PH Exam 2

The nurse works in the ER when a client arrives with respiratory depression associated with a heroin overdose. Which medication should the nurse expect to be ordered for this client?

Naloxone

The nurse examines a client who is taking haloperidol for schizophrenia and notices that she habitually twists her tongue and arms. This side effect of her medication is known as:

Tardive dyskinesia

The nurse teaches about medication to a client who has just been diagnosed with schizophrenia. The psychiatrist has prescribed clozapine to the client. The primary adverse effect that the nurse should mention is:

The metabolic syndrome

Which is a relationship risk factor for intimate partner violence?

Unhealthy family interactions

The physician approaches the client with a treatment plan for his cancer. The client states that his life is in God's hands and refuses conventional treatment. This is an example of:

)Fatalistic behavior

The client states a history of substance abuse but reports current abstinence. If valid, this report means that the client has not used alcohol or illicit substances in at least how many months?

12

On the basis of the understanding of demographic risk factors related to mental illness, which individual would be most likely to have an untreated psychiatric disorder?

18-year-old African-American man

A client arrives at the clinic shaky and requesting a refill on a prescription for alprazolam (Xanax). The nurse suspects that the client might be experiencing substance withdrawal. Which comment by the client would most tend to confirm your suspicion?

"I ran out of pills a week ago and have felt sweaty and agitated ever since."

The nurse assesses a new client and performs a standard screening for intimate partner violence. Which is the most appropriate question to ask first?

"It's normal for couples to disagree about things. What happens when you and your partner disagree?"

An older client is seeking a fourth refill on a prescription for benzodiazepines. The nurse is concerned that the client may be developing a tolerance for the drug. Which comment by the client would most confirm this concern?

"Lately I've had to double up on my dose just for it to be effective."

Which correctly ranks the top four rural health priorities according to the HealthyPeople goals?

(1) Access to quality healthcare, (2) heart disease, (3) diabetes, (4) mental health and mental disorders

The nurse suspect a 16-year-old client is being physically abused by her boyfriend. Compared with adolescent girls with no abuse history, this client is at significantly increased risk for: (Select all that apply.)

-Smoking cigarettes -Anorexia -Becoming pregnant

Which statements by a caregiver would indicate the presence of risk factors for violence and should cause the nurse to have significant concern for the safety of children? (Select all that apply.)

-"My boyfriend says that one day he'll put a bullet through my head if I don't stop nagging him." -"My husband sometimes makes our son come into our bedroom and watch as he hits me." -"The last time we fought, he threatened to go pull out his shotgun."

Which qualifies as an urbanized area according to the U.S. Census Bureau? (Select all that apply.)

-A central city with population of 25,000 and surrounding densely settled territorywith a population of 25,000 with a combined population density of 1,100 peopleper square mile -A central city with population of 20,000 and surrounding densely settled territorywith a population of 30,000 with a combined population density of 1,250 peopleper square mile -A central city with population of 100,000 and surrounding densely settled territorywith a population of 50,000 with a combined population density of 1,500 peopleper square mile

Which instance would be considered child abuse and neglect according to the federal Child Abuse and Prevention and Treatment Act?

-A father leaving a child in the back seat of a car on a hot August day -A mother not feeding a 5-year-old child all day -A mother allowing her boyfriend to punch her daughter -A mother allowing her boyfriend to punch her daughter

The nurse is caring for a client who is from a culture for which the nurse has a limited knowledge base. The nurse conducts the admission interview using cultural humility. Which should the nurse ask in the interview? (Select all that apply.)

-About traditions -Open-ended questions -How the client has addressed the illness

Definitions of rural areas are based on which concepts? (Select all that apply.)

-Administrative -Land-use -Economic

An underserved population is a subgroup of the population that has a higher risk of developing health problems due to marginalization in which areas? (Select all that apply.)

-Age -Gender -Sociocultural status

The nurse assesses a 15-year-old client who shows some signs of possible drug addiction. The nurse reviews the client's health and family history, looking for key indicators for risk of substance dependence, such as: (Select all that apply.)

-Age at first use of illicit substance -Family history of alcoholism

A politically active community health nurse assists in drafting state legislation for alcohol use laws. Which principles of the World Health Organization should be integrated into the draft legislation? (Select all that apply.)

-Alcohol policies should be equitable for all in the state. -Alcohol policies should be sensitive to cultural contexts. -Legislation should protect those exposed to the harmful effects of drinking by others.

