Vulnerable Populations and Homeless- Exam 2
A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as nonchangeable
A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.
A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A) Insurance B) Acculturation C) Knowledge of disease D) Marital status
A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.
When preparing a plan of care for a group of women who are victims of intimate partner violence, the nurse develops interventions aimed at the primary level of prevention. Which of the following would be most appropriate for the nurse to include? A) Assisting them to locate a safe shelter B) Providing immunizations C) Screening for sexually transmitted infections D) Teaching about basic hygiene measures
A Feedback: For women who are victims of intimate partner violence, counseling and helping them locate a safe shelter can assist in preventing homelessness. Providing immunizations and teaching about basic hygiene may be appropriate, but these would not priorities at this time. Screening for sexually transmitted disease would be a secondary level of prevention activity.
A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in care
A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.
The nurse educator knows the nursing student understands the effect of homelessness on the health of children when the nursing student identifies which of the following? A) "Homeless children are four times more likely to become ill." B) "While approximately 87% of homeless children are enrolled in school, only about 77% attend regularly." C) "Fewer than 25% of homeless children graduate from high school." D) "Homeless children are twice as likely as their housed counterparts to repeat a grade in school."
A Feedback: Only one of these statements that directly relates to the effect of homelessness on the health of children is, "Homeless children are four times more likely to become ill."
A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A) Avoiding political involvement in issues B) Working with schools to reduce the dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needs
A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.
When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A) Resource availability B) Relative risk C) Health status D) Housing E) Education
A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.
Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A) Patients feel that they are unable to trust the information given to them and may not follow it as explained. B) Limited access to appropriate level of care C) Poor access to quality care D) Overt discrimination E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts
A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.
When addressing homeless children and youth, which of the following situations are also considered homeless according to the education subtitle of the McKinney-Vento Homeless Assistance Act? Select all that apply. A) Children who share housing with others due to economic hardship or loss of housing B) Children who are abandoned in hospitals C) Children who are awaiting placement in foster care D) Children who are living in motels, trailer parks, or camping grounds E) Children who are living apart from one or more of their parents
A, B, C, D Feedback: The education subtitle of the McKinney-Vento Homeless Assistance Act expands on the definition of homelessness when addressing homeless children and youth. The act includes as homeless those children who share housing with others due to economic hardship or loss of housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in motels, trailer parks, or camping grounds. Children who are living apart from one or more of their parents may not be homeless.
Which of the following are reasons why it is difficult to estimate the number of persons who are homeless? Select all that apply. A) It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. B) It is difficult to locate and account for people who are homeless. C) Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. D) In rural areas, there are fewer housing options and resources for the homeless and as a result people may be forced to live temporarily with friends or family. E) Homelessness is increasing due to poverty and the growing shortage of affordable rental housing.
A, B, C, D Feedback: The following are reasons: It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. It is difficult to locate and account for people who are homeless. Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. In rural areas, there are fewer housing options and resources for the homeless, and as a result, people may be forced to live temporarily with friends or family. It is true that homelessness is increasing due to poverty and the growing shortage of affordable rental housing, but this is not a reason why it is difficult to estimate the number of people who are homeless.
Which of the following are subpopulations that are more likely to be sheltered homeless in urban areas? Select all that apply A) Adult males B) African Americans C) Veterans D) Disabled E) Migrant workers
A, B, C, D Feedback: When compared to their housed counterparts nationwide, the sheltered homeless are more likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural areas, the homeless are more likely to be White, Native American, or migrant workers.
Which of the following are reasons for the increase in poverty rates over recent years? Select all that apply. A) Declining wages B) Decline in public assistance C) Loss of jobs that offer security and carry benefits D) A decline in manufacturing jobs in favor of lower paying service jobs E) Globalization and outsourcing F) Homelessness
A, B, C, D, E Feedback: The increase in poverty rates over recent years may be attributed to declining wages, loss of jobs that offer security and carry benefits, and increase in temporary and part-time employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in favor of lower paying service jobs, globalization and outsourcing, and a decline in public service. As wages drop, the potential to secure adequate housing wanes. This does not mean that homelessness is a cause of poverty. Actually, it is poverty that is known to cause homelessness.
Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless persons
A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.
A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A) Keeping the clients to a firm schedule of visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitations
B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).
