Updated Exam 4

A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: A. advocacy. B. culturally competent care. C. partnership. D. social justice.

A - Advocacy refers to those actions one undertakes on behalf of another. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that lead to improved public health services for these populations.DIF: Cognitive Level: ApplicationREF: Page 380

Vulnerable populations may be exposed to more than one hazard at a time. This is known as: A. cumulative risk. B. disenfranchised populations. C. resilience. D. underserved populations.

A - Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Risks come from environmental hazards (e.g., lead exposure from lead-based paint from peeling walls or that which has been used in toy manufacturing or melamine added to milk supplies), social hazards (e.g., crime, violence), personal behavior (e.g., diet, exercise habits, smoking), or biological or genetic makeup (e.g., congenital addiction, compromised immune status).DIF: Cognitive Level: KnowledgeREF: Page 375

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? A. Bed-wetting episodes B. Desire to return to school C. Fantasies of denial D. Increased playfulness with peers E. Thumb sucking

A, c, e. The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to parents or have nightmares and fantasies that the disaster never occurred. School-related problems may also develop, and the child may not be able to concentrate or may even refuse to attend school.DIF: Cognitive Level: ApplicationREF: Pages 258-259

Which of the following are factors that may contribute to vulnerability? A. Exercise habits B. Crime C. Peeling lead paint D. Social isolation E. Illiteracy

A,b,c,d,e - Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problemsDIF: Cognitive Level: KnowledgeREF: Pages 375, 376

A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? A: Cultural B: Environmental C: Political D: Social

A: Cultural. Cultural attitudes are the beliefs and perspectives that a society values. Perspectives about individual responsibility for health and well-being are influenced by the prevailing cultural attitudes. The media communicate thoughts and attitudes through literature, film, art, television, and newspapers.

A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population? A: Migrant farmworkers B: Seasonal farmworkers C: Underinsured D: Undocumented aliens

A: Migrant farmworkers. A migrant farmworker is a person whose principal employment is in agriculture on a seasonal basis, who has been employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode. Seasonal farmworkers work cyclically in agriculture but do not migrate. The majority of migrant and seasonal farmworkers are foreign born and predominantly Mexican (75%), coming primarily from the west central states and more recently the states of southern Mexico.

In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: A: absolutely honest about what will be reported and what the family can expect. B: authoritarian in approaching the problem. C: cautious in reporting unconfirmed reports of violence. D: sincere in concern for the victims

A: absolutely honest about what will be reported and what the family can expect. The principles of giving care to families who have experienced violence include the following: intolerance of the violence, respect and caring for all family members, safety as the first priority, absolute honesty, and empowerment. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach.

A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: A: carrying heavy book bags. B: changing to home education. C: decreasing fluid intake to avoid nausea. D: keeping up her grades.

A: carrying heavy book bags. If teens return to school, it is important for the nurse to discuss these needs: (1) using the bathroom frequently, (2) carrying and drinking more fluids or snacks to relieve nausea, (3) climbing stairs and carrying heavy book bags, and (4) fitting comfortably behind stationary desks.

A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: A: child abuse. B: depression. C: intimate partner abuse. D: parent's resentment of the preteen.

A: child abuse. To help abusive families, nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence. As children, abusers were often beaten or saw siblings or parents beaten. They learned that violence is a way to manage conflict. Both men and women who witnessed abuse as children were more likely to abuse their children. Financial solvency and support tended to decrease the incidence of child abuse.

A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: A: developmental delays. B: ear infections. C: frequent colds and infections. D: irritability.

A: developmental delays. Young children (newborn to age 5 years) are at greater risk for the most harmful effects of poverty, especially in regard to adequate nutrition and brain development. Other risk factors include maternal substance abuse or depression, exposure to environmental toxins, trauma and abuse, and poor-quality daily care.

For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: A: limitations in following treatment protocols. B: limited number of transient treatment facilities. C: transition to persistent poverty. D: use and abuse of tobacco, alcohol, and illicit drugs.