Pediatric providers face special issues in screening for intimate partner violence (IPV) in a caregiver who is accompanying a child. Which are appropriate strategies for addressing this screening issue? (Select all that apply.)

-Asking the mother indirectly, with a written questionnaire or computer survey -Screening for the safety and dangerousness of the situation before deciding whether to ask the mother

The nurse is called to make an unscheduled visit to a new client in her home. The purpose of the visit is to admit the client and treat an abdominal wound. The nurse discovers that the client is from a culture unfamiliar to her. In this situation, the nurse should demonstrate cultural competence and awareness by: (Select all that apply.)

-Being open to the client's ideas and way of life -Exhibiting respect and patience -Being aware of your own culture

The nurse works with a recovering heroin addict who is currently receiving opioid substitution treatment. Besides reducing his use of heroin, what additional benefits are offered by this treatment? (Select all that apply.)

-Decrease in transmission of HIV -Improving the client's overall health

The nurse cares for a woman who is in her 39th week of gestation and who recently revealed that she is being physically abused by her partner. Which conditions associated with intimate partner violence (IPV) should the nurse look for in this client and in her child now and in the coming weeks? (Select all that apply.)

-Depression in the mother -Low-birth weight infant

The nurse is completing a lethality assessment with a female client. Which are appropriate lethality risk questions? (Select all that apply.)

-Is there a gun in your house? -Has your partner ever been arrested? -What is the worst thing your partner has ever done to you? -Do you feel that the partner is capable of hurting you?

A nurse is preparing to make a mandatory report of intimate partner violence (IPV) with regard to the caregiver of a pediatric client. Which actions are appropriate? (Select all that apply.)

-Determine whether it will be safe to inform the child about the report -Ask the victim whether she has a plan to keep herself and the child safe -Ask the victim if she would like to file a report at the same time as you file yours

The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which strategies are at the government level?(Select all that apply.)

-Ensure children in foster care and detention receive quality treatment to address -Promote high-quality children's television programming and access to other

In assessing a 13-year-old Native American boy who lives on a reservation, the nurse finds that he regularly drinks alcohol and smokes cannabis. He says that most of his friends do so, as well. The nurse is aware that this rate of prevalence is far higher than that for 13-year-olds of all ethnicities nationwide. Which social conditions have researchers associated with this health disparity? (Select all that apply.)

-Greater availability of cannabis from local farms -Lower academic attainment -Proximity to Mexico and drug gangs

The nurse assesses a 33-year-old who abuses alcohol. To gauge how the client's substance use is impairing his ability to fulfill normal role functions, the nurse should use: (Select all that apply.)

-History of arrests for drunken driving -Jobs lost due to intoxication at work and chronic absenteeism -Failing grades in night classes at the local community college

How can genomics help improve care of underserved populations? (Select all that apply.)

-Identify increased risk in certain populations for specific diseases. -Predict how a community might metabolize medications. -Predict a community's unique vulnerability to environmental changes that cancontrol gene expression in some diseases.

The nurse assesses a 12-year-old boy who has been diagnosed with bipolar disorder.Which behaviors should the nurse most expect to observe in this child? (Select all that apply.)

-Irritability -Screaming -Rage episodes -Sleep disturbances

Intimate partner violence is a pattern of assaultive and coercive behaviors. This definition includes: (Select all that apply.)

-Sexual assault -Physical injury -Deprivation

In the United States, detention centers, jails, and prisons are places that provide safety to the public by incarcerating people who have committed crimes and who are deemed a threat to society. Which demographics are true of the majority of inmates? (Select all that apply.)

-Latino or African-American -Average age of 37 years -Male gender

Which most accurately characterize Medicare clients with acute myocardial infarctions(AMIs) who are treated in rural hospitals? (Select all that apply.)

-Less likely to receive recommended treatments than those in urban hospitals -Have significantly higher adjusted 30-day post-AMI death rates from all causesthan those in urban hospitals

A woman who is at high risk for alcohol abuse has just found out that she is pregnant. The nurse counsels her about the long-term effects of alcohol on the child. The nurse should include mention of: (Select all that apply.)

-Low IQ -Facial anomalies -Short attention span

Which risk factors are associated with committing gun-related homicide? (Select all that apply.)

