid D: prospective payments for child services
B: funds to insure currently uninsured children Title XXI of the Social Security Act provides for the State Children's Health Insurance Program (SCHIP) to provide funds to insure currently uninsured children. The SCHIP program is jointly funded by the Federal and State governments and administered by the states. Using broad Federal guidelines, each state designs its own program, determines who is eligible for benefits, sets the payment levels, and decides upon the administrative and operating procedures. The program is subject to change when states undergo budget reductions.
A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for: A: disenfranchisement B: health disparities C: loss of independence D: resilience
B: health disparities Vulnerable populations often have worse health outcomes than other people in terms of morbidity and mortality. These groups have a high prevalence of chronic illnesses, such as hypertension, and high levels of communicable diseases, including tuberculosis (TB), hepatitis B, and sexually transmitted diseases (STDs), as well as upper respiratory tract infections, including influenza. They also have higher mortality rates than the general population because of factors such as poor living conditions, diet, and health status, as well as crime and violence, including domestic violence. Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or with the larger society.
Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by: A: dependency cycle B: health literacy C: income level D: race and ethnicity
B: health literacy A new concern for public nurses and nurses in community health is whether the populations with whom they work have adequate health literacy to benefit from health education. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.
Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: A: community deterioration B: healthcare costs C: juvenile delinquency D: population density
B: healthcare costs Violence is a public health problem that has both emotional and physical effects. Violence is the major cause of premature mortality and lifelong disability, and violence-related morbidity is a significant factor in health care costs. Violent behavior is predictable, and therefore it is preventable, especially with community action.
A client presents at the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: A: acute hepatitis B is self-limiting B: hepatitis A outbreaks are common in facilities where staff change diapers C: hepatitis C is the "silent stalker." D: persons with chronic liver disease are at greater risk for hepatitis A
B: hepatitis A outbreaks are common in facilities where staff change diapers Hepatitis A virus (HAV) is most often transmitted through the fecal-oral route. It remains one of the most frequently reported vaccine-preventable diseases. Outbreaks are common in daycare centers whose staff must change diapers, among household members and sexual contacts of infected individuals, and among travelers to countries where HAV is endemic.
For the nurse to fully understand the threat associated with the release of biological agents and participate in an appropriate response, the Centers for Disease Control and Prevention (CDC) has stated that the biological agents most likely to be employed are those that both have a potential for high mortality and can be easily disseminated to produce: A: immediately severe symptoms B: major panic and social disruption C: multi-syndrome effect D: person-to-person transmission
B: major panic and social disruption Understanding that the most likely agents to be used in bioterrorism are easily disseminated, have a potential for high mortality, and are intended to produce major panic and social disruption allows the nurse to fully understand the nature of the threat and plan to participate in an appropriate disaster response to minimize dissemination, activate early treatment, and manage the public's concerns. Disaster-response planning addresses these components.
During the last stage of AIDS, many opportunistic infections proliferate in persons with weakened immune systems. HIV-infected individuals who live near one another in long-term care facilities, drug treatment facilities, and prisons should be carefully screened before admission because they are at greater risk for acquiring: A: fungal disease B: pulmonary tuberculosis (TB) C: oral candidiasis D: invasive cervical cancer
B: pulmonary tuberculosis (TB) Opportunistic infections may be caused by bacteria, fungi, viruses, or protozoa. The most common opportunistic diseases are Pneumocystis jiroveci pneumonia and oral candidiasis; other diseases are pulmonary TB, invasive cervical cancer, or recurrent pneumonia. TB can spread rapidly among immunosuppressed individuals. Thus HIV-infected individuals who live near one another, such as in long-term care facilities, correctional facilities, drug treatment facilities, or other settings, must be carefully screened and deemed noninfectious before admission to such settings.
Social Justice
Based on the principles of equality in which the worth of every member is respected and valued.
The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: A: 6 months for white mothers B: 10 months for white mothers C: 3 months for African American and Hispanic/Latino mothers D: 12 months for African American and Hispanic/Latino mothers
C: 3 months for African American and Hispanic/Latino mothers Violence that begins in pregnancy may continue for several years after, with increasing severity. Variations by ethnicity have also been observed during this postpartum period: intimate partner violence may peak at 3 months postpartum among African American and Hispanic/Latino new mothers and at 18 months for white mothers. The nurse should look for physical signs of abuse, as well as for controlling or intrusive partner behavior.
