B:230 Final

Which of the following reflects Piagets theory as applied to young adults? a. Voting for a candidate based on popularity b. Voting for a candidate based on media advertisements c. Voting for a candidate based on support of the candidate by peers d. Voting for a candidate based on analysis of views about various issues

ANS: D Young adults are in Piagets formal operational thinking stage during which they analyze issues objectively and insightfully.

The school nurse is planning a workshop for high school students about interpersonal violence (IPV). Which of the following information would the nurse discuss as risk factors for IPV? a. Cultural norms b. Family support c. Drug and alcohol abuse d. Depression

ANS: C Risk factors for IPV may include a victims low self-esteem, low self-control, and personality/conduct disorders. Other risk factors are reported to be lack of social support, dysfunctional family structure, family history of violence, and drug and alcohol abuse.

A 45-year-old client who has experienced a ten pound weight gain during the past year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take? a. Ask the client to describe her daily activity and diet b. Leave a note requesting an iron supplement on the clients chart for the doctor c. Provide the client with information related to aerobic exercise classes d. Ask the client if she is still menstruating

ANS: A A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and a lack of energy. The priority action by the nurse is assessment, which will reveal the reason for a lack of energy.

The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which of the following recommendations would the nurse stress as the most effective way to reduce work-related injuries? a. Make the work environment smoke-free. b. Reduce environmental noise levels. c. Conduct regular walk-through assessments at the worksite. d. Increase paid personal days from one to three.

ANS: A Accidents are twice as high among smokers than nonsmokers. Possible explanations include the loss of attention, the use of one hand for smoking, and irritation of the eyes. Because smoking has such an impact on accident rates, this would have the largest effect on reduction of work-related injuries.

The university health services nurse is preparing a disease prevention program for college students. Which of the following information should the nurse include in the program? a. Living in the dorm increases ones risk of developing meningococcal disease. b. The mortality rate from meningococcal disease is very low. c. There are no antiviral medications that can treat meningococcal outbreaks. d. A vaccine for meningococcal disease has not been developed.

ANS: A Although most outbreaks of meningococcal disease are sporadic, young adults living in dormitories or crowded conditions may be more susceptible than young adults not living in close settings. Meningococcal disease has a high mortality rate. It is caused by a bacterium, not a virus, and antibiotics to treat the disease are readily available. A preventive vaccine is available.

A nurse is providing care to HIV positive clients living in sub-Saharan communities in Africa. When discussing prevention of the transmission of HIV, which of the following statements should be made by the nurse? a. Alternative practices to traditional sexual cleansing should be considered after the death of a spouse. b. Traditional sexual cleansing should be performed with a cleanser who is known to not have HIV. c. Virgin cleansing is a safer option than traditional sexual cleansing. d. Traditional sexual cleansing can lead to further transmission of HIV.

ANS: A Although traditional sexual cleansing can lead to further transmission of HIV is a true statement, it is not the most culturally sensitive response by the nurse. The nurse should respect the cultural practices of the clients living in the sub-Saharan community and discuss that alternative practices may be a better option to traditional sexual cleansing.

As part of a community-wide flu vaccination program for older adults, the nurse is assisting at a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine? a. Do you have any food allergies? b. Have you had the pneumococcal vaccine? c. Have you had the flu in the past 5 years? d. Do you have Medicare?

ANS: A An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells.

A 30-year-old woman with a BMI of 36 is counseled by the nurse regarding interventions to assist with weight reduction. In which order would the nurse discuss the implementation of these interventions? 1. Gastric stapling 2. Medication to reduce appetite 3. Nutrition and exercise education 4. Assessment of lipid profile and blood pressure a. 4, 3, 2, 1 b. 4, 2, 3, 1 c. 3, 4, 2, 1 d. 3, 2, 1, 4

ANS: A Assessment data must be complete before intervention. Diet and exercise are used first, and then pharmaceutical agents to reduce appetite. Bariatric surgery is used when all other options have failed.

Which of the following middle-age adults has successfully transitioned to Eriksons generativity-versus-stagnation stage of development? a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week b. A 63-year-old man who regrets his career choice and feels he cannot change careers c. A 45-year-old woman who resents having to care for her aging mother-in-law d. A 50-year-old man who has not saved for retirement but spends his discretionary income on vacations he takes by himself

ANS: A Generativity according to Eriksons theory involves a sense of productivity, creativity, and the desire to help others, whereas stagnation involves a sense of isolation and focus on oneself.