-Low income -Lack of education -Being a victim of discrimination -Lack of employment opportunities

A client is admitted to the hospital. On admission, it is noted that the client does not speak English. It will take 20 minutes for the hospital interpreter to arrive. The nurse decides to wait for the interpreter rather than relying on the client's husband. Appropriate rationales for this decision include that the interpreter is: (Select all that apply.)

-More likely to be fluent in both languages -Trained in ethics and will be better at explaining cultural differences -More likely familiar with technical healthcare terms

The community health nurse is concerned with the prevalence of new HIV infections in the community and understands the strong correlation between substance use disorders and HIV. Which interventions should the nurse promote in the community health clinic to best address this problem? (Select all that apply.)

-Opioid substitution treatment -Syringe exchange programs

After examining a young woman, the nurse asks her questions about some bruises on her back. The client confides that her husband has started hitting her when they argue. The nurse makes recommendations about getting help; the client dismisses them and states, "It's just a few bruises. I think I can handle it." Which long-term consequences of exposure to violence, according to Healthy People 2020, should the nurse discuss with this client? (Select all that apply.)

-Premature death -Disability -Lost productivity

A 50-year-old woman recently underwent a divorce and has two teenaged children. She has an associate's degree from her local community college and earns an annual salary of $22,000. Which risk factors place this woman at risk for intimate partner violence (IPV)? (Select all that apply.)

-Recent divorce -Annual salary of $22,000

A nurse, new to the community health agency, works in a culturally diverse area of the community. The nurse is responsible for providing holistic care to clients and to be culturally competent. The health agency requires the nurse to demonstrate which competency to exhibit cultural competence? (Select all that apply.)

-Value diversity -Acquire cultural knowledge -Adapt to diversity

What percentage of rural children live in poverty?

24%

Which accurately defines femicide?

A homicide of a female that occurs in the context of intimate partner violence

The nurse enters a client's home to provide care to a wound and teach the client's wife how to care for the wound. The nurse is comfortable with the client's culture and the fact that it is matriarchal in nature. As teaching begins, the husband interrupts and states that the woman does not change bandages according to his culture. He asks if the nurse is familiar with his culture and then says that all members of his neighborhood follow its principles. The nurse should suspect that the client is a member of:

A subculture

An older woman in a rural health clinic tells the nurse that this is the first time she's been in a medical facility for more than 10 years. She shows signs of advanced diabetes, including significant necrosis in her feet. When asked why she didn't come in sooner, she says, "I don't drive, myself, and I hate asking my son to bring me—I feel like such a burden." This situation exemplifies which of the seven A's of challenges to elders in rural areas?

Acceptability

While visiting the home of an 89-year-old woman out in the country, the nurse learns that her primary care provider's office is one hour's drive away. The client states, "I've just stopped going in for appointments in the past few years. It's just too far for me to drive by myself." This situation exemplifies which of the seven A's of challenges to elders in rural areas?

Accessibility

During an assessment, a teenager reveals a 2-year history of inhalant use. Using knowledge that fumes may be inhaled through the mouth, this will achieve a state of intoxication similar to:

Alcohol

Which mental illness is most likely to go untreated?

Alcoholism

Which most accurately defines a medically underserved area?

An area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older

Which is an accurate health factor or effect of living in rural geopolitical areas?

Although only one third of all motor vehicle accidents occur in rural areas, two thirds of the deaths attributed to these accidents occur on rural roads.

The nurse is scheduling a follow-up appointment for a client who recently immigrated from Nicaragua. The client agrees to a 9:00-AM appointment on the following Wednesday. The nurse should anticipate that on the following Wednesday, this client will:

Arrive late for the appointment, after completing whatever tasks the client feels need to be accomplished first

When speaking with an older man in a rural community about his lifelong smoking habit, the nurse is alarmed to learn that he has never heard that cigarette smoking is the major cause of lung cancer. This situation exemplifies which of the seven A's of challenges to elders in rural areas?

Awareness

To demonstrate true cultural sensitivity and awareness, the nurse must:

Be competent in his or her own cultural heritage

During an ice storm, people in one neighborhood banded together and shared the home of a neighbor who still had power and heat. Other neighbors provided food, water, and bedding. In another neighborhood the neighbors did not know one another and weathered the storm alone. Both neighborhoods are part of the same community. What characteristic did the people in the first neighborhood share that made them a subculture that those in the second neighborhood lacked?

Belief in the value of cooperation

The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Encouraging families to spend quality time together by hosting a movie or game night at a local church is an example of a strategy at which level?