A: limitations in following treatment protocols. Homeless people devote a large portion of their time to just trying to survive. Health care is usually crisis oriented and sought in emergency departments. Those who access health care have a hard time following prescribed treatment regimes such as prescribed diets, purchasing prescriptions, or health-promotion or symptom-relief measures.

When determining whether a geographic area is rural or urban, the nurse should recognize that: : A. rural and urban areas, by relative nature, occur on a continuum. B: rural regions have fewer than six persons per square mile. C: rural residents feel isolated. D: rural areas are recreational, retirement, or resort communities.

A: rural and urban areas, by relative nature, occur on a continuum. Rural and urban residencies are not opposing lifestyles. Rather, they are a rural-urban continuum ranging from living on a remote farm, to a village or small town, to a larger town or city, to a large metropolitan area with a core inner city.

Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by: A. dependency cycle. B. health literacy. C. income level. D. race and ethnicity.

B - A new concern for public nurses and nurses in community health is whether the populations with whom they work have adequate health literacy to benefit from health education. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.DIF: Cognitive Level: KnowledgeREF: Page 381-382

Nurses often participate on field assessment teams (surveillance) during a disaster response. These assessments are crucial to best help: A. encourage good intentions of those giving aid. B. match available resources to the population's emergency needs. C. separate casualties and allocate treatment. D. provide compassion and dignity.

B - Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features. Elements of a rapid needs assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions.DIF: Cognitive Level: ApplicationREF: Page 260

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: A. anger. B. delayed stress reaction. C. inability to concentrate. D. insomnia.

B - Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations. Also, they may feel frustration and conflict if their needs seem inconsistent with those of their family and co-workers or if they have left the disaster site thinking that so much more could have been done.DIF: Cognitive Level: ApplicationREF: Page 262

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: A. environmental hazards are minimal. B. individuals must ultimately recover on their own. C. the government provides economic support. D. religious organizations must bear the burden of the community.

B - Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster. During the recovery period all involved agencies pull together to restore the institutions and properly rebuild. In the end, all of the nurses and organizations in the world can only provide partnerships with the victims of disaster. Ultimately, it is up to the individuals to recover on their own.DIF: Cognitive Level: ApplicationREF: Page 262

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? A. Anxiety B. Effects of stress on individuals C. Sense of urgency D. Scapegoating and blaming

B - The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings. Key actions by the nurse can assist others with dealing with the stress, help people cope, allay concerns and fears, identify feelings that they may be experiencing, assist others to think positively and move to the future, and prepare nursing personnel to be effective in a crisis/emergency situation.DIF: Cognitive Level: ApplicationREF: Page 257

A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family's children may qualify for enrollment in the State Children's Health Insurance Program (SCHIP). The nurse's intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides: A. direct financial subsidies for children. B. funds to insure currently uninsured children. C. outreach efforts to enroll eligible children in Medicaid. D. prospective payments for child services.

B - Title XXI of the Social Security Act provides for the State Children's Health Insurance Program (SCHIP) to provide funds to insure currently uninsured children. The SCHIP program is jointly funded by the Federal and State governments and administered by the states. Using broad Federal guidelines, each state designs its own program, determines who is eligible for benefits, sets the payment levels, and decides upon the administrative and operating procedures. The program is subject to change when states undergo budget reductionsDIF: Cognitive Level: ApplicationREF: Page 379

A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for: A. disenfranchisement. B. health disparities. C. loss of independence. D. resilience.

B - Vulnerable populations often are more likely than the general population to suffer from health disparities (i.e., wide variations in health services and health status among certain population groups). The less than adequate care experienced by these groups can be defined by age, gender, race or ethnicity, education or income, disability, geography, or sexual orientation. Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or with the larger society.DIF: Cognitive Level: ApplicationREF: Pages 375-376

Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. The nurse should be aware that marijuana has which of the following characteristics? A. Decreases appetite B. May lead to tolerance C. Is highly toxic D. Has little quality control E. Is a safe therapeutic agent