A man tells a nurse that he is concerned about his risk of developing cancer. Which of the following behaviors would place the man at higher risk of developing cancer? a. Smoking a half of a pack of cigarettes a day b. Exercising three times a week c. Consuming green, leafy vegetables several times a week d. Visiting a chiropractor every week

ANS: A Habits that place older adults at a high risk for developing cancer: not following nutritional guidelines, high stress levels, not engaging in a regular exercise program, and smoking cigarettes and using other tobacco products.

A nurse is working in the community to prevent bicycle and motorcycle fatalities. Which of the following measures would be most effective for the nurse to promote? a. Use of helmets b. Increasing the minimum age for motorcycle licensure c. Construction of bike paths along busy roads d. Right-of-way laws for bicyclists

ANS: A Head injury is the major cause of death related to bicycle or motorcycle accidents. Bicycle helmets are believed to be the single most effective preventive measure available to decrease the incidence of brain and head injury.

Which of the following statements made by a client best identifies someone who would benefit from health promotion interventions? a. I have a new grandchild and want to be part of her life. b. My mother lived until she was 90, so a long life is in my genes. c. Some chronic illness is just a part of aging. d. I hope Ill live a lot longer, but one never knows.

ANS: A Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling that illness is just part of aging or leaving health up to chance will not help the person make necessary lifestyle changes.

A nurse has received a grant to provide a community-based education series for middle-age adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group? a. Diet and exercise b. Seat belt use c. Depression screening d. Cancer prevention

ANS: A Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes mellitus. An educational series devoted to discussing diet and exercise will have the greatest impact on health.

A nurse is conducting a home visit for an older adult in the summer. Which of the following items should the nurse should locate in the home? a. Fan b. Porch chair c. Synthetic blend clothing d. Thermometer

ANS: A Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air. Light-weight cotton clothing breathes and facilitates cooling, whereas synthetic material retains heat.

Which of the following medications is generally recommended to help preserve cardiovascular health in middle-age women? a. Aspirin b. Folic acid c. Estrogen d. Estrogen receptor modulator

ANS: A Only aspirin is recommended to help maintain cardiovascular health by lowering the risk of clot formation.

A nurse is working at a clinic in a third world country and suspects a child has severe acute malnutrition (SAM). Which of the following assessment findings would be expected? a. Distended abdomen b. Bulging eyes c. Large tears when crying d. Lethargy

ANS: A Severe wasting is characterized by sunken eyes, visible ribs, and protruding shoulder blades. Children with severe wasting usually have a distended abdomen and general overall appearance in some way similar to an older adult. In general, these children are irritable, anxious, and cry easily; yet they will often have absence of tears while crying due to lachrymal gland atrophy.

A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and 12 because the childrens parents died in a car accident. Which of the following are priority nursing interventions that the nurse can implement to help the grandparents cope with the responsibility of raising their grandchildren? a. Connecting them with the Grandparents Raising Grandchildren support group b. Encouraging them by reinforcing how they successfully raised their own children c. Volunteering to provide respite time for them as needed d. Assuring them that their stress level will lessen as they gain confidence

ANS: A Stress experienced by grandparents who must raise grandchildren can be lessened by counseling and participation in support groups.

Which of the following age groups is experiencing the greatest increase in suicide rates? a. 15 to 24 b. 25 to 39 c. 40 to 59 d. 60 to 70

ANS: A Suicide rates among people aged 15 to 24 have been increasing to such an extent that they are the second leading cause of death in this age group in some developed and developing countries.

Which of the following individuals would be at greatest risk of injury? a. 80-year-old who does not have air conditioning or a fan b. 70-year-old who has new dentures c. 68-year-old who has difficulty tasting salt in food d. 84-year-old who needs hearing aids

ANS: A Sweating decreases in older adults, predisposing them to heat stroke.

Which of the following statements about alcohol intake is correct? a. Women have a higher death rate related to alcoholism than men. b. A woman who drinks two glasses of wine per day with her evening meal is considered a moderate drinker. c. More women than men are considered problem drinkers. d. Women who experience fewer cognitive effects from drinking are less likely to drink heavily than do women who get a buzz from drinking.

ANS: A The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men than women are considered problem drinkers. Moderate drinking for women is defined as one alcohol-containing drink a day. Women who are able to hold their liquor are more likely to drink excessively than those who cannot hold their liquor.

A nurse has recently accepted the position of unit nurse manager on a long-term care unit. Which of the following directives should the nurse give to the staff nurses? a. Encourage residents to participate in unit activities such as Scrabble and bingo. b. Demonstrate the caring aspect of nursing by dressing residents before breakfast. c. Fill in missing words during conversation with the residents to avoid embarrassment. d. Instruct the aides to get residents ready for breakfast as quickly as possible to make sure they are ready to eat.