Immunity to disease through vaccination is known as: A: Natural immunity B: Resistance C: Acquired immunity D: Herd immunity
C: Acquired immunity Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent. Having measles once protects against future infection. Acquired immunity may be induced by active or passive immunization. Natural immunity refers to species-determined, innate resistance to an infectious agent. Resistance is the ability of the host to withstand infection, and it may involve natural or acquired immunity. Herd immunity refers to the immunity of a group or community.
Nurses in community health conducting health education classes for populations vulnerable to HIV/AIDS should explain the natural history of the progression of human immunodeficiency virus (HIV). Of particular importance is the fact that the disease may go undetected during the primary infection phase because: A: the immune system increases antibody production B: the incubation period is prolonged C: antibody tests are typically negative D: symptoms include myalgias, sore throat, and rash
C: antibody tests are typically negative Initially the body's CD4 white blood cell count drops for a brief time when the virus is most plentiful in the body. The immune system increases antibody production in response to this initial infection, which is a self-limiting illness. The symptoms are lymphadenopathy, myalgia, sore throat, lethargy, rash, and fever. An antibody test in this phase is usually negative, so it is often not recognized as HIV.
Factors that contribute to newly emerging or reemerging infectious disease can be related to microbial adaptation and changes made by the infectious agent. However, most of the emergence factors are related to environmental changes and: A: increase in the number of vectors B: industrialization and urbanization. C: consequences of human activities/behaviors D: unpredictable variances in the climate
C: consequences of human activities/behaviors Most of the emergence factors are consequences of activities and behavior of the human hosts and environmental changes such as deforestation, urbanization, and industrialization. The rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Changing sexual behavior and illegal drug use influence the spread of HIV/AIDS and other STDs.
It is estimated that one in 11 males becomes a father during his teen years. The nurse should be aware that many young men facing paternity have specific challenges such as: A: acting as though they are interested when they are disinterested B: avoiding prenatal care involvement C: desiring and needing to be involved with their children D: being rejected by the young woman's family E: rejecting their role as a father
C: desiring and needing to be involved with their children D: being rejected by the young woman's family Nurses can acknowledge and support the young man as he develops in the role of father. Young men react differently when they learn that their partner is pregnant, and it often depends on the nature of the relationship before pregnancy. Many young men will accompany the young woman to a health care center for pregnancy diagnosis and counseling. A large percentage of young men will continue to accompany the young woman to some prenatal visits and may even attend the delivery. These young men may also want to and need to be involved with their children regardless of changes in the relationship with the teen mother. It is not unusual for a young man to be excluded or even rejected by the young woman's family. He may then begin to act as if he is disinterested when he may really feel that he cannot provide resources for his child or know how to take care of the child.
A strategy that may improve compliance with tuberculosis (TB) treatment is the: A: increased tuberculosis testing protocols B: increased confirmatory testing protocols C: expansion of directly observed therapy D: treatment compliance education
C: expansion of directly observed therapy To prevent TB, the CDC works with public health agencies in other countries to improve screening and reporting of cases and to improve treatment strategies. This includes coordination of treatment for infected individuals who migrate to the United States. Nurses administer tuberculin skin tests and provide education on the importance of compliance to long-term therapy. They may also be involved in directly observed therapy (DOT) and contact investigations of cases in the community. In DOT programs for TB medication, nurses observe and document individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk for the TB becoming resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease.
A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: A: Child neglect B: Family secrets C: Father-daughter incest D: Impaired family functioning
C: father-daughter incest Incest occurs in all races, religious groups, and socioeconomic classes. A typical pattern is as follows: The daughter involved in the parental incest is usually 9 years of age at the onset and is often the oldest or only daughter. The father seldom uses force. He is more likely to use threats, bribes, intimidations, or misrepresentation of moral standards. These children may have difficulty in social situations and demonstrate avoidance behaviors. They may also attempt to cover or protect their bodies. Therefore the nurse must be aware of these indicators in order to conduct an appropriate assessment and plan appropriate interventions.
A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in: A: delinquent behavior B: drug use C: field work D: Migrant Education Program
C: field work Children of migrant farm workers may need to work for the family's economic survival. Federal law does not protect children from overworking or from the time of day they work outside of school. Therefore, children may work until late in the evening or very early in the morning every day of the week. These children may experience constant fatigue and are set up for failure in school.
An undocumented migrant farmworker has been diagnosed with tuberculosis (TB). The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. A major challenge that the client may face related to ongoing treatment for TB is: A: affordable care B: discrimination C: fragmented services D: language barriers
C: fragmented services Although migrant workers move from job to job, their health care records typically do not go with them. This leads to fragmented services in such areas as TB treatment, chronic illness management, and immunization. When migrant farmworkers move, they must independently seek out new health services to continue their medications. Also, people with TB may forfeit treatment because they are afraid of immigration authorities.