B, D, E Compared with the other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. However, because of its illegal status, there is little quality control, and a user may consume contaminated marijuana that may cause problems. Tolerance can develop, as well as physical dependence; however, withdrawal is benign.DIF: Cognitive Level: KnowledgeREF: Page 439

Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response? A. Disillusionment and reconstruction is most associated with response efforts. B. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. C. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. D. Disillusionment is the longest phase in the stress reaction process. E. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

B, c, e - The first two phases, the Heroic and Honeymoon phases, are most often associated with response efforts. The latter two phases, Disillusionment and Reconstruction, are most often linked with recovery. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Survivors will gather to share experiences and stories. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. The last phase, Reconstruction, is the longest. Homes, schools, churches, and other community elements need to be rebuilt and reestablished.DIF: Cognitive Level: KnowledgeREF: Page 259

An eighth-grader is brought to the emergency department by a parent for unusual skin blistering and discoloration around the nose and lips. The parent states that the child will not say what caused the injury. The nurse should consider the possible use of: A. crystallized methamphetamine B. Inhalants C. MDMA - ecstasy D. PCP (phencyclidine).

B. Inhalants. Inhalants are often among the first drugs that young children use. The primary abusers of most inhalants are adolescents who are 12 to 17 years of age. Use often ends in late adolescence. The 2008 National Survey on Drug Use and Health found that 729,000 persons age 12 or older had used inhalants for the first time in the past 12 months and 70% of them were under the age of 18. Depending on the dose, the user may feel a slight stimulation, less inhibition, or even lose consciousness. There is a link between school performance and use of an inhalant. Other signs include paint or stains on clothes or the body; spots or sores around the mouth; red or runny eyes or nose; chemical breath odor; a drunk, dazed, or dizzy appearance; nausea and loss of appetite; and finally anxiety, excitability, and irritability.DIF: Cognitive Level: ApplicationREF: Page 440

Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is a disadvantage to the use of Methadone? A. Methadone is inexpensive. B. Methadone carries a risk of overdose. C. Methadone prevents relapse. D. Methadone is long acting and effective orally.

B. Methadone carries a risk of overdose. Methadone maintenance is a harm reduction intervention because it reduces deviant behavior (needle-sharing practices) and introduces addicted persons to the health care system. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting, effective orally, and inexpensive with few known side effects. However, there is a risk of overdose with the use of Methadone.DIF: Cognitive Level: KnowledgeREF: Page 447

A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill? A: Assessment B: Case management C: Geriatrics D: Tertiary prevention

B: Case management. Nurses working in rural areas, including those working with migrant farmworkers, have opportunities to use many skills of nursing in community health. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models to address some of those deficits and resolve rural health disparities.

The community health nurse performs an assessment of violence by observing which of the following community characteristics? (Select all that apply.). A: Presence of social support networks B: Crime rates C: Levels of unemployment D: Presence of physical disabilities in individuals E: Presence of family violence

B: Crime rates C: Levels of unemployment Identification of risk factors is an important part of primary prevention used by nurses who work with clients in a variety of settings. Although abuse cannot be predicted with certainty, several factors influence the onset and support the continuation of abusive patterns. Assessing for violence in a community context is completed by observing community characteristics inclusive of crime rates, unemployment levels, lack of neighborhood resource and support systems, and a lack of community cohesiveness. Individual factors include the presence of physical disability and familial factors are those related to violence and other family factors.

A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? A: Emotional abuse B: Emotional neglect C: Physical abuse D: Physical neglect

B: Emotional neglect Neglect is more difficult to assess than is abuse. Emotional neglect is the omission of basic nurturing, acceptance, and caring essential for healthy personal development. These children are largely ignored or in many cases treated as a nonperson. It is difficult for a neglected child to feel a great deal of self-worth because the parents have not demonstrated that they value the child. Astute observations of children, their homes, and the way they relate to their caregivers can provide clues of neglect.