ANS: A To encourage cognitive health nurses should inspire older individuals to take classes, read, engage in stimulating conversation and entertainment, keep their minds active, and continue learning throughout their lives. They are encouraged to continue with self-care activities rather than relinquish them to caregivers. Residents should be encouraged to perform self-care activities themselves. When help is required, it should be provided in an unhurried manner. Filling in missing words makes the resident dependent on the staff and reduces motivation to communicate, and the words supplied may not be the intended words.

A nurse is planning health care for young adults. Which of the following factors about the interventions should be recognized by the nurse as having the greatest impact on whether they are effective? a. Culturally sensitive b. Match the persons health care beliefs c. Cost effective d. Gender neutral

ANS: A Unless the interventions are culturally sensitive, they are not likely to be successful. Although the other factors are important, the priority consideration is cultural sensitivity.

A nurse is planning community health programming for young adults. Based on the objectives for Healthy People 2020, which of the following topics would be priority areas for programming? (select all that apply) a. Prenatal care b. Physical activity c. HIV d. Suicide

ANS: A, B Healthy People 2020 objectives targeted for the young adult include increasing the proportion of adults who engage in regular aerobic activity of moderate intensity and increasing the proportion of women who receive early and adequate prenatal care. HIV and suicide rates are not mentioned in the target areas for young adults.

Which of the following individuals is at risk for developing osteoporosis? (select all that apply) a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis b. A 40-year-old woman who works as a secretary c. A 60-year-old woman who walks three miles a day d. A 50-year-old man who works as a mason

ANS: A, B Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals, and people on long-term steroid use. It increases with age.

A community health nurse has received a grant to present a program about violence prevention. Which of the following individuals has a higher than average risk of homicide? (select all that apply) a. 33-year-old woman who served 5 years in prison b. 20-year-old homeless man c. 28-year-old man with a history of bipolar disorder d. 24-year-old woman who has a female partner

ANS: A, B, C Homicide is closely associated with alcohol and drug abuse and frequently is related to other violent acts, such as robbery. Other risk factors for homicide include a history of loss of employment, detention or prison experience, access to firearms, abuse in the home, mental illness, social isolation, and homelessness.

A nurse is conducting a community health education program about osteoporosis with a group of older adults. Which of the following individuals in attendance is at greatest risk for developing osteoporosis? (select all that apply) a. 65-year-old Asian woman who smokes one pack of cigarettes per week b. 80-year-old White man who has three glasses of wine per day c. 74-year-old White woman on daily oral prednisone for emphysema d. 68-year-old Black man who has a sedentary lifestyle

ANS: A, B, C Osteoporosis is a disease of bone loss common to women age 70 and older and men age 80 and older. The disease occurs six times more frequently in women than it does in men. Risk factors include a small, thin frame; White or Asian ancestry; family history; excessive thyroid medication or high doses of cortisone-like drugs for asthma, arthritis, or cancer; a diet low in dairy products and other sources of calcium; physical inactivity; smoking cigarettes; and drinking alcohol

The nurse working in a retirement community for older adults is conducting a psychosocial assessment of all residents. Which of the following questions should the nurse ask during the assessment process? (select all that apply) a. Have you thought about harming yourself? b. Are you still playing bridge every Thursday? c. How does your congestive heart failure affect your life? d. Has your financial situation changed since last year?

ANS: A, B, C Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to, depression. Economic difficulty is not a predictor of suicide in older adults.

A nurse is conducting a community health education program for Hispanic women ages 18 to 35. Which of the following items should the nurse recommend that they increase in their diet on a daily basis? (select all that apply) a. Calcium b. Folic acid c. Iron d. Sodium

ANS: A, B, C Women of childbearing age frequently consume a diet deficient in calcium, iron, and folic acid.

A nurse is working in a domestic violence shelter. Which of the following individuals would the nurse expect to encounter? (select all that apply) a. 34-year-old White woman who is vice president of a communications company b. 26-year-old Black woman who has a live-in boyfriend c. 29-year-old Hispanic man who has been married for 2 years d. 21-year-old unemployed White woman who has been with her boyfriend for 3 years

ANS: A, B, C, D Abusive behavior victims come from all racial, ethnic, and socioeconomic levels.

An 80-year-old person is admitted to the hospital. During the health assessment process, which of the following conditions should the person be screened for by the nurse? (select all that apply) a. Polypharmacy b. Kidney failure c. Illegal drug use d. Alcoholism

ANS: A, B, C, D Alcoholism and illegal drug use are often overlooked by health care professionals because of a persons age. Many older adults take multiple over-the-counter and prescription medications and are at risk for drug interactions.