Community

The nurse conducts a well-child clinic in your community. The client population is culturally diverse, and, although the clinic is busy, it runs smoothly because it has an interpreter. In addition to the interpreter, it is important that the nurses treat each client that reflects his or her individual cultural needs. This is cultural:

Competence

The nurse is caring for a client who is a refugee from Haiti. The client's family has been displaced because of an earthquake in their country. The client has healing fractures on his right arm as well as fractured ribs. He tells the nurse that, before care begins, the nurse must consult with his Voodoo healer. Which is the nurse's best response?

Consulting with the healer and updating the physician regarding treatment and any herbal medications that may be used

he Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which exemplifies a strategy at the family level?

Create daily homework routines and limit television viewing.

A Mexican-American client arrives at the emergency department. He reports abdominal pain and has been vomiting for 5 days. The nurse notes that he is exhibiting symptoms of dehydration, and his vital signs and labs confirm this. The nurse asks the client why he waited so long to seek medical care. He states that he is being treated by the Curandero and wishes to continue while in the hospital. The nurse recognizes the different cultural assumptions regarding care. This situation is an example of:

Cross-cultural nursing

The nurse is caring for a client who refuses the food as served. He states that the food is foreign to him and will make him ill. All food must be blessed. The personal care attendant is upset by this behavior and states that the client should eat the food anyway. The client's behavior is most likely a result of:

Cultural belief

A group of teens develop their own method of texting in a language that they feel is all their own. The change is subtle, but the meanings and the feelings associated with the text are known only to a select few. This behavior is an example of:

Culture

The nurse assesses a client who recently immigrated to the United States from Haiti.The client reports upset stomach and diarrhea. He explains that a witch doctor put a curse on him and that he sometimes sees evil spirits around him. The most accurate way to describe this type of illness would be as a:

Culture-bound syndrome

A new client, who is Latin American, is getting settled in the hospital. She is expecting her family to arrive soon. A physician enters and informs the client that she requires surgery and asks that she sign the necessary documents. The client refuses and becomes agitated. Which is the most likely cultural reason for the client's reluctance to sign the documents?

Decision of importance is typically made by the family as a group.

An injury prevention objective of Healthy People 2020 is:

Decreased incidents of homicide, child maltreatment, and physical assaults

In researching the problem of homelessness in the city, the nurse discovers that the number of mentally ill homeless has steadily grown over the past couple of decades.The biggest reason for this trend is:

Deinstitutionalization

A client, diagnosed with hypertension, is prescribed a no-added-salt, low-fat diet. He agrees and repeats the teaching principles. At the next visit, the nurse notices salted meat on the counter and the client shows the nurse his food diary. The diet in the past week does not reflect the physician's orders. What cultural component may have contributed to the noncompliance with the diet order?

Diet may not meet the cultural criteria for food choices

The nurse cares for a client in a community health clinic. The nurse is uncomfortable because the client remains very close when communicating. This discomfort makes it difficult to concentrate on the interview. When the nurse backs away, the client stops speaking and leaves. This is an example of:

Differing views of personal space

The nurse teaches a client about pharmacologic treatments for alcohol-dependent disorders. The client correctly understands the teaching when she tells the nurse that a medication that induces aversive effects if alcohol is consumed is:

Disulfiram

A nurse is assessing a client who was recently released from prison. Based on knowledge of the incidence rates of various types of crimes that lead to incarceration, the nurse suspects that the client may have committed which crime?

Drug possession and trafficking

During a conference after rounds, a nurse states, "They are in the United States now; you would think that they would act like us." This nurse is exhibiting:

Ethnocentrism

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exemplifies a primary prevention strategy for mental health problems?

Educate families and community groups about mental health issues, symptoms of stress, and barriers to seeking help

There is substantial variation in the incidence of mood disorders and suicide across cultures worldwide. The two most consistent factors associated with the incidence of depression and anxiety are:

Education level and employment status

The nurse counsels a college student who admits to frequent binge drinking. Based on her age and environment, the most likely reason for this student's binge drinking is to:

Enhance mood or affective state

The nurse assesses a 19-year-old client for alcohol abuse. Which would be the most significant risk factor for alcohol abuse in this client?

Enrollment in college

A nurse receives blood test results that indicate that a 14-year-old client has been using cannabis. Based on knowledge of factors that affect rate of cannabis use among youth, which would be the most effective strategy to discourage this behavior?