The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farm workers. The local health department is informed of this rise in cases and schedules a case mapping of local: A: bars frequented by migrant workers B: farm fields employing migrant workers C: housing for migrant workers D: restaurants frequented by migrant workers
C: housing for migrant workers Housing conditions greatly vary among states and localities. When housing costs are high, 50 farm workers may live in one house, or three families may share one trailer. Some may live in cars or tents if necessary. Housing may lack individual sanitation, bathing, or laundry facilities. Poor-quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis.
A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: A: advocate for government programs to treat survivors B: demonstrate the provider's commitment to address the need for services C: increase awareness of community resources to address violence and abuse D: increase the number of individuals identified as perpetrators
C: increase awareness of community resources to address violence and abuse Referral is an important component of tertiary prevention. Nurses should know about available community resources for abuse victims and perpetrators. If attitudes and resources are inadequate, it is often helpful to work with local radio and television stations and newspapers to provide information about the nature and extent of human abuse as a community health problem. People often do not seek services early in an abusive situation because they simply do not know what is available to them.
A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be: A: complicated to address B: costly to serve C: invisible to the community D: resilient to the community
C: invisible to the community. Disenfranchisement refers to a feeling of separation from mainstream society. Groups such as the poor, the homeless, and migrant workers are "invisible" to society as a whole and forgotten in health and social planning. Vulnerable populations are at risk for disenfranchisement because their social supports are generally weak, as are their links with formal community organizations.
Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to: A: adult immunization rates B: chronic respiratory illness rates C: maternal/infant morbidity rates D: obesity rates
C: maternal/infant morbidity rates HPSAs tend to have a high proportion of racial minorities and fewer specialists, such as pediatricians, obstetricians, and gynecologists, available to provide care to at-risk populations. There are extreme variations in pregnancy outcomes from one part of the country to another, and even within states.
Indiscriminate use of "good drugs" has caused more health problems from adverse reactions, drug interactions, dependence, addiction, and overdoses than has the use of "bad drugs." The high-risk population group that most experiences the negative consequences identified above is: A: adolescents B: injection drug users C: older adults D: pregnant women
C: older adults Older adults consume more prescribed and OTC medications than does any other age group. Problems with alcohol consumption, including interactions with prescribed and OTC drugs, far outnumber any other substance-abuse problem among older adults. Factors such as slowed metabolic turnover of drugs, age-related organ changes, enhanced drug sensitivities, a tendency to use drugs over longer periods, and a more frequent use of multiple drugs contribute to greater negative consequences from drug use among older adults.
A young female client visits a local clinic, seeking treatment for a urinary tract infection (UTI). During the assessment, the nurse conducts an extensive sexual history/activity screening to determine the risk for a sexually transmitted disease and potential complication of: A: genital warts B: herpes simplex virus 1 C: pelvic inflammatory disease (PID) D: primary syphilis
C: pelvic inflammatory disease (PID) Gonorrhea is the second most common reportable infectious disease in the United States. Women are often asymptomatic and therefore do not seek treatment, placing them at greater risk for developing pelvic inflammatory disease (PID).
A nurse in community health is working in a rural setting. In planning for programs to address the population's needs, the nurse should be aware that, in general, rural populations: A: engage in physical activity during leisure time B: engage in preventive behaviors C: perceive their overall health as less favorable D: use seat belts
C: perceive their overall health as less favorable In general, people in rural areas have a poorer perception of their overall health and functional status than do urban residents. Rural residents older than 18 years assess their health status less favorably than do urban residents. Studies show that rural adults are less likely to engage in preventive behavior, which increases their exposure to risk.
An example of secondary prevention for infectious disease prevention is: A: malaria chemoprophylaxis B: Pneumocystis carinii pneumonia (PCP) chemoprophylaxis for people with AIDS. C: quarantine D: restaurant inspections
C: quarantine The goal of secondary prevention is to prevent the spread of disease once it occurs. Activities center on rapid identification of potential contacts to a reported case. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities through treatment and rehabilitation.
A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of: A: drug abuse B: drug addiction C: substance abuse D: adverse drug reaction
C: substance abuse Substance abuse is the use of any substance that threatens a person's health or impairs social or economic functioning. This definition is more objective and universal than the government's definition of drug abuse, which is the use of a drug without a prescription or any use of an illegal drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed. Adverse drug reactions are associated with side effects.
human capital
Combined human potential of the people living in a community; measure of macroeconomic theory that involves improving human qualities, such as health, and is a focus for developing and spending money on goods and services because health is valued, it increases productivity, enhances the income earning ability of people, and improves the economy
linguistically appropriate health care
Communicating health-related assessment and information in the recipient's primary language, when possible, and always in a language the recipient can understand.