Which of the following young adults exemplifies Kohlbergs postconventional level of moral reasoning? a. 28-year-old person who calls in sick so as to help a friend move to a new location b. 22-year-old man who uses marijuana on the weekends with friends c. 30-year-old woman who volunteers at a soup kitchen one day a month d. 35-year-old who works long hours so as to be considered for a promotion

ANS: C Someone in Kohlbergs postconventional level of moral reasoning is able to do what is beneficial or right regardless of peer pressure to take another course of action.

A community health nurse is caring for a variety of different people in the community. Which of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? (select all that apply) a. A 54-year-old couple whose young adult daughter and grandson move back into their home b. A 44-year-old single mother raising three adolescent children without child support c. A 60-year-old couple whose children have established successful careers in another state d. A 36-year-old couple whose child plays competitive tennis

ANS: A, B, D Stressors of middle age include adult children moving back home, heading a single parent household, and parents whose child plays competitive sports with an emphasis on winning. The couple who has children living out of state who have established successful careers are at the least risk to have stress related to family dynamics

Which of the following nursing interventions implies respect for a persons spirituality? (select all that apply) a. Changing the position of the bed in a Muslim clients room so that it faces east b. Contacting the chaplain to assess the clients spiritual needs c. Saying a silent prayer with a client at the clients request d. Praying out loud in the room of a dying client

ANS: A, C Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by the nurse is needed to allow the person in any setting to achieve spiritual health. The nurse can provide an environment that is supportive to the practice of the persons spirituality. Praying out loud does not demonstrate respect for a persons spirituality but imposes the nurses belief system on the person. Nurses should be able to assess the persons spirituality initially and determine if it is necessary to further consult the chaplain.

The occupational health nurse working for a large corporation is a member of a task force to improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? (select all that apply) a. On-site walking paths b. On-site food vendors c. On-site counseling services d. On-site meetings of support groups such as Alcoholics Anonymous

ANS: A, C, D On-site facilities that improve health (walking paths) and psychological well-being (support groups, counseling) will help to create a positive work environment. Depending on the food vendor who is on-site, the healthy food options may not be beneficial to the employees.

An occupational health nurse is conducting a blood pressure screening. Which of the following clients is at greatest risk of mortality from cardiac disease? (select all that apply) a. Black man with a blood pressure of 130/80 b. Mexican American man with a blood pressure of 110/60 c. White woman with a bold pressure of 120/80 d. Black woman with a blood pressure of 128/78

ANS: A, D According to the JNC VII, the risk for cardiovascular events rises when blood pressure is greater than 115/75. Blacks have a higher death rate from heart disease than do Whites. Mexican Americans have the lowest rate of hypertension.

A 32-year-old woman visits the occupational health nurse because of malaise. Which of the following assessment data indicates that the client may be experiencing achievement-oriented stress? a. Sleeping 10 hours per day b. Unintentional loss of 10 pounds in the past 3 weeks c. Expressed fear of company layoffs d. Calling in sick once every 2 weeks for the past month

ANS: B Achievement-oriented stress is characterized by lack of sleep, skipping meals, and workaholic habits. It differs from situational stress, which would be caused by changes in job function for example.

Which of the following circumstances accounts for one of the leading cause of death in young adults? a. Tobacco use b. Binge drinking and driving c. Illegal drug use d. HIV infection

ANS: B Alcohol-related accidents among individuals ages 15 to 24 continue to be a leading cause of preventable morbidity, disability, and death.

The parents of a young adult female have recently divorced. Which of the following is the young adult most likely to experience? a. Relief b. Depression c. Unemployment d. Inability to sustain own relationships

ANS: B Although dissatisfaction and unhappiness are frequent precursors to separation and divorce, the decision to dissolve a marriage is not easy. Divorced young adults frequently suffer severe emotional strain and depression. Some young adults are unable to adjust to role and status changes and to threats of self-concept. Young adults whose parents divorce have an increased rate of divorce, but that does not mean that they are unable to sustain their own relationships.

Which of the following nursing diagnoses is a priority related to the problem of urinary incontinence? a. Risk for social isolation b. Risk for impaired skin integrity c. Risk for inadequate fluid intake d. Risk for impaired coping

ANS: B Although social isolation and decreased fluid intake may occur because of urinary incontinence, impaired skin integrity is a major concern because of its impact on physical and psychological health.

Which of the following information about anthrax is correct? a. Anthrax is a viral infection. b. Anthrax can cause skin lesions or pneumonia. c. Anthrax is spread by person-to-person contact. d. Anthrax is treated by IV penicillin for 30 days.

ANS: B Anthrax is a bacillus that is not spread person-to-person. An anthrax infection is treated by using ciprofloxacin, levofloxacin, doxycycline, or penicillin for 60 days.