Rural residents appear to have a more persistent, endemic level of depression. The factors that may contribute to this level of depression may be related to which of the following? (Select all that apply.). A: Crisis intervention B: Gaps in continuum of mental health services C: Sufficient number of mental health services D: Tolerance for destructive coping behaviors E: Trust in the health care professionals

B: Gaps in continuum of mental health services, D: Tolerance for destructive coping behaviors. There appears to be a more persistent, endemic level of depression among rural residents. Factors that relate to this level of depression are high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.

When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas? A: Large metropolitan areas B: Most rural and highly populated urban areas C: Most rural and suburban areas D: Small suburban and all urban areas

B: Most rural and highly populated urban areas. Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults occur in the most rural counties. Residents of rural areas have the highest death rates resulting from unintentional injuries in general and motor vehicle injuries in particular.

The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: A: confront the daughter when she arrives to pick the father up. B: discuss the findings with the caregivers to determine the cause of the injuries. C: educate the staff about indications of elder abuse. D: make a referral to the primary care provider for follow-up.

B: discuss the findings with the caregivers to determine the cause of the injuries. Rough handling by caregivers can lead to bruises and bleeding into body tissues because of the fragility of older adult clients' skin and vascular systems. It is often difficult to determine whether the injuries of older adults result from abuse, falls, or other natural causes. Careful assessment through both observation and discussion can help determine the cause of injuries so that proper plans for interventions can be made.

Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: A: community deterioration. B: health care costs. C: juvenile delinquency. D: population density.

B: health care costs. Violence is a public health problem that has both emotional and physical effects. Violence is the major cause of premature mortality and lifelong disability, and violence-related morbidity is a significant factor in health care costs. Violent behavior is predictable, and therefore it is preventable, especially with community action.

All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: A: fleeing to a shelter. B: homicide. C: possessive behavior. D: spontaneous abortion

B: homicide. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the greater potential for homicide, the effects on the children in the household, and the more serious long-term emotional and physical consequences. As a woman tries to leave the abusive relationship, the risk for homicide increases, creating a catch-22 scenario. A nurse encountering evidence of severe abuse needs to consider the safety of the woman and her children as the priority.

A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: A: developmental disorders. B: mental health problems. C: parental neglect. D: violence potential.

B: mental health problems. Children are at risk for disruption of normal development by biological, environmental, and psychosocial factors that impair their mental health, interfere with their education and social interactions, and keep them from realizing their full potential as adults. Children can develop depression or behavior problems in response to an actual or potential loss.

A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be: A. complicated to address. B. costly to serve. C. invisible to the community. D. resilient to the community.

C - Disenfranchisement refers to a feeling of separation from mainstream society. Groups such as the poor, the homeless, and migrant workers are "invisible" to society as a whole and forgotten in health and social planning. Vulnerable populations are at risk for disenfranchisement because their social supports are generally weak, as are their links with formal community organizations.DIF: Cognitive Level: ApplicationREF: Page 376

The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: A: 6 months for white mothers. B: 10 months for white mothers. C: 3 months for African-American and Hispanic/Latino mothers. D: 12 months for African-American and Hispanic/Latino mothers.

C: 3 months for African-American and Hispanic/Latino mothers. Violence that begins in pregnancy may continue for several years after, with increasing severity. Variations by ethnicity have also been observed during this postpartum period: intimate partner violence may peak at 3 months postpartum among African-American and Hispanic/Latino new mothers and at 18 months for white mothers. The nurse should look for physical signs of abuse, as well as for controlling or intrusive partner behavior.

It is estimated that one in 15 males becomes a father during his teen years. The nurse should be aware that many young men facing paternity have specific challenges such as: (select all that apply). A: acting as though they are interested when they are disinterested. B: avoiding prenatal care involvement. C: desiring and needing to be involved with their children. D: being rejected by the young woman's family. E: rejecting their role as a father.

