Public Health - Quiz 2 - Ch. 3, 6, 8, 18, 19, 26, 27, 28

Facts about Economic Influences

1. Link between poverty and poorer health outcomes 2. Approximately 97% of all health care dollars are spent for individual care while only 3% is spent on population level health care. 3. The U.S. spends more on health care than any other nation. 4. The current health care system is at the point where it is not affordable. 5. Knowledge about health economics is particularly important to community-oriented nurses.

3. Health Workforce Trends

1. Not enough primary care providers, especially in the most underserved areas - Ex. inner cites, very rural areas 2. Move to contain costs & move to community-based care 3. Current nursing shortage - By 2016, expecting 587,000 new nursing positions - 55% of surveyed nurses intend to retire between 2011 and 2020 4. Need to increase number of minority nurses to help decrease health disparities - In 2008, minority nurses represented about 22% of the RN population

An enormous variety of facilities and providers make up the health care system. What are some examples of these?

- Physicians - Dentists' offices - Hospitals - Managed care organizations - Nursing homes - Mental health centers - Rehabilitation centers - Local, state, and federal official & voluntary agencies

Environmental Health Assessment

1. Air (indoor/outdoor), water, land, or food 2. Chemical, biological, or radiological 3. Environmental health assessment - "I PREPARE" - Windshield survey - Environmental databases - Environmental health assessment form - Inquire/observe about unintended environmental exposures

What is The goal of public health finance?

"to support population focused preventive health services"

ANA scope and standards of environmental health: What are the 10 principles that comprise the standards?

(1) it is essential that nurses know about environmental health (2) nurses should not use products or practices that harm health or the environment (3) nurses have a right to work in a safe and healthy place and nurses and other health care professionals have the right to know in a timely manner about any possible harmful products, chemicals, pollutants, and hazards to which they may be exposed (4) multidisciplinary collaboration is a factor that sustains a healthy environment; (5) the choice of materials, products, technology and practices in the environment that affect nurses is based on best practices (6 and 7) nurses should respect the diversity of the people whom they serve and also focus on the quality of the environment in which they and their clients work and live (8) nurses, other health care workers, families, patients and communities have the right to know timely information about potentially harmful products (9 and 10) nurses should participate in both research and advocacy related to promoting a safe and healthy environment (ANA, 2007) .

What is the process of home visits?

1. Initiation phase 2. Pre-visit phase 3. In-home phase 4. Termination phase - Makes referrals when appropriate 5. Post-visit phase

Chapter 27 - Test your Knowledge - AKA Quizlet questions I found and copied and pasted

Taken from https://quizlet.com/328132072/chapter-27-hiv-infection-hepatitis-tuberculosis-and-stds-flash-cards/

Chapter 26 - Test your Knowledge - AKA Quizlet questions I found and copied and pasted

Taken from https://quizlet.com/328503847/chapter-26-infectious-disease-prevention-and-control-flash-cards/

Risk Factors for Families

- Genetics - Age - Biological characteristics - Personal health habits - Lifestyle - Environment

Nursing Responsibilities in Family Nursing

- Helping families promote their health - Meeting family health needs - Coping with health problems within the context of the existing family structure and community resources - Collaborating with families to develop useful interventions *Nurses must be knowledgeable about family structures, functions, processes, and roles. Nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures.*

What are the The 11 diseases children are immunized against?

- Hepatitis B - Diphtheria - Pertussis - Measles - Mumps - Rubella - Polio - Haemophilus influenzae, - Type B meningitis - Varicella (chickenpox) - Streptococcus pneumonia.

Parasitic Diseases

- Intestinal parasitic infections - Parasitic opportunistic infections

Health of Families, has historically, have focused on what?

- The effect of illness on families - The role of the family in the cause of disease - The role of the family in its use of services

Current Health Care System in U.S. - Quality

1. Institute of Medicine (IOM) reports - To Err Is Human: Building a Safer Health System (IOM, 2000) - Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) 2. Hospital compare

Reducing Environmental Health Risks

1. Apply the basic principles of disease prevention 2. Risk Communication - The right information to the right people at the right time 3. Ethics - Essential for making ethical decisions regarding environmental health 4. Governmental Environmental Protection - Manages environmental exposures through the development and enforcements of standards and regulations - Educates public about risks and risk reductions - Environmental Protection Agency; Food and Drug Administration; Department of Agriculture; local health department 5. The Good quality Protection Act of1996 sets strict guidelines for the handling of food to protect against contamination

2. Social and Economic Trends

1. Changing lifestyles - To be healthy one must take care of one's self 2. Growing appreciation of the quality of life - Shift in values changing the importance of financial success 3. Changing composition of families and living patterns 4. Rising household incomes - Average per-person income is increasing - Gap between the richest 25% and the poorest 25% is widening 5. Revised definition of quality health care 6. Economic downturn of 2008 7. Affordable Care Act

What two groups of people are more at risk than others and why?

1. Children - Breathe more rapidly than adults = great exposure to air pollutants - Bodies work differently than adults: blood-brain barrier, kidneys, growing bodies 2. Pregnant women - Must be careful for infant's development

What are the forces Stimulating Change in U.S. Health Care System

1. Demographic Trends 2. Social and Economic Trends 3. Health Workforce Trends 4. Technological Trends

Epidemiology and surveillance of HIV/AIDS

1. Disproportionately affects minorities 2. Worldwide 38 million persons live with HIV infection - Two-thirds of those live in sub-Saharan Africa - About 12 million people in the United States - 20% of those are unaware of their infection 3. Heterosexuals account for 27% of estimated new cases (2009) 4. More concentrated in urban areas

4. Technological Trends. What are the positive and negative effects?

1. EMR Positive effects: - Improve health care services - Reduce costs (efficient means of delivering care; replacing people with machines) - More convenience (time & travel) Negative effects: - Can also increase costs - Increase cost d/t High-tech. equipment is expensive, quickly becomes outdated, often requires highly trained personnel - Legal liability - Potential for decreased privacy - Too much reliance on machines

Family Functions

1. Economic function 2. Reproductive function 3. Socialization function 4. Affective function - Provides boundaries and a structure that gives a sense of belonging and identity of who the family members are individually and to their family. 5. Health care function Like all families, family functions may change over time

Social and Family Policy Challenges

1. Family Medical Leave (1993) 2. Social Security and Temporary Assistance to Needy Families 3. Challenges - Social policies - Teen pregnancy prevention policies 4. School immunization laws 5. Medicare and Medicaid (1965) 6. Affordable Care Act (2010)

Concepts in Family Health Risk

1. Family health - Acondition including the promotion and maintenance of physical, mental, spiritual, and social health for the family unit and for individual family members 2. Health risk - The factors that determine or influence whether disease or other unhealthy results occur 3. Health risk appraisal - The process of identifying and analyzing an individual's prognostic characteristics of health and comparing them with those of a standard age-group, thereby providing a prediction of a person's likelihood of prematurely developing the health problems that have high morbidity and mortality in this country 4. Health risk reduction - The application of selected interventions to control or reduce risk factors and minimize the incidence of associated disease and premature mortality; risk reduction is reflected in greater congruity between appraised and achievable ages 5. Family crisis - a Situation whereby the demands of the situation exceed the resources and coping capacity of the family 6. Life events - Age-related risks to a person's health that often occur during transitions from one developmental stage to another 7. Lifestyle

Testing for HIV

1. HIV antibody test Offered in many locations Screening may be confidential or anonymous 2. HIV test counseling - To receive test results, assess risk - Discuss risk behaviors and how to avoid engaging in them - Develop with the client a risk-reduction plan - Establish the follow-up appointment and posttest counseling - Partner notification and contact tracing 3. Posttest counseling A. Negative - Counsel on risk-reduction activities; make sure client understands test may not be truly negative (6-12 weeks before evidence of HIV antibody) B. Positive - Counsel about the need for reducing his or her risks and notifying past partners

Healthy People 2020

1. Healthy People 2020 goals are examples of strategies to provide better access for all people. 2. Levels of Prevention Economic Prevention Strategies - Primary Prevention - Secondary Prevention - Tertiary Prevention

Hepatitis

1. Hepatitis A virus - Most often transmitted through the fecal-oral route; sources may be water, food, or sexual contact - Often silent in children. 2. Hepatitis B virus - Spread through blood and body fluids; can survive at room temperature for at least 1 week. 3. Hepatitis C virus - Spread through blood or body fluids - Most common chronic blood-borne infection in the United States - Leading cause of chronic liver disease, end-stage liver disease, liver cancer, and liver transplants in the United States.