Which one of the following statements regarding mental illness and homelessness is most accurate? A) 75% of the sheltered homeless report a severe mental illness. B) Deinstitutionalization or being released from institutions into the community contributes to the number of persons who have a severe mental illness who are homeless. C) Mental illness only contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. D) Mental illness and substance abuse are not often comorbid conditions that contribute to homelessness
B Feedback: Deinstitutionalization or being released from institutions into the community contributes to the number of severely mentally ill persons represented in the homeless population. Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. Mental illness and substance abuse are often comorbid conditions, which, coupled with poor physical health, make it especially difficult to secure employment and safe, affordable housing.
After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A) Homelessness B) Acute illness C) Income D) Immigrant status
B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.
Which one of the following statements about mental health issues and homeless young people is most accurate? A) 87% of homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. B) Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. C) It is not common for homeless youths to be arrested for running away, breaking curfews, or being without supervision. D) Homeless youth are persons under age 18 who lack parental, foster, or institutional care.
B Feedback: Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. One in six homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision. Homeless youth are persons under age 18 who lack parental, foster, or institutional care, but this is not necessarily related to mental health issues.
Which one of the following statements about relative risk is most accurate? A) Lifestyle, behaviors, and choices do not relate to relative risk. B) Relative risk refers to exposure to risk factors identified from a substantial body of research. C) Relative risk means that if a risk exists, the illness or adverse event will occur. D) Any factor that is likely to cause increased risk is considered relative risk.
B Feedback: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.
Which one of the following statements is true regarding social capital? A) Social capital includes investments in individuals' capabilities and skills. B) Social capital includes marital status and family structure. C) Social capital includes jobs, income, housing, and education. D) Examples of social capital are education and job training.
B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.
A community health nurse is working with a community-based organization to develop programs to provide quality accessible health care to the homeless population. Which of the following would be the most appropriate source from which to seek funding for this program? A) Projects for Assistance in Transition from Homelessness (PATH) B) Health Care for the Homeless (HCH) C) The Interagency Council on Homelessness D) U.S. Department of Housing and Urban Development
B Feedback: The HCH program (a provision of the McKinney Act) awards grants to community-based organizations that seek to provide quality, accessible health care to the homeless and would be the most appropriate source for funding. PATH is a grant program created under the McKinney Act to support the delivery of services to persons with severe mental illnesses, including those who are homeless or at risk of becoming homeless. The Interagency Council on Homelessness coordinates the federal response to homelessness and creates a national partnership with public and private sectors to reduce and end homelessness in the United States. HUD provides funding for supportive housing for low-income families, as well as low-income individuals with disabilities, and low-income elderly.
Which of the following would a community health nurse expect to assess in the population of homeless men? A) Marital status B) Substance abuse C) Permanent employment D) Frequent use of shelters
B Feedback: The majority of homeless men are single adults. Homeless men are more likely to be employed than their homeless female counterparts; yet, they usually hold temporary, low wage jobs that offer little security. They are also more likely than homeless women to have uncontrolled substance abuse issues. This makes it more difficult for them to access shelters, which tend to require abstinence for admission
For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually transmitted infections? A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infections. B) They lack education or job training skills and may resort to prostitution or survival sex, which increases their risk for HIV, hepatitis, and sexually transmitted infections. C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility. D) It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.
B Feedback: The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually transmitted infections is that they lack education or job training skills and may resort to prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infection; they may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.
Which one of the following statements is true regarding the socioeconomic gradient of health? A) The behavior of smoking is lowest among those who have low income and low educational levels. B) The socioeconomic gradient of health has been found in populations around the world. C) All persons who have a low socioeconomic status will develop particular health problems. D) The socioeconomic gradient of health is universal.
B Feedback: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.
After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A) Direct B) Inverse C) Positive D) Unequal
B Feedback: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.
A community health nurse who will be working with a homeless population is planning care. Which of the following would the nurse need to do first? A) Develop trust with the population B) Clarify personal values and beliefs C) Focus on the issue of homelessness D) Visit the local shelter where the clients are
B Feedback: When working with the homeless population, it is crucial that the nurse clarify personal beliefs and values about poverty, homelessness, addictions, and mental disorders to ensure nonjudgmental care. Trust too is essential, but this would need to occur after the nurse has clarified his or her values and beliefs. Biases or judgments on the nurse's part would undermine the development of trust. The nurse needs to use a comprehensive, holistic approach or focus, not just focus on the population's homelessness. Visiting the local shelter may be helpful to gather information about what the nurse might expect, but it isn't the first thing the nurse would do.
The community health nurse is explaining the reasons for health problems in the homeless population. Which of the following would the nurse identify as the most likely reason? A) Issues related to storage of medications B) Lack of transportation to keep appointments C) Time and energy focus on survival needs D) Limited access to health care services
C Feedback: Although issues related to medication storage, lack of transportation, and limited access to health care play a role, many homeless people expend their time and energy trying to meet basic survival needs such that health care takes a backseat to finding food, clothing, or shelter.