Which of the following interventions are appropriate relative to the nursing diagnosis: Health-Seeking Behaviors Related to Preconceptual Assessment and Preparation for Childbearing? a. Encouraging the consumption of a moderate-fat diet to prepare for pregnancy b. Referral to genetic counseling based on family history c. Counseling to avoid hard liquor d. Substituting a nutritional supplement for a meal so as to assure adequate vitamin intake

ANS: B Assessment of biophysical risk factor is an important intervention, which includes review of genetic disorders, nutrition problems, and current medical problems. Before and during pregnancy, the diet should be well-balanced, low in fat and sodium, and high in calcium and iron. Nutritional supplements are not required unless the woman is malnourished. Alcohol in all forms including beer and wine should be avoided.

The nurse working in the college health center is planning a program about sexually transmitted diseases (STDs). Which of the following information should the nurse include in the program? a. STDs are the third most common infection in young adults. b. STDs can be transmitted by any intimate contact, not just sexual intercourse. c. STDs usually occur as a single infection. d. STDs are the most common reason for a visit to the health center.

ANS: B STDs can be transmitted from oral and anal sex, not just vaginal intercourse, and many young adults do not understand this. STDs are the most common infection in persons age 15 to 24. A person may have multiple STDs. STDs are generally unreported and not treated.

A nurse conducted a 5-week education series about health maintenance. Which of the following statements by a participant indicates the analysis stage of cognition as defined by Blooms taxonomy? a. If I eat too much food and do not exercise, I will gain weight. b. Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not do moderate exercise at least 5 days a week, I will gain weight. c. I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight. d. I can eat more if I exercise more.

ANS: B During the analysis stage of cognition, all aspects of learning come together in thought and the individual is cognizant of the relationships and interactions of all the parts. If I eat too much food and do not exercise, I will gain weight indicates knowledge (recall of facts). I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight indicates application. I can eat more if I exercise more indicates comprehension.

A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the following considerations would be made by the nurse when deciding which neighborhoods to visit? a. Hispanic women have the highest rate of breast cancer of all minority groups in the United States. b. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups. c. The death rate from breast cancer in Hispanic women has risen in the past 10 years. d. Breast cancer in Hispanic women is usually diagnosed at an early stage.

ANS: B Even though Hispanic women have a breast cancer rate approximately 40% lower than non-Hispanic White women, their death rate is higher and the cancer is diagnosed at a later stage.

A 62-year-old person states to the nurse, I have trouble with my peripheral vision. Sometimes, I do not notice objects unless they are in front of me. Which of the following disorders is the client likely experiencing? a. Presbyopia b. Glaucoma c. Cataracts d. Diabetic retinopathy

ANS: B Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve. Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated. Peripheral vision is affected in glaucoma. Presbyopia is farsightedness. Cataracts cause cloudy vision.

The school nurse has been asked to present a workshop on how to prevent CA-MRSA spread in the school. Which of the following interventions should be emphasized? a. Completing prophylactic antibiotic therapy for those in close contact with an infected person b. Using correct hand-washing technique c. Requiring those infected stay home from school until the infection has resolved d. Disinfecting all classrooms on a daily basis

ANS: B Hand washing is an effective way to prevent spread of the infection. In order to contract the infection, students must come into contact with a draining wound, etc.

Which of the following projects would most likely be administered by International Micronutrient Malnutrition Prevention and Control (IMMPaCT) Program? a. Researching best methods to preserve the freshness of foods b. Surveying various populations about consumption patterns c. Comparing the effectiveness of vitamin pills versus fresh fruit and vegetables d. Analyzing the relationship between BMI and cardiovascular disease

ANS: B IMMPaCt provides its skills and resources toward working to eradicate vitamin and mineral deficiencies around the globe. The IMMPaCT programs activities include conducting surveys; providing micronutrients to infants, young children, and women of childbearing age; and monitoring and evaluating intervention systems.

The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29 kg/m2, age 41. Which of the following actions should be taken by the nurse? a. Encourage the client to continue her dietary and exercise patterns. b. Discuss her current dietary and exercise lifestyle habits. c. Counsel the client that she will face chronic health problems because of her weight. d. Encourage the client to adopt a low-calorie diet to help control her weight.

ANS: B Obesity is defined as a BMI of 30 kg/m2. The client is at risk for obesity. Further data should be gathered related to her dietary and exercise patterns so as to plan appropriate interventions. Adoption of a low-calorie diet may not be an appropriate intervention depending on what additional data collection reveals. Also, dietary changes should be accompanied by regular aerobic exercise.