Caring for AIDS patients in the community

1. Identifying resources such as social and financial support services 2. Interpreting school and work policies 3. Assisting employers by educating managers about how to deal with ill or infected workers to reduce the risk of breaching confidentiality or wrongful actions such as termination 4. HIV drug therapy is referred to as H.A.A.R.T. (Highly Active Antiretroviral Therapy)

1. Demographic Trends

1. Increased fertility & decreased mortality 2. "Baby Boom" & Baby Bust" 3. Increasing average age 4. Change in largest minority group - African American to Hispanic - Hispanic persons now outnumber African Americans as the largest minority group - Whites predicted to make up only 50.1% of the U.S. population in 2050 - Growing foreign-born population 5. Change in household composition - More single-parent homes 6. Mortality for both genders in all age-groups declined. - Leading deaths changed from infectious diseases to chronic and degenerative diseases

Economics and the Future of Nursing Practice

1. Plan for future changes in health care - Nurses must plan for future changes in health care financing by becoming aware of the costs of nursing services, identifying aspects of care where cost savings can be safely achieved, and developing knowledge on how nursing practice affects and is affected by the principles of economics. 2. Continue to focus on improving the overall health of the nation - Nursing must continue to focus on improving the overall health of the nation, defining its contribution to the health of the nation, deriving the value of nursing care, and ensuring its economic viability within the health care marketplace. 3. Effect changes in the health care system - Nurses must effect changes in the health care system by providing leadership in developing new models of care delivery that provide effective, high-quality care and by assuming a greater role in evaluating client care and nurse performance. 4. Nursing leadership - It is through their leadership that nurses will contribute to improved decision making about allocating scarce health care resources, and promoting primary prevention as an answer to improve many of the current population level health outcomes.

The American health care system is divided into two components. What are those two components?

1. Private or personal care - Primary care system > community health center 2. Public health - Public health system

Financing of Health Care

1. Public Support - Medicare - Medicaid - Prospective Payment System (PPS) - Diagnosis-related Groups (DRGs) 2. Public Health 3. Other Public Support - TRICARE, Veterans Administration, Indian 4.. Health Service 5. Private Support 6. Evolution of Health Insurance Employers, individuals, managed care, medical savings accounts

What is the definition of primary care?

1. Refers to personal health care that provides first contact and continuous, comprehensive, and coordinated care - It deals with the most common needs of members of a community by providing preventive, curative, and rehabilitative services. 2. Managed care (HMOs and PPOs) - Medicare and Medicaid - Managed care attempts to reduce healthcare costs by requiring families to choose an MD from their network and not allowing services without their permission

How is the public health system defined/set up?

1. Seeks to ensure that the health of the community is protected, promoted, and ensured 2. Overlaps with the primary care system 3. Is mandated through laws that are developed at the national, state, or local level 4. Is organized into multiple levels comprising the federal, state, and local systems

Tuberculosis

1. TB screening tests - Skin testing with purified protein derivative (PPD) (secondary prevention) - Followed by chest radiography for persons with a positive skin reaction and pulmonary symptoms 2. The emergence of multidrug-resistant TB has prompted the use of directly observed therapy (DOT) in the United States and other countries to ensure adherence with drug treatment regimens

Current Health Care System in U.S. - Cost

1. The "Great Recession" 2. Aging Baby Boomer generation 3. Affordable Care Act

What are the factors Affecting Resource Allocation in Health Care?

1. The Uninsured 2. The Poor 3. Access to Care - Medicaid - Safety net providers - Patient Protection and Affordable Health Care Act 4. Rationing Health Care

HIV, Hepatitis, and Sexually Transmitted Diseases

1. These diseases are often acquired through behaviors that can be avoided or changed. - Focus considerably on disease prevention. - Prevention can take the form of vaccine administration, early detection, or teaching clients about abstinence or safer sex. 2. Individuals who live with these chronic infections can transmit them to others.

Current Health Care System in U.S. - Access

1. Two-class system: A. Private - Those with insurance or who can pay for health care are viewed as receiving superior care B. Public - Those who depend on public funds Uninsured - Working poor who do not qualify for public funds (either make too much money or are illegal immigrants)

As communicators and educators, what can nurses can do?

1. Write letters to local newspapers responding to environmental health issues affecting the community. 2. Serve as a credible source of information at community gatherings, formal governmental hearings, and professional nursing forums. 3. Volunteer to serve on state, local, or federal commissions. Know the zoning and permit laws that regulate the effects of industry and land use on the community. 4. Read, listen, and ask questions. As informed citizens nurses can lead in fostering community action to address threats to environmental health.

Certain environmental health risks disproportionately affect poor people and people of color in the United States. A poor person of color is more likely to.....

1. live near a hazardous waste site or an incinerator 2. Have children who are lead poisoned, 3. Have children with asthma, which has a strong association with environmental exposures.

The family system

A basic unit within which health behavior, including health values, health habits, and health risk perceptions, is developed, organized, and performed

Family Health

A dynamic changing relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of the family system

Risk Assessment

A process to determine the probability of a health threat associated with an exposure *Assessing Risks in Vulnerable Populations* Used to develop health-based standards - Point source - Nonpoint source

Why were practitioner's were able to focus on individual infections and trauma in the 1900's?

Advances were made in safe water, sewage disposal, and pasteurization of milk

Transmission of Communicable Diseases

Agent, host, and environment Acquired immunity - Develops after an exposure to a disease, Innate immunity - Present at birth. Modes of transmission - Vertical transmission - Horizontal transmission - Common vehicle - Vectors Disease development Disease spectrum - Endemic - Epidemic Important Note *Subclinical disease states pose the biggest risk to public health according to the disease spectrum*

Chapter 18 - Test your Knowledge - AKA Quizlet questions I found and copied and pasted

All From https://quizlet.com/328075889/chapter-18-family-development-and-family-nursing-assessment-flash-cards/

What does it mean when one says "Families are neither all good nor all bad?" This saying indicates what about nursing behaviors towards families?

All families have both strengths and difficulties. All families have seeds of resilience. A healthy family is resilient, strong, and functional Family systems theory focuses on helping the family maintain routines and rituals within the family *Nurses need to view family behavior on a continuum of need for intervention when the family comes in contact with the health care system*

Family Medical Leave Act (FMLA)

Allows a family member to take a defined time off of work for family events without fear of job loss

What is the Role of Nurse in Prevention?

Control, teach about, monitor, and treat persons with communicable diseases

What are the agents of Bioterrorism?

Anthrax (Bacillus anthracis) Plague (Yersinia pestis) Smallpox (variola major) Botulism (Clostridium botulinum) Tularemia (Francisella tularensis) Selected hemorrhagic viruses (Filoviridae and Arenaviridae)

What are roles for Nurses in Environmental Health

Assessment Referral Community involvement and public participation Risk communication Epidemiologic investigations Policy development

What is primary Prevention?

Behavior and lifestyle have been shown to have the greatest effect, with the environment and biology accounting for the greatest effect on the development of all illnesses. Despite the significant impact of behavior and environment on health, estimates indicate that most health care dollars are spent on secondary and tertiary care.

Why had worldwide concern about infectious diseases increased?

Concern has increased with the growth of migration. As people move from one place to another they bring their diseases, levels of immunity and resistance to diseases, and the viruses or bacteria they may harbor that have not emerged as diseases in them. Infectious disease is the number one cause of death worldwide Note The topic is complex and includes study of a wide range and variety of organisms, the pathology they may cause; and their diagnosis, treatment, prevention, and control. The topic also requires a global perspective in that currently some infectious diseases are reappearing in the United States such as measles in which the recent increase is attributed to children traveling to countries where the vaccination rate is not as high as in the United States.

Health economics

Concerned with how scarce resources affect the health care industry.

Family Nursing

Consists of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness

What are the forces Influencing the Health Care System of the Future?

Consumers - Want lower costs and high-quality health care without limits and with improved ability to choose providers of their choice. Employers/Purchasers - Want to be able to obtain reasonably priced basic health care plans for their employees. Health care systems - Want a better balance between consumer and purchaser demands. Legislation - Legislation concerning access and quality continues to be enacted.