C: desiring and needing to be involved with their children. D: being rejected by the young woman's family. Nurses can acknowledge and support the young man as he develops in the role of father. Young men react differently when they learn that their partner is pregnant, and it often depends on the nature of the relationship before pregnancy. Many young men will accompany the young woman to a health care center for pregnancy diagnosis and counseling. A large percentage of young men will continue to accompany the young woman to some prenatal visits and may even attend the delivery. These young men may also want to and need to be involved with their children regardless of changes in the relationship with the teen mother. It is not unusual for a young man to be excluded or even rejected by the young woman's family. He may then begin to act as if he is disinterested when he may really feel that he cannot provide resources for his child or know how to take care of the child.

A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: A: child neglect. B: family secrets. C: father-daughter incest. D: impaired family functioning.

C: father-daughter incest. Incest occurs in all races, religious groups, and socioeconomic classes. A typical pattern is as follows: The daughter involved in the parental incest is usually 9 years of age at the onset and is often the oldest or only daughter. The father seldom uses force. He is more likely to use threats, bribes, intimidations, or misrepresentation of moral standards. These children may have difficulty in social situations and demonstrate avoidance behaviors. They may also attempt to cover or protect their bodies. Therefore the nurse must be aware of these indicators in order to conduct an appropriate assessment and plan appropriate interventions.

A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in: A: delinquent behavior. B: drug use. C: field work. D: Migrant Education Program.

C: field work. Children of migrant farmworkers may need to work for the family's economic survival. Federal law does not protect children from overworking or from the time of day they work outside of school. Therefore children may work until late in the evening or very early in the morning every day of the week. These children may experience constant fatigue and are set up for failure in school.

An undocumented migrant farmworker has been diagnosed with tuberculosis (TB). The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. A major challenge that the client may face related to ongoing treatment for TB is: A: affordable care. B: discrimination. C: fragmented services. D: language barriers.

C: fragmented services. Although migrant workers move from job to job, their health care records typically do not go with them. This leads to fragmented services in such areas as TB treatment, chronic illness management, and immunization. When migrant farmworkers move, they must independently seek out new health services to continue their medications. Also, people with TB may forfeit treatment because they are afraid of immigration authorities.

The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of this rise in cases and schedules a case mapping of local: A: bars frequented by migrant workers. B: farm fields employing migrant workers. C: housing for migrant workers. D: restaurants frequented by migrant workers.

C: housing for migrant workers. Housing conditions greatly vary among states and localities. When housing costs are high, 50 farmworkers may live in one house, or three families may share one trailer. Some may live in cars or tents if necessary. Housing may lack individual sanitation, bathing, or laundry facilities. Poor-quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis.

A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: A: advocate for government programs to treat survivors. B: demonstrate the provider's commitment to address the need for services. C: increase awareness of community resources to address violence and abuse. D: increase the number of individuals identified as perpetrators.

C: increase awareness of community resources to address violence and abuse. Referral is an important component of tertiary prevention. Nurses should know about available community resources for abuse victims and perpetrators. If attitudes and resources are inadequate, it is often helpful to work with local radio and television stations and newspapers to provide information about the nature and extent of human abuse as a community health problem. People often do not seek services early in an abusive situation because they simply do not know what is available to them.

Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to: A: adult immunization rates. B: chronic respiratory illness rates. C: maternal/infant morbidity rates. D: obesity rates.

C: maternal/infant morbidity rates. HPSAs tend to have a high proportion of racial minorities and fewer specialists, such as pediatricians, obstetricians, and gynecologists, available to provide care to at-risk populations. There are extreme variations in pregnancy outcomes from one part of the country to another, and even within states.

A nurse in community health is working in a rural setting. In planning for programs to address the population's needs, the nurse should be aware that, in general, rural populations: A: engage in physical activity during leisure time. B: engage in preventive behaviors. C: perceive their overall health as less favorable. D: use seat belts.

C: perceive their overall health as less favorable. In general, people in rural areas have a poorer perception of their overall health and functional status than do urban residents. Rural residents older than 18 years assess their health status less favorably than do urban residents. Studies show that rural adults are less likely to engage in preventive behavior, which increases their exposure to risk.

The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to: A. Conduct a comprehensive assessment and formulate a plan for treatment. B. establish a long-term trust relationship to prevent disappointment. C. schedule appointments for appropriate immunizations for the children. D. use every opportunity to teach about preventive health care.

D - Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions of environmental hazards and violence and assurance of safe food and water.DIF: Cognitive Level: ComprehensionREF: Page 384

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: A. ARC disaster training. B. community preparedness. C. personal preparedness. D. professional preparedness.

D - Preparedness can take place at three levels: personal, professional, and community. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.DIF: Cognitive Level: ApplicationREF: Page 253

The major factor that has increased Florida's vulnerability to natural disasters in recent decades has been: A. El Niño. B. geography. C. trade winds. D. urbanization.

D - The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms.DIF: Cognitive Level: ComprehensionREF: Page 249

A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of: A. poverty. B. resilience. C. risk. D. vulnerability.

D - Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources.DIF: Cognitive Level: ApplicationREF: Page 376

A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of: A. disenfranchised populations. B. disadvantaged populations. C. vulnerability. D. vulnerable populations.

D - Vulnerable populations are those groups who have an increased risk to develop adverse outcomes. A vulnerable population group is a subgroup of the population, more likely to develop health problems as a result of exposure to risk or to have worse outcomes from a health problem than is the rest of the population. The risks are often cumulative risks from environmental hazards, personal behavior, or biological or genetic makeup.DIF: Cognitive Level: ApplicationREF: Page 375

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: A. immunizations. B. active tuberculosis (TB) cases. C. WIC enrollees. D. vulnerable populations.

D - When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.DIF: Cognitive Level: ApplicationREF: Page 260

In the event of a disaster, shelters are generally the responsibility of which of the following entities? A. Centers for Disease Control & Prevention (CDC) B. Federal Emergency Management Agency (FEMA) C. Public Health Service (PHS) D. Red Cross chapter

D. Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress.DIF: Cognitive Level: ApplicationREF: Pages 260-261

The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? A: Assessment level B: Design level C: Evaluation level D: Implementation level

D: Implementation level Although deinstitutionalization was noble in conception, it was bankrupt in implementation. Families and communities were not prepared to take on the treatment responsibilities they had to assume, and little education was available. Either care settings such as nursing homes, personal care settings, supervised apartments, rooming houses, single-occupancy hotels, and other similar settings were not available, or people were not educated or prepared to deal with this population.

A nurse in community health working in an inner city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: A: at home. B: full term. C: identical twins or triplets. D: low-birthweight babies.

D: low-birthweight babies. Poor pregnant women are more likely than other women to receive late or no prenatal care and to deliver low-birthweight babies, premature babies, or babies with birth defects.

A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': A: dependence on their primary care provider. B: normal sensory losses. C: reduced social contacts. D: underutilization of the mental health system.

D: underutilization of the mental health system. Older adults, because they may depend on others for care, are at risk for abuse and neglect. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underutilize the mental health system and are more likely to be seen in primary care or to be the recipient of care in institutions. The nurse can reach them by organizing health-promotion programs through senior settings or other community-based settings.

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: A: competition. B: unemployment. C: survivor guilt. D: work-related stress.

D: work-related stress. Productive and paid work is an expectation in mainstream American society. Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.

For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize drug addiction can be successfully treated, anyone may develop drug dependence, and: a. any drug can be abused. b. illegal drugs are the category of abused drugs. c. prescription drugs rarely cause dependence. d. over-the-counter (OTC) drugs are "good drugs."

a. Any drug can be abused. A health care approach to ATOD problems is the harm reduction model. This is a new public health model that nurses can use to treat individuals, families, and communities. To develop a therapeutic attitude, the nurse must realize that any drug can be abused, anyone may develop drug dependence, and drug addiction can be successfully treated.DIF: Cognitive Level: KnowledgeREF: Page 434

A client is back for his follow-up appointment and says to the nurse, "I know. I know. I drink too much, but the job is so stressful that I need to find a way to unwind at the end of the day. You would too!" The nurse should recognize that this is a primary symptom of addiction known as: a. denial. b. social drug use patterns. c. setting variable. d. coping.