Which of the following statements is the best definition of polypharmacy? a. The use of more than five medications prescribed by different physicians b. The use of multiple medications for the same or different health problems c. The use of multiple pharmacies and self-management of medications d. The use of multiple medications and supplements simultaneously

ANS: B Polypharmacy is the use of multiple medications for the same or different health problems. It is a major concern for elderly people, with the rate of polypharmacy in this population being between 9% and 39%.

The clinic nurse has seen the following four people today. Which of the following people is demonstrating a healthy coping pattern? a. Discusses very little except the loss of her husband 3 years ago b. Talks about the good times she and her husband had before his illness and death 1 year ago c. States that life is not worth living without her husband, who died 2 years ago d. Blames herself for her husbands death because she did not make him go to the doctor

ANS: B Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects on coping, whereas positive reappraisal has a positive effect.

A woman who is being discharged from the hospital is oriented to person, place, and time, and her memory is intact. She has occasional forgetfulness without a consistent pattern of memory loss. Which of the following housing options would be most appropriate for this woman? a. Independent living b. Retirement community c. Assisted living d. Nursing facility

ANS: B Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact, but has occasional forgetfulness without a consistent pattern of memory loss. Independent living may be appropriate for the person if she had a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression.

A nurse volunteered to work at a natural disaster site. Which of the following questions should the nurse ask to determine if the 26-year-old individual being screened is depressed or has suicide ideation? a. Tell me about your pets. b. What do you do for work? How has your work been affected by this disaster? c. Have you thought of harming yourself? d. Have you seen your friends since the disaster?

ANS: C Direct questioning about the intent to harm oneself is appropriate for the nurse to ask during screening/counseling sessions.

A nurse is using the four-step public health approach to address violence in the community. Which of the following actions would the nurse take first? a. Analyze a variety of data sources to determine the cause of the problem. b. Examine risk factors that have contributed to the violence. c. Develop an evidence-based program to address the problem. d. Train community members to discuss the problem within their neighborhoods.

ANS: B The WHO has proposed a four-step public health approach which includes: defining the problem; identifying risks and protective factors; devising and testing means of dealing with violence; and applying successful means on a large scale. Defining the problem is the first step in this process. Examination of different data sources are needed to understand the magnitude of the problem.

A nurse is conducting a community education program. Which of the following should be stressed as the leading cause of death in middle-age adults? a. Automobile accidents b. Malignant disease c. Homicide d. Suicide

ANS: B The leading causes of death during middle adulthood are heart disease, cancer, and accidents. Accidents are the major cause of death for children and young adults. Homicide and suicide are major causes of death for young adults

An occupational health nurse is planning injury-prevention educational sessions. Which of the following considerations should be made by the nurse? a. Education should be focused on workers with the least experience. b. All workers need continued education related to safety issues. c. OSHA rules apply to all companies with more than 25 employees. d. Middle-age workers have the lowest rate of injury of any age group.

ANS: B The role of the occupational health nurse is focused on keeping the worksite safe for employees. Experienced workers may not know how to prevent injury. OSHA applies to all companies. There are no data to support that middle-age workers have the lowest rate of injury. Physical and cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline in vision/hearing).

A nurse is planning a community health education program for young adults. Which of the following considerations should be made by the nurse? a. The age span encompassing young adulthood is between 20 to 30 years of age. b. The number one cause of death for young adults is injury. c. The number of young adults in the United States is increasing. d. The maternal mortality rate is at its lowest point since 1980.

ANS: B Young adulthood spans the years between ages 18 to 35. The number of young adults in the United States is declining, and the maternal mortality rate is at its highest level since 1980.

Which of the following interventions will have the greatest impact on reducing constipation in older adults? (select all that apply) a. Offering pureed foods that are easy to digest b. Encouraging fluids between meals c. Administering laxatives on a daily basis d. Assisting with ambulation

ANS: B, D Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid intake, can stimulate the colon and resolve constipation. Pureed foods do not contain adequate fiber. Increased fluid intake and exercise should be implemented before relying on medication to relieve constipation.

A nurse has accepted a position as director of health services in a retirement community. Which of the following statements about retirees is important for the nurse to consider as she plans programs? (select all that apply) a. Depressed and inactive. b. Left their job to spend more time with family. c. Left their job because of ill health. d. Happy and well-adjusted to retirement.

ANS: B, D Research has demonstrated that the majority of retirees are in good health and happy with their decision to leave work so as to spend more time with their families.

Which of the following effects of divorce on middle-age adults and children has been documented by research? a. Children adapt to divorce more rapidly than do adults. b. Emotional healing after a divorce takes approximately 24 months in adults. c. Children of divorced parents may have life-long difficulty forming relationships. d. Children of divorced parents undergo similar emotional turmoil as their parents.