Friedman Family Assessment Model

Takes a macroscopic approach to family assessment Views the family as a subsystem of society Enables nurses to assess the family system as a whole, as part of the whole society, and as an interaction system

Generation Y is very comfortable with technology and expect healthcare providers to be as well. This can lead to what?

Technological disparity which causes a "digital divide"

What is the nurse's Role in Providing Preventive Care for Communicable Diseases?

Counselor Educator - Safer sex - Drug use Advocate Case manager Primary-care provider Community outreach Standard precautions

Environmental Justice

Equal protection from environmental hazards for individuals, groups, or communities regardless of race, ethnicity, or economic status

Chapter 8

Economic Influences

Healthy People 2020

Emphasizes individual and community issues Some objectives relate specifically to families or homes

Chapter 6

Environmental Health Nurses need to know how to assess for environmental health risks and develop educational and other preventive interventions to help individuals, families, and communities understand and, where possible, decrease the risks.

People who live in poverty are more likely to be exposed to what?

Environmental hazards due to things like crowded living conditions, living closer to hazardous wastes, having poorer quality foods available to them and being exposed to hazards such as lead in paint, pollution in the air or water or working in hazardous jobs.

Chapter 18

Family Development and Family Nursing Assessment

Chapter 19

Family Health Risks

Four Approaches to Family Nursing 2. Family as the client

Family is first, and individuals are second

Four Approaches to Family Nursing 4. Family as a component of society

Family is seen as one of many institutions in society, along with health, education, religious, or financial institutions

Family Nursing Assessment

Family problem areas are identified and family strengths are emphasized as the building blocks for interventions.

Paying Health Care Practitioners

Fee-for-service Capitation - Gives a set monthly payment to take care of a group of clients regardless of the services needed or provided Reimbursement for nursing services

Four Approaches to Family Nursing 3. Family as a system

Focus is on the family as client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts; simultaneously focuses on individual members and the family as a whole

Public health economics

Focuses on the producing, distributing, and consuming of goods and services as related to public health.

Chapter 3- Test your Knowledge - AKA Quizlet questions I found and copied and pasted

Found mostly on https://quizlet.com/315553532/chapter-3-the-us-health-and-public-health-care-systems-flash-cards/

Multidisciplinary Approaches Including Nursing Competencies

Geologists, meteorologists, and chemists all contribute information to help understand how and when humans may be exposed to hazardous chemicals, radiation (such as radon), and biological contaminants. The public health field also depends on food safety specialists, sanitarians, radiation specialists, and industrial hygienists.

*Family policy*

Government actions that have a direct or indirect effect on families. Many programs that do exist for families, such as Social Security and Temporary Assistance to Needy Families, are not available to all families. State assistance for families varies by state.

Chapter 27

HIV Infection, Hepatitis, Tuberculosis, and Sexually Transmitted Diseases

Four Approaches to Family Nursing 1. Family as the context, or structure

Has a traditional focus that places the individual first and the family second

*Health of the Nation*

Increased attention to improving the health of everyone in the United States Limited attention has been given to (or research done on) family health risk and the role of society in promoting healthy families.

Diseases of Travelers

Individuals traveling outside the United States need to be aware of and take precautions against potential diseases they may be exposed to. Traveler may return to United States with an "unplanned souvenir"; health professionals taking client history need to consider recent travel by the client. Malaria. Food-borne and waterborne diseases. Diarrheal diseases.

Health Care-Acquired Infections

Infections acquired during hospitalization or developed within the hospital setting. - May involve patients, health care workers, visitors, and anyone who has contact with a hospital. Universal precautions: procedures to prevent exposure to blood-borne diseases.

Chapter 26

Infectious Disease Prevention and Control

What is Contracting With Families and what does it involve?

Involves a shift in responsibility and control toward a shared effort by client and professional, rather than by the professional alone Process - Beginning - Working - Termination

Paying Health Care Organizations - What is Prospective reimbursement?

It is based on the medical diagnosis

Chapter 8 - Test your Knowledge - AKA Quizlet questions I found and copied and pasted

Mainly From https://quizlet.com/244253696/nurs-450-ch-8-flash-cards/

What are the goals of managed care plans?

Managed care plans try to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost

What did Mary Brewster work to improve?

Mary Brewster worked to improve the environment of the Henry Street neighborhood. - Aimed to improve physical environment and social conditions that affected health

Of the four major factors that affect health—personal behavior (or lifestyle), environmental factors (including physical, social, and economic environments), human biology, and the health care system what is said to have the least effect? The greatest effect?

Medical services are said to have the least effect. Behavior and lifestyle have been shown to have the greatest effect, with the environment and biology accounting for the greatest effect on the development of all illnesses

Prevention and Control of Communicable Diseases

Primary prevention - Seeks to reduce the incidence of disease by preventing it before it happens Secondary prevention - Aims to prevent the spread of disease once it occurs, such as through testing for harmful products or adverse blood levels Tertiary prevention - Works to reduce complications and disabilities through treatment and rehabilitation

Chapter 6 - Test your Knowledge - AKA Quizlet questions I found and copied and pasted

Most found on https://quizlet.com/239227960/chapter-6-environmental-health-flash-cards/

Human Immunodeficiency Virus Infection

Natural history of HIV - The primary infections (within about 1 month of contracting the virus) Clinical latency (body shows no symptoms) - A final stage of symptomatic disease Transmission - Exposure to blood, semen, vaginal secretions, and breast milk - HIV is not transmitted through casual contact such as touching or hugging someone with HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone with HIV infection

Is there a single theory or conceptual framework that fully describes the relationships and dynamics and can be used to understand and intervene with families?

No. An integrated theoretical approach is necessary because one theoretical perspective does not provide nurses with enough knowledge to work effectively with families. Community/public health nurses must also blend family nursing theories with public health theories and frameworks to work both with individual families and populations of families.

Local health departments offer Services and programs. Is every local department ran the same?

No. They vary depending on the state and local health codes that must be followed, the needs of the community, and available funding and other resources.

Barriers to accessing health are many, and are often dependent upon the age group. Who has greater barriers, people with greater health threats or young and healthy individuals who are laid off or working poor?

One might assume that people with greater health threats have more barrier. In actuality, young and healthy individuals who are laid off or working poor often have greater barriers.

Working with Families for Healthy Outcomes

Pre-encounter data collection Determine where to meet the family Making an appointment with the family Planning for your own safety Interviewing the family: defining the problem Designing family interventions - Family nursing diagnosis Evaluation of the plan

What is the difference between Primary Care and Primary Health Care?

Primary health care (PHC) is broader than primary care The setting for PHC is within all communities of a country and involves all aspects of society (World Health Organization, 1978)

Vector-borne diseases

Refers to illnesses for which the infectious agent is transmitted by a carrier (vector) - Lyme disease - Rocky Mountain spotted fever - Zoonoses - Rabies

Paying Health Care Organizations - What is *Retrospective reimbursement?*

Requires the fee to be calculated ahead of time and then reconciled against fee-for-service medical claims to determine shared savings after the episode of care ends.

The State department is responsible for what?

State board of nursing - Nurse practice acts State health departments

Family Demographics

Study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing

What are family demographics and what is the nurses role in this?

Study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing An important use of family demography by nurses is to forecast stresses and developmental changes experienced by families and to identify possible solutions to family problems.

Surveillance of Communicable Diseases

Surveillance - Gather the who, when, where, and what; these elements are then used to answer why Surveillance for agents of bioterrorism - Syndromic surveillance systems (used in cases such as incidence of school absenteeism) - Early Aberration Reporting System (EARS) *A good surveillance system systematically collects, organizes, and analyzes current, accurate, and complete data for a defined disease condition* *The resulting information is promptly released to those who need it for effective planning, implementation, and evaluation of disease prevention and control programs.*

Chapter 19 - Test your Knowledge - AKA Quizlet questions I found and copied and pasted

Taken from https://quizlet.com/328113270/chapter-19-family-health-risks-flash-cards/

What does that 3% spent on pent on population level health care include?

The 3% includes monies spent by the government on public health as well as the preventive health care dollars spent by private sources.

Chapter 3

The U.S. Health and Public Health Care Systems

Environmental Health Sciences - Toxicology

The basic science that studies the health effects associated with chemical exposures

Family structure

The characteristics and demographics (gender, age, number) of individual members who make up family units. More specifically, the structure of a family defines the roles and the positions of family members.