a. Denial. The role of the nurse in secondary prevention is to accurately assess the client to identify substance abuse and plan appropriate interventions. A progression in drug-use patterns and related problems warns about the possibility of addiction. Denial is a primary symptom of addiction and can be demonstrated by the following: lying about use; minimizing use patterns; blaming or rationalizing; intellectualizing; changing the subject; using anger or humor; and "going with the flow" (agreeing that a problem exists, stating behavior will change, but not demonstrating any behavior change).DIF: Cognitive Level: ApplicationREF: Page 443

The nurse is evaluating a new home health client for ongoing management at home following back surgery for a traumatic injury. The client has been receiving a morphine-based drug for long-term pain management over the past 6 months. The nurse's assessment should include a plan for addressing the client's: a. drug dependence. b. drug addiction. c. substance abuse. d. opiate addiction.

a. Drug dependence. Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. This is a physiological change in the central nervous system; therefore the drug must be continued to prevent withdrawal symptoms. The morphine should be gradually tapered rather than abruptly stopped to prevent withdrawal symptoms.DIF: Cognitive Level: ApplicationREF: Page 435

A nurse in community health is following an older woman who complains frequently of migraine headaches, backaches, and GI disturbances. During a recent visit, the woman states that her adult son now lives with her. He was recently let go from his job. He enjoys hanging out with his old buddies. When he feels better he will look for a new job. Despite the added burden she really enjoys having her son around again. The nurse should explore this further to determine whether the family is: a. abusive. b. codependent. c. coping. d. estranged.

b. Codependent Drug addiction is often a family disease. People in close relationship with the addict often develop unhealthy coping mechanisms to continue the relationship. This is known as codependency, a stress-induced preoccupation with the addicted person's life, leading to extreme and excessive concern with the addict. Codependents try to meet the addict's needs at the expense of their own. Codependency may underlie medical complaints and emotional stress seen by health care providers such as ulcers, skin disorders, migraine headaches, chronic colds, and backaches.DIF: Cognitive Level: ApplicationREF: Page 446

The harm reduction approach to substance abuse focuses on health promotion and disease prevention. A primary prevention strategy that can be used by the nurse to address substance abuse under this approach is to: a. assess for recreational drug use. b. destroy the myth of good drugs versus bad drugs. c. encourage children to "just say no." d. refer to an addiction treatment program.

b. Destroy the myth of good drugs versus bad drugs. Rationale: Nurses are experts in medication administration and understand the potential dangers of indiscriminate drug use and the inherent inability of drugs to cure problems. Nurses can influence the health of clients by destroying the "good drugs versus bad drugs"myth. This means (1) teaching clients that no drug is completely safe and that any drug can be abused and (2) helping persons learn how to make informed decisions about their drug use to minimize potential harm.DIF: Cognitive Level: ApplicationREF: Page 441

Indiscriminate use of "good drugs" has caused more health problems from adverse reactions, drug interactions, dependence, addiction, and overdoses than has the use of "bad drugs." The high-risk population group that most experiences the negative consequences identified above is: a. adolescents. b. injection drug users. c. older adults. d. pregnant women.

c. Older adults. Older adults consume more prescribed and OTC medications than does any other age group. Problems with alcohol consumption, including interactions with prescribed and OTC drugs, far outnumber any other substance-abuse problem among older adults. Factors such as slowed metabolic turnover of drugs, age-related organ changes, enhanced drug sensitivities, a tendency to use drugs over longer periods, and a more frequent use of multiple drugs contribute to greater negative consequences from drug use among older adults.DIF: Cognitive Level: ComprehensionREF: Pages 444-445

A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of: a. drug abuse. b. drug addiction. c. substance abuse. d. adverse drug reaction.

c. Substance abuse. Substance abuse is the use of any substance that threatens a person's health or impairs social or economic functioning. This definition is more objective and universal than the government's definition of drug abuse, which is the use of a drug without a prescription or any use of an illegal drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed. Adverse drug reactions are associated with side effects.DIF: Cognitive Level: ApplicationREF: Page 435