ANS: C Although research is continuing, longitudinal studies by Wallerstein and her colleagues beginning in the early 1970s indicate that children bear the emotional scars of a divorce for a lifetime. The emotional response to divorce is different for children and parents, with most parents adjusting to the divorce within 3 years after the event.

A nurse is counseling a 23-year-old woman about oral, transdermal, injectable, vaginal ring, and implant contraceptive methods. Which of the following risks of using these methods should be stressed by the nurse? a. Toxic shock syndrome b. Nausea c. Blood clots d. Ectopic pregnancy

ANS: C Blood clots are a potential risk with using all of these contraceptive methods. Ectopic pregnancy is a possible complication of IUDs. Nausea may occur with the use of Plan B, and toxic shock syndrome may occur with use of a diaphragm.

A 26-year-old client has a total cholesterol of 206 mg/dL and an LDL of 110. Which of the following conclusions can be drawn by the nurse? a. The client has achieved the target levels for cholesterol in young adults. b. The client has a very low risk of developing heart disease. c. The client requires counseling about cardiac disease risk factors. d. The client has early-onset cardiac disease.

ANS: C Cardiovascular assessment of the young adult includes determining the presences of hyperlipemia, hypertension, diabetes, chest pain, or heart disease. This client has an elevated cholesterol levels and requires additional education about risk factors that may lead to cardiac disease. The Healthy People 2020 target is to reduce the mean total blood cholesterol levels among adults to 177.9 mg/dL. A diagnosis of heart disease cannot be made on the basis of these lab values.

A nurse is conducting a community education program about cognition in older adults. Which of the following information should be included? a. Some form of mild dementia is a normal part of aging. b. All forms of dementia have the same symptoms, but progress at different rates. c. Assessment for dementia should be part of routine physical exams. d. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not likely to have a cognition problem.

ANS: C Cognitive alterations are key symptoms that indicate changes in physiological function among older persons. Thus, assessment of cognition is an important part of routine assessments. Dementia is not a normal part of aging. Dementia symptoms vary according to the specific type of dementia. A score of 23 or lower on the MMSE indicates a problem with cognition.

Which of the following statements concerning urinary incontinence is correct? a. Urge incontinence occurs when one has the urge to void but is unable. b. Stress incontinence is associated with emotional turmoil. c. Functional incontinence occurs is associated with environmental barriers. d. Incontinence with high post-void residual occurs when someone laughs or sneezes.

ANS: C Functional incontinence is associated with environmental barriers, physical limitations, or cognitive impairment in which the client is unable to reach the toilet. Stress incontinence occurs when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void once the urge to void is felt. Urge, mixed, or stress incontinence with high post-void residual is caused by physiological changes that affect voiding, such as an enlarged prostate gland.

A nurse formed a political action committee to advocate for health insurance for the uninsured. On which of the following populations would the nurse focus the groups efforts? a. Asian Americans b. Blacks c. Hispanic Americans d. Working-poor White Americans

ANS: C Hispanic Americans are the largest minority group in the United States and have the highest uninsured rate.

A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a night. Which of the following responses should be made by the nurse? a. Do you want a sleeping pill? b. Make sure that you do not nap during the day even if you are tired. c. Do you feel excessively tired during the day? d. The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.

ANS: C It is important to assess the quality of sleep as well as the effects that the limited sleep has on this individuals daily activities. Medication should not be the first intervention used to help someone attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing themselves to stay awake.

1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle. Which of the following statements would be most appropriate way for the nurse to reply? a. There is really nothing you can do to prevent a lot of wrinkles. It is part of aging. b. As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we can do to prevent it. c. Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure. d. Wrinkles are caused by genetic factors

ANS: C Loss of subcutaneous fat and collagen damage related to sun exposure cause wrinkles.

The public health nurse is conducting a screening of young adults for metabolic syndrome. When asked about the syndrome, which of the following responses should be made by the nurse? a. Anyone who has low blood sugar, high cholesterol, and high blood pressure has this syndrome and is at risk for cardiac disease. b. This syndrome helps predict heart disease. Once it is diagnosed, the correct medication can be prescribed and heart disease avoided. c. This syndrome is a warning sign that the person could develop heart disease. When someone has metabolic syndrome, dietary and activity level changes are recommended. d. Anyone who has high cholesterol, high blood pressure, and high blood sugar has coronary artery disease. Once we make the diagnosis, we can begin to treat the disease.

ANS: C Metabolic syndrome is diagnosed when a person has high cholesterol, high blood pressure, and high blood sugar. A person with this syndrome is at risk for coronary artery disease. Lifestyle changes are tried before medication is used.