Family structure

The characteristics and demographics (gender, age, number) of individual members who make up family units. More specifically, the structure of a family defines the roles and the positions of family members. 1. Married family 2. Single-parent family 3. Multi-adult household (with or without children) *No "typical family" model exits*

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care? a. Clinic operating hours b. Ability to pay for services c. Availability of local provider services d. Transportation availability

b. Ability to pay for services

Ch. 6 - Key Terms

advanced-practice nursing (APN), p. 36 Affordable Care Act, p. 34 community participation, p. 39 Declaration of Alma-Ata, p. 39 disease prevention, p. 39 electronic medical record (EMR), p. 37 health, p. 35 health promotion, p. 39 managed care, p. 40 National Health Service Corps (NHSC), p. 41 primary care, p. 40 primary health care (PHC), p. 39 public health, p. 40 root cause analysis, p. 39 U.S. Department of Health and Human Services (USDHHS), p. 40

Emerging infectious diseases

Those in which the incidence has actually increased in the past two decades or has the potential to increase in the near future - Ebola virus - HIV/AIDS - New influenza viruses (i.e., A H1N1) - West Nile virus (WNV)

Key Terms

agent, p. 93 compliance, p. 104 consumer confidence report (CCR), p. 97 enforcement, p. 102 environment, p. 93 environmental epidemiology,methyl mercury, p. 105 monitoring, p. 104 nonpoint source, p. 95 permitting, p. 102 persistent bio accumulative toxins (PBTs), p. 105 persistent organic pollutants (POPs), p. 105 point-source, p. 94 right to know, p. 97 risk assessment, p. 98 risk communication, p. 102 toxicology, p. 92 p. 105 environmental justice, p. 104 environmental standards, p. 104 epidemiologic triangle, p. 93 epidemiology, p. 93 host, p. 93 indoor air quality, p. 95

The Right to Know Laws

The public has a right to know about hazardous chemicals in the environment Consumer confidence report (CCR) Material Safety Data Sheet (MSDS)

Economics

The science concerned with the use of resources, including the producing, distributing, and consuming of goods and services

Epidemiology

The science that helps us understand the association between exposures and health effects in human population

Environmental Health Sciences - Epidemiology

The science that helps us understand the strength of the association between exposures and health effects in human populations 1. Epidemiology triangle - Host, Agent, Environment 2. Prevalence - Derived by comparing the number of people found to have the condition with the total number of people studied, and is usually expressed as a fraction, as a percentage, or as the number of cases per 10,000 or 100,000 people. 3. Geographic information systems (GIS)

What is the nurses responsibility when it comes to advocacy?

To be informed consumers and to be advocates for citizens in their community regarding environmental health issues

What is an important use of family demography by nurses?

To forecast stresses and developmental changes experienced by families and to identify possible solutions to family problems.

Community-Oriented Nursing Approaches to Family Health Risk Reduction What is the purpose of home visits?

To give a more accurate assessment than do clinical visits of the family structure, the natural or home environment, and behavior in that environment

It has always seemed that in the United States the health care pyramid was upside down. That is, the majority of funds were spent on high-cost reparative care. What would be more logical?

To have a system that builds upon a base of public health followed by primary care and then specialty care. The integration of primary care and public health is necessary for the future health of the nation. *Shift from primary/specialty care to public health*

What has been the trend in the trend in the delivery of health care?

To move health care to community settings; thus family nursing is very pertinent to nurses in community health. Extra Notes Family nursing is a specialty area that has a strong theory base and is more than just "common sense" or viewing the family as the context for individual health care. Family as context places the individual as the foreground, family as the background Family nursing consists of nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness.

Family

Two or more individuals who depend on one another for emotional, physical, and/or financial support; members of the family are self-defined Nurses need to ask people who they consider to be their family and then include those members in health care planning *The family may range from traditional nuclear and extended family to such "post-modern" family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.*

What all does the federal system encompass?

U.S. Department of Health and Human Services - National Health Service Corps - U.S. Public Health Service: Health Resources and Services Administration (HRSA): Bureau of Health Professionals; National Institutes of Health (NIH); Agency for Healthcare Research and Quality (AHCRQ); Food and Drug Administration (FDA); Centers for Disease Control and Prevention (CDC) - Centers for Medicare and Medicaid Services (CMS) - Department of Homeland Security (DHS) Department of Agriculture Department of Justice Department of Commerce Department of Defense Department of Labor

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? a. "Don't drop out of school." b. "Sign up for childbirth classes." c. "Sign up for the WIC program." d. "Take your prenatal vitamins daily."

a. "Don't drop out of school."

Family Systems Theory

Views the family as a whole with boundaries that are affected by the environment

Gonorrhea main symptoms is

Yellow, green discharge from penis

Should nurses ask patients who is considered a member of their family?

Yes Nurses need to ask people who they consider to be their family and then include those members in health care planning

Which of the following strategies would a nurse expect to be implemented by a typical state environmental agency? (Select all that apply.) a. Acting, through unannounced inspections, to ensure compliance b. Writing permits that help limit toxic hazards c. Monitoring hazardous substances to uphold established standards d. Obtaining and analyzing samples to confirm compliance

a. Acting, through unannounced inspections, to ensure compliance c. Monitoring hazardous substances to uphold established standards d. Obtaining and analyzing samples to confirm compliance The organization and approach to environmental protection vary somewhat among states, but the common essential strategies of prevention and control via the permitting process, establishment of environmental standards, and monitoring, as well as compliance and enforcement, are found in every state.

A woman and man who have come to the health clinic begin to argue loudly. You gave me an STD! the man yells. The woman screams back, Not me. I don't have an STD! Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. Actually, you're very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done. b. Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary. c. Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again. d. You may be able to get treatment from your pharmacist so you wont have to be embarrassed like this again.

a. Actually, you're very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done. b. Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary. c. Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again. Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STD test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person.

A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the states citizens c. Employing and supervising school health nurses d. Establishing and maintaining free clinics for HIV-positive drug abusers

a. Administering the Medicaid program b. Assessing the health needs of the states citizens State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in such areas as ongoing assessment of health needs.

Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) a. Agencies policies regarding eligibility for services b. Family's feelings about the home visit and willingness to continue c. Nurses perception of the amount of time needed to complete required tasks d. Reimbursement policies of third-party payers

a. Agencies policies regarding eligibility for services b. Family's feelings about the home visit and willingness to continue d. Reimbursement policies of third-party payers Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the familys willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurses time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurses perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available.

A nurse is planning to conduct research on patient care outcomes. Which of the following agencies would the nurse use as a resource? a. Agency for Health Care Research and Quality b. Federal Agency for Patient Care Outcomes c. National Center for Nursing Research d. U.S. Agency for Patient Care Effectiveness

a. Agency for Health Care Research and Quality The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care.

A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c. Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the childs immunizations are up to date. d. A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.

a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

Key Terms

acquired immunity active immunization agent anthrax common vehicle communicable diseases communicable period disease ebola disease elimination emerging infectious diseases endemic environment epidemic epidemiologic triangle eradication Health care acquired infections (HAIs) herd immunity horizontal transmission host incubation period infection

What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Approximately 12% of the U.S. population was born in a different country. b. Hispanics are the largest minority group population. c. Households consisting primarily of intact families continue to grow. d. Mortality for both genders in all age groups declined.

a. Approximately 12% of the U.S. population was born in a different country. b. Hispanics are the largest minority group population. d. Mortality for both genders in all age groups declined. Demographic figures confirm that 12% of the current U.S. population is foreign-born, with most immigrants coming from Latin America and about half as many from Asia. Families make up about 69% of all households, a decline from 81% in 1970. Although African Americans used to be the largest minority group, as of 2003, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined.

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a. Areas where people share dressing or bathing facilities b. Daycare centers and schools c. Long-term care facilities d. Senior citizen centers

a. Areas where people share dressing or bathing facilities Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas.

Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) a. Asking questions related to health implications at policy meetings b. Calling the local health department to report problems at the hospital c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees

a. Asking questions related to health implications at policy meetings c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees Advocacy roles of the community-oriented nurse include attending policy meetings to obtain health-related information, holding public meetings (or serving on panels at meetings) to provide health-related information, serving on health-related committees, and informing local media about environmental hazards in the community.

A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d. Survey families in the community to determine whether they eat clay and how much clay they eat.

a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.