The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? A: Assessment level B: Design level C: Evaluation level D: Implementation level
D: Implementation level Although deinstitutionalization was noble in conception, it was bankrupt in implementation. Families and communities were not prepared to take on the treatment responsibilities they had to assume, and little education was available. Either care settings such as nursing homes, personal care settings, supervised apartments, rooming houses, single-occupancy hotels, and other similar settings were not available, or people were not educated or prepared to deal with this population.
A population-level tertiary prevention intervention typically performed by nurses and aimed at controlling communicable diseases is: A: HIV testing counseling B: Needle exchange program C: Partner notification D: Standard precautions teaching
D: Standard precautions teaching The importance of teaching caregivers about infection control in home care is vital. The nurse treating an HIV client in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and other groups may have concerns about transmission of HIV. Others, who may not have concerns about transmission, may not take adequate precautions or may believe myths that they may not become infected.
A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: A: Competition B: Unemployment C: Survivors guild D: Work-related stress
D: Work-related stress Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.
The nurse in community health is aware that HIV-infected children should attend school, because the benefit of attendance far outweighs the risk of transmitting or acquiring infections. School attendance should be reconsidered when there is evidence of: A: lack of handicapped access B: availability of homebound instruction C: prejudice of teachers and/or students D: cases of measles
D: cases of measles Attendance at school may be inadvisable if cases of childhood infections are in the school, since the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior.
A nurse in community health working in an inner city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: A: at home B: full-term C: identical twins or triplets D: low birth-weight babies
D: low birth-weight babies Poor pregnant women are more likely than other women to receive late or no prenatal care and to deliver low-birthweight babies, premature babies, or babies with birth defects.
A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': A: dependency on primary-care provider B: normal sensory losses C: reduced social contacts D: underutilization of the mental health system
D: underutilization of the mental health system Older adults, because they may depend on others for care, are at risk for abuse and neglect. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underutilize the mental health system and are more likely to be seen in primary care or to be the recipient of care in institutions. The nurse can reach them by organizing health-promotion programs through senior settings or other community-based settings.
The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to: A: conduct a comprehensive assessment and formulate a plan for treatment B: establish a long-term trust relationship to prevent disappointment C: schedule appointments for appropriate immunizations for the children D: use every opportunity to teach about preventive health care
D: use every opportunity to teach about preventive health care Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions of environmental hazards and violence and assurance of safe food and water.
A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of: A: poverty B: resilience C: risk D: vulnerability
D: vulnerability Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources.
A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of: A: disenfranchised populations B: disadvantaged populations C: vulnerability D: vulnerable populations
D: vulnerable populations Vulnerable populations are those groups who have an increased risk to develop adverse outcomes. A vulnerable population group is a subgroup of the population, more likely to develop health problems as a result of exposure to risk or to have worse outcomes from a health problem than is the rest of the population. The risks are often cumulative risks from environmental hazards, personal behavior, or biological or genetic makeup
Disempowerment
External locus of control
Vulnerable groups
Groups of individuals who may be at increased risk for health problems due to exposure to certain risk factors R/T: social resources, $, physical, environmental
Federal poverty guidelines
Income level for a certain family size that the federal government uses to define poverty
Homelessness definition
Lack of fixed, regular address and adequate sleeping arrangements
What is the primary cause of vulunerability to health problems?
Poverty
vulnerability
Results from the interaction of internal and external factors that cause a person to be susceptible to poor health.
Disenfranchisement
Sense of social isolation; a feeling of isolation from mainstream society.
wrap-around services
Social and economic services provided, either directly or through referrals, in addition to available comprehensive health services. In this way, social and economic services that will help ensure the effectiveness of health services are "wrapped around" health services.
social determinants of health
Social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age
Pregnant teens health concerns
Violence, Nutrition, Education, Infant care
health disparities
a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage
cumulative risks
are related risks that increase in effect with each added risk
Comprehensive services
health services focusing on more than one health problem or concern
poverty
refers to having insufficient financial resources to meet basic living expenses. These expenses include cost of food, shelter, clothing, transportation, and medical care.
resilience
the ability to withstand many forms of stress and deal with several problems simultaneously with developing health problems
Determinants of health
the range of personal, social, economic, and environmental factors that influence health status