A community health nurse is evaluating a population for socioeconomic resources. Which of the following would the nurse address? A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providers
C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.
An instructor reviews the definition of homelessness according to the McKinney Vento Homeless Assistance Act with a group of community health nursing students. The instructor determines that the students need clarification when they include which of the following as homeless? A) Someone living in a public shelter B) Someone living in a park C) Someone who is incarcerated D) Someone who lives in his or her car
C Feedback: The McKinney-Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a person as homeless who lacks a fixed, regular, adequate night time residence including supervised public or private shelters that provide temporary accommodations, institutional settings providing temporary shelter, or public or private places that are not designed for or used as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds). Incarcerated individuals, however, are not considered homeless under this definition.
After teaching a group of community health students about public and private sector programs and initiatives aimed at combating homelessness, the instructor determines that they need additional teaching when they identify which of the following as a private sector organization? A) National Coalition for the Homeless B) National Alliance to End Homelessness C) National Resource Center on Homelessness and Mental Illness D) National Low Income Housing Coalition
C Feedback: The National Resource Center on Homelessness and Mental Illness is a federally sponsored public program for addressing the needs of the homeless. The National Coalition for the Homeless, the National Alliance to End Homelessness, and the National Low Income Housing Coalition are private sector resources.
Which of the following would a community health nurse use to define vulnerable populations? A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illness
C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.
Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedback
C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.
Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining grounded
C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.
After reviewing statistics on homelessness, which of the following would a community health nurse identify as the fastest growing segment of the homeless population? A) Children under age 18 years B) Families headed by a female single parent C) Families headed by a male single parent D) Families with children
D Feedback: Families with children are the fastest growing segment of the homeless population based on statistics, accounting for approximately 34% of the homeless population. Single female parents account for most of the homeless families. However, because many two-parent families and families headed by single fathers are becoming homeless because of the recession, and most homeless provider organizations serving families are geared to serving single women with children, it can be harder for intact families and families headed by men to access shelter.
When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A) Vulnerable populations are fairly similar across the nation and globally. B) Statistics about vulnerable populations are highly accurate. C) The most important causative factor is race or ethnicity. D) Many of the factors and conditions suggest vulnerability overlap.
D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.
When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor? A) Social support networks B) Crime rates C) Transportation D) Living conditions
D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).
Which of the following would likely provide the best estimate of the number of persons who are homeless? A) Counting the number of homeless people on a particular day B) Counting the persons who are homeless in a given week C) Counting the number of persons who are homeless at a specific time on a specific date D) The number of people who have been homeless over the course of a year
D Feedback: Rather than trying to count the number of homeless people on a given day or week (point in time counts), it may be more prudent to measure the number of people who have been homeless over a longer timeframe such as over the course of a year (period prevalence counts).
When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse
D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.
A community health nurse is preparing a program for a local community group about homelessness. A portion of the program will address homeless men. Which of the following would the nurse include? A) Homeless men are not looked down upon less than other groups. B) Homeless men are usually eligible for social services. C) Homeless men are perceived as blameless for their situation. D) Single, low-income men only qualify for medical assistance if disabled.
D Feedback: Single, low-income men only get medical assistance if they are disabled. Homeless men are more likely to be treated with disdain than other homeless subgroups. Some people perceive homeless men as largely to blame for their plight, believing that they are able bodied and should be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough to warrant eligibility for health and social services. Often health and social programs give priority to women and children.
A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizations
D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.
A community health nurse is working with a group of homeless clients with substance abuse problems. Which of the following would be appropriate for the nurse to do at the tertiary level of prevention? A) Conduct mass screening for common communicable diseases B) Institute a mobile van to assist in early diagnosis of common illnesses C) Advocate for counseling programs to address high risk behaviors and abuse D) Assist in ensuring participation in substance abuse rehabilitation programs
D Feedback: Tertiary prevention level activities include treatment of complications of advanced disease, providing rehabilitative care, such as participation in a substance abuse rehabilitation program, and offering counseling and support. Conducting mass screenings for common communicable diseases associated with substance abuse and a mobile van program to assist in early diagnosis are secondary prevention level activities. Advocating for counseling programs to address risk behaviors and abuse would be a primary prevention level activity.
Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A) Exposure to risk factors affects the population's social and human capital. B) Everyone is at risk because of stressful events occurring in life. C) A risk for a negative outcome increases with lower education and income levels. D) Certain groups are impacted by stressful events more than others.
D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.