A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? a. Be sure to take a 30-minute walk each day. b. Call our office if you have any questions or concerns at all. c. Come back in 2 weeks for follow-up on your surgery. d. Continue to take the drug until it is gone, even if you're feeling better earlier.

a. Be sure to take a 30-minute walk each day. The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

a. Being bitten by an infected mosquito Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance. Vectors include mosquitoes, which can transmit the infectious agent by biting the host.

A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Interactionist theory

a. Bioecological systems theory The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time.

Which of the following are the major sources of air pollution in the United States? (Select all that apply.) a. Burning of fossil fuels b. Waste incineration c. Industrial plants d. Motor vehicles

a. Burning of fossil fuels b. Waste incineration d. Motor vehicles Motor vehicles are the greatest single source of air pollution in the United States. The burning of fossil fuels (diesel, industrial boilers, and power plants) and waste incineration are two other major contributors.

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? a. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement

a. Capitation

Key Terms

acquired immunodeficiency syndrome (AIDS) chlamydia directly observed therapy (DOT) genital herpes genital warts gonorrhea hepatitis A virus (HAV) hepatitis B virus (HBV) hepatitis C virus (HCV) HIV antibody test human immunodeficiency virus (HIV) human papillomavirus (HPV) incidence incubation period injection drug use nongonococcal urethritis (NGU) partner notification pelvic inflammatory disease (PID) sexually transmitted diseases (STDs) syphilis tuberculosis (TB)

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center.

a. Check the most recent consumer confidence report. The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies.

Which of the following statements are accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. Many families are seeing decreases in family income. d. Massive and unexpected social and economic changes have occurred.

a. Citizens are appreciating the quality of life enjoyed in the United States. c. Many families are seeing decreases in family income. d. Massive and unexpected social and economic changes have occurred. One of the social trends influencing health care is a growing appreciation of the quality of life. The first decade of the twenty-first century has added massive and unexpected changes to health, economic, and social conditions in the form of terrorist attacks, hurricanes, fires, floods, and infectious diseases. In addition to layoffs, outsourcing, and other economic forces, many families are seeing wage decreases.

Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a hazardous vacant lot c. Referring a child with toxic lead levels to a neurologist d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

a. Collecting blood specimens from preschool children to check for lead levels Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages.

A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take? a. Conducting a sexual behavior survey with the adolescents b. Establishing in-school education related to transmission of sexual infections c. Providing free condoms at schools and universities d. Providing follow-up educational programs for those diagnosed with an STI

a. Conducting a sexual behavior survey with the adolescents Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? a. Contracting b. Crisis intervention c. Empowerment d. Strategic planning

a. Contracting Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

A new mother is a full-time college student who lives with her parents, because the babys father has been imprisoned related to theft and drug abuse. The infants grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this familys needs? a. Developmental b. Interactional c. Structure-function d. Systems

a. Developmental Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughters (and grandchilds) needs.

A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a. Does your 4 year-old have a booster seat in the car? b. Have you noticed any physical problems as you go about your daily routine? c. What concerns do you have today? d. Why did you decide to come in for a checkup?

a. Does your 4 year-old have a booster seat in the car? Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident.

A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Equal rights c. Primary prevention d. Risk protection

a. Environmental justice Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities. The Environmental Justice Act would be used in support of the nurses position.

A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

a. Facilitation of interprofessional care The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors.

Which of the following provides evidence that the U.S. health care system is in crisis? (Select all that apply.) a. Full-time employees may not have health insurance as a benefit. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors.

a. Full-time employees may not have health insurance as a benefit. c. Long work hours and provider fatigue are a major factor in medical errors. Although 61% of the non-elderly population continues to obtain health insurance through their employer as a benefit, employment does not guarantee insurance. As a result of the nursing shortage, nurses work longer hours and provider fatigue is a major factor in errors. The Institute of Medicines (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care.

Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

a. Function and structure change over time. The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the twenty-first century exciting and challenging.

A male client visits the clinic office complaining of a yellow, green discharge from his penis. Which of the following STDs has the client most likely contracted? a. Gonorrhea b. Syphilis c. Herpes simplex virus 2 d. Human papillomavirus

a. Gonorrhea The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility.

A public health nurse is counseling a client who is trying to determine if a health maintenance organization (HMO) or preferred provider organization (PPO) will provide the better health care coverage. Which of the following best describes one main difference between these two types of coverage? a. HMOs provide comprehensive care to members for a fixed fee. b. PPOs designate providers that members can choose. c. PPOs provide one model of care delivery. d. HMOs provide financial incentives to encourage members to select HMO providers.

a. HMOs provide comprehensive care to members for a fixed fee.

Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

a. HSV-2 is a viral infection that is both chronic and incurable. Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. I wouldn't sit next to someone with HIV. b. Having unprotected sex with someone who is infected spreads HIV. c. Sharing needles when shooting up drugs spreads HIV. d. Transfusions of blood products that are contaminated can spread HIV.

a. I wouldn't sit next to someone with HIV. HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. Worldwide, the largest number of HIV infections result from heterosexual transmission.

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? a. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement

a. Managed care plan

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. Wait, said the new mother. Why is my son getting two shots? Which of the following statements would be the best response by the nurse? a. One injection protects your son, while the other encourages his body to build up immunity. b. One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him. c. Since youve already been infected with the virus, your son needs twice as much protection. d. The second shot is just to make sure the first one works.

a. One injection protects your son, while the other encourages his body to build up immunity. Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection.

A nurse has been successful in creating improvement in a family's health. Which of the following characteristics is most likely displayed by the nurse? a. Skilled at recognizing and strengthening the family's competencies b. Skilled at obtaining referrals and resources for the family c. Skilled at communication and interpersonal relationships d. Skilled at assessing and naming the familys main problems

a. Skilled at recognizing and strengthening the family's competencies The nurses approach to the family should be positive and focused on competencies rather than on problems or deficits.

Which of the following demographic factors is expected to have the greatest influence on national health care spending? a. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

a. The aging population

A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.) a. The family wont have to travel. b. It is cheaper for the family because of reimbursement requirements. c. Meeting at home is much more convenient for the family. d. The nurse wont be distracted by other clients or responsibilities. e. It would save money for the nurse and the clinic.

a. The family wont have to travel. c. Meeting at home is much more convenient for the family. Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurses employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) a. The nurse can assess the family environment. b. The family will feel more comfortable. c. Families typically welcome others into their home. d. More family members can typically be involved.

a. The nurse can assess the family environment. b. The family will feel more comfortable. d. More family members can typically be involved. Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the familys home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.

A nurses Mantoux test is positive for exposure to tuberculosis. Which of the following conclusions should be drawn by the nurse? a. The nurse has been exposed to tuberculosis. b. The nurse has tuberculosis. c. The positive test result probably is due to a problem in the testing process. d. The test is inaccurate and needs to be repeated.

a. The nurse has been exposed to tuberculosis. An individual who tests positive has been exposed and may be infected, but if that person shows no clinical signs, the person is not diseased. Infection refers to the entry, development, and multiplication of the infectious agent in the susceptible host. Disease is one of the possible outcomes of infection. People with latent TB have no symptoms, are not infectious, and can continue on with life. They may develop active TB. A nurse who interacts with clients may receive INH for a year as a precaution.

A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.) a. The reason for the visit b. Everything the nurse knows about the family c. How many visits will be planned d. The cost of the visit and how this may be paid

a. The reason for the visit d. The cost of the visit and how this may be paid The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the familys situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the familys willingness for a home visit. If the family does not have a phone, mail can be used to share information.

A home health nurse who is visiting a family for the first time asks, Could we review your extended family and other persons or groups with whom you interact each week? Which of the following provides the best rationale for the nurse asking this question? a. To assess the family's environment and social resources and risks b. To communicate with relevant others as needed c. To determine financial assets available to the family in case of serious need d. To understand the extended family relationships

a. To assess the family's environment and social resources and risks The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a. Why the data are needed b. How best to interview each individual in the family c. The most convenient time for you to visit the family d. The rationale or purpose of the visit

a. Why the data are needed c. The most convenient time for you to visit the family d. The rationale or purpose of the visit Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. It can be assumed that the nurse would already know agency policies. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual). Therefore, the preferred time to visit is when most family members will be available. Similarly, it is more informative to see the family in their home setting than to establish a different site for the visit.