Explain the risks associated with cannabis use

The nurse visits a community health clinic in a remote rural area, at which emergency care is not provided because the facility lacks the medical staff necessary to offer such services. Based on this information, which is the most accurate description of this situation?

Health professional shortage area

The nurse assesses a 7-year-old girl who has had problems at school lately with her behavior and mood. On the basis of the description provided by the child's mother, the nurse suspects either attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder may be involved. Which behaviors—when occurring in all spheres of the child's life—would most strongly suggest ADHD rather than bipolar disorder in this client?

Hyperactivity and impulsivity

The nurse works with a 16-year-old client who has an alcohol use disorder. Which mental disorder, highly correlated to substance use disorder, should the nurse also assess for in this client?

Major depression

The nurse assesses a client who recently attempted suicide by prescription drug overdose. Based on knowledge of a recent study of the findings of the Third NationalHealth and Nutrition Survey, what is the most important risk factor to assess for in this client?

Major depressive disorder

The nurse is present when a mother begins cupping her child. She states that it will help to heal the child's respiratory tract infection. The nurse understands that the cultural belief that cupping will aid in the healing process is a:

Learned behavior

The nurse performs motivational interviewing with a college student in the university health center regarding the student's history of binge drinking. The nurse hopes to ascertain the student's readiness to change her behavior and encourage her to make better choices related to alcohol use. The interview should begin with:

Listening empathetically to establish trust

The nurse helps a client who is a victim of intimate partner violence (IPV) with safety planning. The client worries about what to do if her partner becomes violent again. A safety suggestion for the when the client is at home is for her to go to the:

Living room because there are windows

The nurse works at a clinic in Arizona that provides bilingual (English and Spanish)care to low-income immigrant workers from Mexico. Which designation most accurately describes the area or the population this nurse serves?

Medically underserved population

The nurse works with a client who is struggling with heroin addiction. Which examination should the nurse perform to screen for a comorbidity that is highly associated with substance use disorders?

Mental status examination

.In the Healthy People 2020 federal initiatives in the United States, which group is identified as needing special attention and creative solutions to live a healthy life in the face of sobering health disparities and social injustices?

Mentally ill people

The nurse educator is responsible for conducting educational seminars for the staff. After the education component of the program, the group engages in discussion. It is important that nurses routinely attend educational programs related to cultural competence because:

Nurses can facilitate social change.

The client is admitted to the hospital for new-onset hypertension and chest pain. During the admission interview you ask the client if she takes over-the-counter medications, and she states no. She adds that she routinely visits a folk healer. The nurse's response should include:

Obtaining a list of the herbs and folk medications that are taken and notifying the physician

The nurse works with a client who has just been diagnosed with schizophrenia. While discussing the various medication options for this disorder, the nurse explains that some have been associated with the development of type 2 diabetes. The client explains that she is already at risk for developing diabetes and would like to avoid any medications that might promote the disease. On the basis of this information, which medication should this client most avoid?

Olanzapine

The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which level is represented by hosting a health fair to ensure all children who are eligible for Medicaid or state children's health insurance program are enrolled?

Organization

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exemplifies a tertiary prevention strategy for mental health problems?

Promote support groups for people with mental health disorders

Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a tertiary prevention strategy?

Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him

Who is in the best position to recognize both children being victimized and children perpetrating violence?

School nurse

Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a secondary prevention strategy?

Screening a woman for evidence of abuse who has several risk factors for IPV

A nurse working in the rural Southeast United States sees many young white adolescent girls in the clinic. The nurse should be aware that which type of substance use is highest among this demographic?

Sniffing glue

Epidemiological studies are essential to target programs to populations in greatest need.To help measure progress toward improving mental health, which is a primary focus of epidemiologic studies?

Social costs

The nurse is speaking with a 14-year-old client who has attempted suicide by cutting his wrists in the past. How would the nurse implement a means-restriction approach to suicide prevention in this case?

Suggest to the client's parents that they lock up all sharp knives in the house

The nurse screens a woman who is 6 months pregnant for alcohol use. Which screening instrument should be used?

T-ACE

Which is a societal risk factor for intimate partner violence?

Traditional gender roles

Which most accurately defines gender-based violence?

Violence that targets people or groups of people on the basis of their gender

At what age are prodromal assessment symptoms of bipolar disorder typically evident?

Younger than 3 years of age