Which of the following best describes the use of genomic health care? a. Assists with understanding family relationships b. Assists with determining familial health risks c. Useful in learning about environmental risk factors d. Useful in detecting risk for developing cancer

b. Assists with determining familial health risks Genomic health care can give health care providers the tools that they need to use a persons unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a persons risks for the same diseases that other family members experienced. Genomic health care is broader than detecting risk for developing cancer.

A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. Dont you know HIV children are immunosuppressed? she exclaimed. Which of the following would be the nurses best response? a. All children have to have these immunizations before they can attend school. b. Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized. c. Im so sorry; I forgot for a moment your child was HIV positive. d. The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them.

b. Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized. Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Many states do have a no shots, no school law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the families strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional

b. Building on the families strengths and resilience The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used. Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the familys strengths gives the nurse assets on which to draw in planning care.

How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their providers permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their providers permission Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers).

When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs. b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. c. The presence of an STD in women with cervical cancer may lead to congenital defects in offspring. d. The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.

b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information.

6. Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The prevalence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

b. Children are more susceptible to environmental toxins because of their smaller size. Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink. Autism has increased 1000% since the mid-1980s. However, there is not a direct link to environmental toxins discussed in the text. The prevalence of asthma is at an all time high. Only about 5% of all cancers are strongly associated with heredity.

Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the clients name, address, or contact information? a. Client doesn't actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test and collection agencies will not be able to harass them. d. Client wants to be sure care providers don't share results with their family.

b. Client may be engaged in illegal activities (drug use). An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination.

A nurse enters a familes home for the first time. Which of the following goals should the nurse have? (Select all that apply.) a. Assessing each family member in detail both physically and psychologically b. Collaborating with the family to establish goals and a plan for meeting them c. Determining the exact relationship between each member of the family d. Exploring the families perception of their problems and needs

b. Collaborating with the family to establish goals and a plan for meeting them d. Exploring the families perception of their problems and needs During the beginning phase of the nurse-family interaction, three activities occurmutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.

A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this, which of the following actions would be taken by the nurse? (Select all that apply.) a. Advertise in the media throughout the entire surrounding area. b. Communicate the correct information in a timely fashion. c. Share all the data found on the community assessment. d. Talk to those affected or those worried about the situation.

b. Communicate the correct information in a timely fashion. d. Talk to those affected or those worried about the situation. Sharing all the data would be overwhelming, and much of the data might not be relevant. Using epidemiological statistics would not be meaningful to those without the education or experience to be able to draw an appropriate conclusion. Instead, the correct information must be given in a language the audiencenamely, those at risk or worried about the riskcan understand. Use the communication channels the neighborhood residents use and meet at a common meeting place for the community. It is wasteful of resources to advertise in media throughout a wider region or to meet at a central regional facility when only community residents will be interested or involved.

12. African-American females have a higher mortality rate from breast cancer than White females. This is an example of: a. Projection b. Disparity c. Racism d. A sentinel event

b. Disparity Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.

Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a cauliflower appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

b. Elevated growths with a cauliflower appearance HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter.

Which of the following accurately describes a challenge that will be faced by health care providers in the twenty-first century? a. Lack of available space to provide care for clients in hospitals b. Emergence of new and old communicable and infectious diseases c. New guidelines for chronic disease management d. Increased use of technology leading to a decreased need for health care workers

b. Emergence of new and old communicable and infectious diseases

Which of the following components of the epidemiological triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

b. Environment The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the womans body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection.

Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

b. Essential care available to all community members, which encourages self-management Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford.

Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurses plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurses plan. d. Nurse has informed family how to complete the required actions.

b. Family is capable of the required actions. Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The plan cannot be the nurses choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.

Which of the following groups pays the largest amount for health care in the United States today? a. Consumers b. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

b. Federal and state government

A community health nurse is trying to increase enrollment in SCHIP. Which of the following interventions would be most effective? a. Explaining the program to children enrolled in public school systems b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments c. Having a newspaper campaign with information and applications printed in the newspaper d. Sending literature about the SCHIP program home with schoolchildren each year

b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments SCHIP builds on Medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid. Thus, the population that needs to be targeted for SCHIP is those being seen for medical care who do not have insurance.

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Conduct health risk assessments of randomly selected individuals b. Perform a windshield survey c. Review facility permits and consumer confidence reports d. Survey community members

b. Perform a windshield survey Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides first-hand information about the community and areas of concern that must be investigated.

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers complaints and general unhappiness d. Increased pressure to decrease overlap in services

b. Increased focus on emergency preparedness and response Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies.

Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

b. Infectious diseases In countries with higher standards of living, where people live longer, chronic diseasesheart disease, cancer, and strokeare the leading causes of death. Infectious diseases, however, are still the number-one cause of death worldwide.

A nurse is concerned about the prevalence of tuberculosis among migrant farmworkers. Which of the following activities would be best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

b. Initiate directly observed therapy (DOT) for tuberculosis treatment. Tertiary prevention is carried out among persons already infected with the disease. In this instance DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems.

Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs b. It can cause problems in infants born to infected mothers c. It is not frequently seen in the United States d. It is so difficult and expensive to treat

b. It can cause problems in infants born to infected mothers Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers, although it is rather easily treated with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

b. It may be difficult to find a convenient time for all family members to be present. It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family.

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) b. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

b. Low socioeconomic status

A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family

b. Making referrals when appropriate It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure.

A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a. I make most of the decisions so the kids don't notice much difference. b. My daughter is pretty independent; she's active in both sports and theater. c. My son is old enough to get a job and help pay all these medical bills. d. My wife taught our daughter how to cook simple meals.

b. My daughter is pretty independent; she's active in both sports and theater. Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

A nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? a. CINAHL b. National Library of Medicine c. State health department d. Closest local library

b. National Library of Medicine Technology helps us understand environmental threats. The National Library of Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms.

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as laboratory services and equipment. Which of the following best describes this part of Medicare? a. Part A b. Part B c. Part C d. Part D

b. Part B

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? a. Applying for a grant to establish a day care center to serve dependent older adult clients living with working families b. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare

b. Persuading legislators to pass a bill offering health care financial aid to families at risk

An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? a. Avoidance of alcohol b. Regular physical exercise c. Daily consumption of calcium-rich foods d. Monthly self-breast and testicular exams

b. Regular physical exercise Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a. The child develops allergies with sneezing. b. The child persists in biting behavior or is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school.

b. The child persists in biting behavior or is unable to control body secretions. d. There is an outbreak of chickenpox in the school. Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because 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. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Strong disapproval by parents of well children is an opportunity to teach these persons how HIV is transmitted.

The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The families basic needs are being met. c. The couples in-laws are unavailable to share their expertise about child care. d. The married couple is excited about their first baby.

b. The families basic needs are being met. In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepares food will probably prepare meals based on the diet plan for all the family. d. The family member who prepares food will probably prepare special meals for the newly discharged member.

b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. However, if family members are supportive, they will want to try to help the ill member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill members needs without making drastic changes in the overall eating patterns of the family.

A client with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a. Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered. b. This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs. c. This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember. d. Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs.

b. This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs. It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment.

10. Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide exposure to oversight d. To monitor employee safety

b. To ensure compliance Ensuring compliance refers to the process of making certain that permitting requirements are met. Although this activity may be seen as a type of monitoring, the question asks for the purpose, which is to ensure compliance. Enforcement involves penalties such as fines or facility closure.

Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families? a. Understanding of same sex marriage laws within the state b. Understanding of personal feelings of working with members of this community c. Assessment of the family structure within the LGBT family d. Assessment of sexual orientation in a safe environment

b. Understanding of personal feelings of working with members of this community Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, Im sorry to bother you when you're not feeling well, but I need to ask you a few questions. Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. Do you know how you got this infection? b. Who lives with you? c. Where are you employed? d. Where do you usually eat?

b. Who lives with you? c. Where are you employed? The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the clients place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others.

Key Terms

behavioral risk, p. 334 biological risk, p. 329 contracting, p.340 economic risk, p. 333 empowerment, p. 341 Environmental risk, p. 327 family crisis, p. 328 family health, p. 326 Genomics, p. 332 health risk appraisal, p. 327 health risk reduction, p. 327 health risks, p. 327 home visits, p. 337 in-home phase, p. 338 initiation phase, p. 337 life-event risks, p. 329 policy, p. 334 post-visit phase, p. 340 previsit phase, p. 338 social risks, p. 333 termination phase, p. 340 transitions, p. 329

At the local level, health departments provide care that is mandated by __________ and __________ regulations.

by state and federal regulations.

Which of the following families is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b. A man knows that his grandfather, father, and older brother all died of cardiac disease. c. A man is currently unemployed and despairs about finding a position. d. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

c. A man is currently unemployed and despairs about finding a position. A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a. A broken line b. A dashed line c. A solid line d. Two parallel lines

c. A solid line Marriage is indicated by a solid line on a genogram

A nurse asks a family member, What has changed between you and your spouse since your childs head injury? Which of the following focuses of the family is the nurse assessing? a. The context b. The client c. A system d. A component of society

c. A system When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions.

Which of the following best describes a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

c. A woman is pregnant with her first child. Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.

How does the Department of Agriculture promote the health of U.S. citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food, so no foodborne illnesses can occur c. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists

c. By collaborating with others to provide food or food stamps to needy persons The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat.

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business man who works for a large corporation d. A 32-year-old man who works part-time at a small business

d. A 32-year-old man who works part-time at a small business

A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. Ask the staff in employee health if there have been any other complaints. b. Call the local health department about any recent problems at the hospital. c. Check the material safety data sheet on any chemicals you have used recently. d. See the nurses health care provider for a complete work-up.

c. Check the material safety data sheet on any chemicals you have used recently. Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling.

7. A nurse focuses on the care of the individual while viewing the clients family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurses view represent? a. Client b. Component of society c. Context d. System

c. Context Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the family as context concept, the family serves as either a resource or a stressor to individual health and illness.

In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) a. Conferring appropriate social status b. Educating the younger members c. Ensuring physical and mental health d. Fostering interpersonal relationships and support

c. Ensuring physical and mental health d. Fostering interpersonal relationships and support Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, conferring social status. Today, however, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health.

A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a. Assess the family and the home setting for both strengths and problems. b. Determine the family's expectations of a home visit. c. Establish rapport between the nurse and the family. d. Engage in extended social interaction as would be expected from any guest.

c. Establish rapport between the nurse and the family. With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurses self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the clients expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a. Family systems b. Structural-functional c. Family developmental d. Interactionist

c. Family developmental The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.

The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) a. A reassessment of resources should be done if the plan does not work. b. Individual family members must all be willing to make the plan their first priority. c. Goals must be realistic and feasible. d. Ongoing negotiation is central to the process.

c. Goals must be realistic and feasible. d. Ongoing negotiation is central to the process. In contracting, an important aspect is obtaining the familys view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The familys inability to change as easily and quickly as they had hoped does not mean the plan is not workableonly that more time and effort may be necessary.

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? a. Insurance resources b. Health care rationing c. Health economics d. Medical technology

c. Health economics

Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Herpes

c. Hepatitis B At the time of this writing, HBV infection can be prevented by immunization; vaccines for the remaining options are not yet available.

A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? a. I cant visit my husband in the hospital when Im at work all day. How can I be sure he's all right? b. My husband always handled our finances. Now that he's gone, I'll have to learn how to do this. c. I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children. d. What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?

c. I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children. A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable too conceive of how to cope.

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? a. A proportion of actual cost arbitrarily decided by the Medicare panel b. The federal budget constraints for the current fiscal year c. Hospital and health care provider feedback and political persuasion d. Prospective payment scale based on the medical diagnosis

d. Prospective payment scale based on the medical diagnosis

Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered

c. Incidence of school absenteeism Syndromic surveillance systems use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks. These systems incorporate factors such as the previously mentioned temporal and geographic clustering and unusual age distributions with groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs, skin rashes, gastrointestinal symptoms) with the goal of detecting early signs of diseases that could result from a bioterrorism-related attack. Syndromic surveillance systems may include tracking emergency department visits sorted by syndrome symptoms as well as other indicators of illness including school absenteeism and sales of selected over-the-counter medications. In recent years, the tracking of cold medicines used to make crystal methamphetamine has received considerable attention.

A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influenza. Which of the following phases of the nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation

c. Intervention Giving immunizations is an intervention that will increase the number of people who will be vaccinated. Intervention includes coordinating medical, nursing, and public health actions to meet the clients needs.

A nurse is explaining the health care system in the United States to a group of physicians visiting from South America. How would the nurse best describe the current health care system? a. It is a logical, rational approach to meeting expressed needs while still trying to control costs. b. It is a system in the process of reform as problems have become increasingly apparent. c. It is divided primarily into two components: private health care and public health care. d. It is the best in the world with outstanding research and high-technology care available to all.

c. It is divided primarily into two components: private health care and public health care.

A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, My mom said she couldn't see you and you should go away. Which of the following actions should be taken by the nurse? a. Demand the child let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch with the nurse . d. Point out that legally once an appointment has been made the mother needs to be seen.

c. Leave a card with information on how to get in touch with the nurse . The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

Which of the following best explains how the government inadvertently encourages low-income persons to use emergency departments as their primary care provider? a. A huge amount of paperwork is required when Medicaid clients go to a physician's office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. c. Legally, emergency departments must see clients even if clients can't pay. d. Physicians' limited office hours make them unavailable during evenings and weekends.

c. Legally, emergency departments must see clients even if clients can't pay.

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. Lets go through these medications and see which ones we can delete. b. You can get these medicines at this clinic for free. c. Lets see if we can get some help from Medicare to help you pay for these medications. d. These medications are important. Do your best to pay for them.

c. Lets see if we can get some help from Medicare to help you pay for these medications. This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions.

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department c. Medicaid d. Medicare

c. Medicaid

A community is experiencing an epidemic of the measles. The nurse is trying to determine if this problem is happening in other communities as well. Which of the following resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Morbidity and Mortality Weekly Report d. Weekly National Report of Communicable Diseases

c. Morbidity and Mortality Weekly Report Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The National Notifiable Diseases Surveillance System (NNDSS) data are collated and published weekly in the Morbidity and Mortality Weekly Report (MMWR).

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. Why, he asks, should my tax dollars be used to pay for their children to be immunized? Which of the following would be the best response by the nurse? a. Immunizations are required by law, and if their parents cant afford it, you and I will have to pay for it. b. Its just the right thing to do. c. Only by making sure most kids are immunized can we stop epidemics that might hurt all of us. d. Were a religious God-fearing community, and we take care of each other.

c. Only by making sure most kids are immunized can we stop epidemics that might hurt all of us. Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease.

A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his appliances with new energy-efficient ones.

c. Reduce, reuse, and recycle. All citizens can engage in minimizing their impact on the environment by reducing, reusing, and recycling. Although it would be nice to replace all appliances for energy-efficient newer models, most people cant afford thatfurthermore, it is an environmental issue to discard the used models. Similarly, downsizing to a smaller living space could help the environment, because the nurse would use less energy, but again, not everyone can afford all the expenses involved in moving. On the other hand, all persons can reduce, reuse, and recycle the individual products they currently consume.

A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? a. Determine the family's willingness for another home visit b. Establish the purpose of the visit c. Review the family's learning and other accomplishments of the visit d. Review the family record and reason for referral

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

A public health nurse is assisting the community in dealing with the effects of lead paint poisoning. Which of the following activities would the nurse most likely complete? (Select all that apply.) a. Administering medications to those with signs of lead poisoning b. Assessing community members for any health problems c. Setting up a blood screening program with the local health department d. Encouraging local landlords to improve the condition of their housing

c. Setting up a blood screening program with the local health department d. Encouraging local landlords to improve the condition of their housing The nurses role is to understand the roles of each respective agency and organization, know the public health laws, and work with the community to coordinate services to address the communitys needs. Other needed interventions include organizing a blood-lead screening program through the local health department, educating local health providers to encourage them to systematically test children for lead poisoning, and working with local landlords to improve the condition of their housing stock.

Which of the following services would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulance

c. Stay in skilled nursing facility

In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System

c. Structure Family structure refers to the characteristics and demographics (gender, age, number) of individual members who make up the family. Structure defines the roles and the positions of family members.

A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a. Confirm the reason for the assessment. b. Demonstrate culture awareness. c. Take time to build trust. d. Understand the family dynamics.

c. Take time to build trust. Assessment is interactive. As you are evaluating families, they are evaluating you. Too much disclosure during the early contacts between the family and nurse may scare the family away. Slow the process down, and take time to build trust.

An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention.

Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a. What helps you to cope with situations involving your wife's cancer? b. How has your child's illness affected the behavior of your other children? c. Tell me about any illnesses your other family members have. d. Who do you turn to for support outside your immediate family?

c. Tell me about any illnesses your other family members have. Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health.

Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

c. The client who is employed and often works 12 hours a day without moving from the computer desk Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.

Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center.

c. The client who is employed and often works 12 hours a day without moving from the computer desk Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesnt move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease

A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a. Side effects of PrEP include extreme lethargy and joint pain. b. PrEP has been shown to be effective in preventing transmission of the disease from sharing needles. c. The effectiveness of PrEP will depend on your adherence to the medication regimen. d. PrEP will prevent you from contracting HIV and Hepatitis B.

c. The effectiveness of PrEP will depend on your adherence to the medication regimen. Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b).

Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear results will be positive. b. They avoid the problem (maybe it will go away). c. They don't recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

c. They don't recognize their symptoms as possibly being due to HIV. When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV.

12. A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. Is anyone else in your family having these symptoms? b. Can you tell me about your house or apartment? c. What jobs have you held longest? d. Where do you live?

c. What jobs have you held longest? An exposure history should identify current and past exposures, have a preliminary goal of reducing or eliminating current exposures, and have a long-term goal of reducing adverse health effects. The I PREPARE mnemonic consigns the important questions to categories that can be easily remembered. Asking about previous employment helps to answer the P of past work.

A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? a. Did any of the hunters in your family kill a deer this year? b. How do you keep your rifles safe from curious children? c. Where do you shoot with your handguns? d. Where do you keep your rifles locked when it is not hunting season?

c. Where do you shoot with your handguns? Risk reduction is a complex process that requires knowledge of risks and families perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the familys perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

In the United States, which demographic group has the highest risk for HIV infection? a. African-American homosexual men b. Hispanic IV drug abusers c. White homosexual men d. White lesbians

c. White homosexual men The largest number of new HIV infections in 2009 (11,400) were in white men who had sex with other men (MSM), and this was followed by black MSM (10,800).

Key Terms

capitation, p. 146 covered lives, p. 146 diagnosis-related groups (DRGs), p. 136 economics, p. 130 effectiveness, p. 147 efficiency, p. 147 enabling, p. 144 fee-for-service, p. 146 gross domestic product (GDP), p. 138 health care rationing, p. 131 health economics, p. 130 human capital, p. 133 inflation, p. 130 intensity, p. 134 managed care, p. 145 means testing, p. 140 Medicaid, p. 132 medical technology, p. 134 Medicare, p. 139 prospective payment system (PPS), p. 142 public health economics, p. 130 retrospective reimbursement, p. 146 return on investment, p. 133 safety net providers, p. 132 third-party payers, p. 134

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility Erythema alone does not indicate a positive finding. For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10 mm induration would be a positive finding in an immigrant from a region with high TB infection. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

Which of the following individuals would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English b. A 25-year-old female with health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployed

d. A 30-year-old male who is unemployed

A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test. b. A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure. c. A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood. d. A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml.

d. A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml. AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? a. Education of health care providers moved into universities. b. People finally had enough money to pay for medical care. c. The improved outcomes of hospital care were recognized. d. Advances were made in safe water, sewage disposal, and pasteurization of milk.

d. Advances were made in safe water, sewage disposal, and pasteurization of milk.

A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurses commitment to the family and enter the home quickly. d. Drive away and notify the family from a safer location.

d. Drive away and notify the family from a safer location. Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

he nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation

d. Evaluation In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. If you chose assessment, understand that this would have been done earlier in the process because assessment was needed to determine that a problem existed and that interventions were needed.

16. Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy

d. Family policy Government actions that have a direct or indirect effect on families are called family policy.

Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental theory b. Structural-functional theory c. Family role theory d. Family systems theory

d. Family systems theory The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory

Of the four main factors that affect health, which is the least important? a. Environment b. Human biology c. Lifestyle choices d. Health care system

d. Health care system

A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

d. Most of the conversation was between the father and the eldest daughter. Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment d. Neglecting to order certain tests or treatment to minimize cost to the provider

d. Neglecting to order certain tests or treatment to minimize cost to the provider

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

d. Occupational Safety and Health Act The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. Others may contribute to safety but do not have the full oversight of OSHA.

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

d. Passive immunity Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a nonimmunized individual, such as the transfer of antibody by administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination

During which phase of the home visit does the nurse document what was accomplished? a. Pre-visit phase b. In-home phase c. Termination phase d. Post-visit phase

d. Post-visit phase A major task of the post-visit phase is documenting the visit and services provided.

A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations of Healthy People 2020 d. Services mandated by the state government

d. Services mandated by the state government At the local level, health departments provide care that is mandated by state and federal regulations.

A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching

d. Skin rash without itching Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

A client who is very upset says to the nurse, But we always used a condom! How could I have genital warts? Which of the following would be the best response by the nurse? a. Are you positive you always used a condom? b. Condoms don't always work. c. The condom might have had a tear in the latex. d. Skin to skin contact to a wart may have occurred outside the area that the condom covers.

d. Skin to skin contact to a wart may have occurred outside the area that the condom covers. The challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur.

A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss

d. Taking a defined time off of work for family events without fear of job loss The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.

A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? a. Apply for emergency financial assistance on the family's behalf. b. Arrange for community members to assist with child care. c. Invite the mother to join a cancer support group. d. Teach the family how to navigate the health care system

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

A nurse is trying to maximize the quality of life of her clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition d. Teaching a high school boy about sexually transmitted infections and proper condom application

d. Teaching a high school boy about sexually transmitted infections and proper condom application

The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the mans married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the family? a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c. There is no family here, only three adults sharing resources between themselves and two biologically related children. d. The family includes whoever the adults state are family members.

d. The family includes whoever the adults state are family members. Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A family may range from the traditional nuclear model with extended family to such postmodern family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur? a. The results will probably be negative for HIV. b. The results will probably be positive for HIV. c. The probability of disease is so low there is no reason to be tested. d. The test results wont be reliable so soon after exposure.

d. The test results wont be reliable so soon after exposure. It may take up to 6 months after exposure to the HIV virus before an HIV antibody test can test positive, although most infected people will test positive within 3 months. A negative test, therefore, is not a reliable indicator of infection status if exposure is very recent. The incubation period or the time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease may be between 10 and 15 years for AIDS.

A client was clearly very relieved when an HIV test came back negative. Thank goodness. Ive had sex several times without a condom, and when one of my friends said he was sick, I think I panicked. Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV-free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months. The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks. All persons who have an STD test should be counseled about risk-reduction activities before and after the test is done.

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

d. There is no treatment for HBV, which can be a very serious illness. Both HBV and HIV are blood-borne pathogens. Health care workers may be exposed to either from needle stick injuries and mucous membrane splashes. However, HBV remains alive outside the body for a longer time than does HIV and thus has greater infectivity. The virus can survive for at least 1 week dried at room temperature on environmental surfaces, and therefore infection control measures are crucial in preventing transmission. There is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease.

A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacologist d. Toxicologist

d. Toxicologist Toxicology is the basic science that studies the health effects associated with chemical exposures. The other specialists would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes.

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis

d. Tuberculosis HIV-infected persons who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB.

A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities

d. Unhealthy activities Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded. b. Nurses must be recognized and rewarded for health promotion efforts. c. Nursing research into patient care outcomes must be expanded and funded. d. Universal access to essential health services should be available for all citizens.

d. Universal access to essential health services should be available for all citizens. The ANAs position is based on the belief that health care is a basic human right. Thus, a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents.

The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. How many children do you have, and who is the father of each? b. Is there a register of families who are members of this commune? c. Tell me about your significant other. d. Who are the members of your and your childs family?

d. Who are the members of your and your childs family? The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning.

A high school student is planning to volunteer at the hospital after school, so she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a. I will be using tiny tines to administer the TB antigen to the skin on your arm. b. Notify the clinic immediately if you experience any redness or itching at the test site. c. The areas should be kept dry until you return; cover it with plastic wrap when bathing. d. You will need to return in 2 to 3 days to have any reaction interpreted.

d. You will need to return in 2 to 3 days to have any reaction interpreted. The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters.

Key Terms

dysfunctional families, p. 309 family, p. 307 family demographics, p. 307 family functions, p. 307 family health, p. 309 family nursing, p. 307 family nursing assessment, p. 319 family nursing diagnosis, p. 317 family nursing theory, p.310 family structure, p. 308 functional families, p. 309 presentation, p. 316