A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain from a chronic neurological disease. The man asks the nurse to please help him leave this world so that his suffering ends. Which of the following actions would be most appropriate for the nurse to take? a. Assist the doctor with the mans request b. Refuse to care for the man c. Contact the pain care specialist d. Provide the man with names of doctors who participate in assisted suicide

ANS: C Nurses caring for chronically ill older adults have the added responsibility of determining who is at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible and free of pain through the use of pharmacological and nonpharmacological interventions. Refusing to care for the man could be construed as abandonment and is not necessary. Consulting a pain care specialist is the correct action.

The nurse is working at a crisis hotline center. Which of the following callers would be most at risk for suicide? a. A 16-year-old girl who broke up with her boyfriend b. A 26-year-old male who has been laid off from his job c. A 50-year-old female who has a history of alcohol abuse d. A 40-year-old male whose brother died suddenly

ANS: C Older adults have a greater risk of committing suicide than do younger people. Major factors contributing to suicide in Europe and North America include mental disorders especially depression and alcohol use disorders.

The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice program, so he can help his father decide if the program would be of benefit to him. Which of the following responses should be given by the nurse? a. At hospice, your father will be heavily medicated, so he will not have pain. b. All of your fathers care will be provided by nurses at hospice. c. Hospice care can take place either at home or in a hospice facility. d. Visiting hours are about the same at hospice as they are here in the hospital.

ANS: C Once the person is placed in hospice care, treatment to relieve pain and other symptoms is continued by the physician after they have decided to end all curative treatment. Hospice care can occur in the home, a hospice inpatient facility, nursing home, and acute care hospital. The focus of hospice care is to help the person remain alert but free of pain. Families are encouraged to participate in care giving. There are no restrictions to visiting hours.

A 52-year-old woman going through menopause tells the nurse working in the womens health center that she is interested in slowing down the aging process and asks if she should take estrogen. Which of the following statements would be the best response by the nurse? a. The latest research has shown that estrogen is safe to take and will help keep you healthy. Ill tell the nurse practitioner that you are interested in estrogen therapy. b. Estrogen is safe to take for about 10 years. Ill get you some information on estrogen therapy that you can take home and read. c. The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes. d. You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.

ANS: C Research about the safety of estrogen therapy is mixed, therefore it is only recommended for short-term use (1 to 3 years) and only to relieve hot flashes. Natural products do not need research to back up their claims of safety or efficacy.

According to Eriksons theory of development, which of the following older adults has successfully navigated the stage of ego integrity versus despair? a. 72-year-old man who is reluctant to retire because work is everything to me b. 78-year-old woman who has scheduled her third face lift c. 80-year-old man who has informed his children that he has made his funeral arrangements d. 67-year-old woman who is depressed because she has not been promoted at work for the past 10 years

ANS: C Successfully navigating the stage of ego integrity versus despair requires that the individual accept normal bodily changes associated with aging, find meaning in life apart from work, accepts the inevitability of death, and is at peace with his or her life.

A nurse is discussing optimal activity for young adults. Which of the following information should be stressed? a. Forty-five minutes of moderate exercise per day are required to maximize health benefits. b. An increase in heart rate from 70 to 200 beats/min during exercise is optimal. c. Moderately brisk walking is an appropriate aerobic exercise. d. Sixty minutes of exercise three times a week is recommended.

ANS: C The Healthy People 2020 goal is to increase the proportion of adults who engage in moderate physical activity for 150 minutes a week (30 minutes five times per week) to 47.9% from 43.5%. Aerobic conditioning achieves cardiovascular fitness through five periods of moderately intense exercise weekly for about 30 minutes or more at a heart rate of approximately 220 minus the age of the person multiplied by 65% to 85%. Young adults are encouraged to engage in fitness activities that increase the heart rate to approximately 150 beats or more per minute. Moderately brisk walking that increases the heart rate is an appropriate aerobic exercise.

A community health nurse is working with a diverse population of older adults within the community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse when working with this diverse population? a. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. b. Hispanic older adults tend to rate their health as poorer than other ethnic groups. c. Older adults who tend to rate their health as fair or poor are also financially poor. d. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs.

ANS: C The National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic groups regarding their health status, their perceived need for assistance with routine needs, and the need for assistance with activities of daily living. In all groups, those who described their health as fair or poor were also more likely to be financially poor.

A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements would most likely be made by the nurse? a. The desire for sexual intimacy declines rapidly with age. b. Older adults are very well-informed about sexuality. c. Older adults need to practice safe sex. d. The danger of contracting STDs during sexual intimacy is extremely low in older adults.

ANS: C The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern in all age groups.

A nurse working on a post-partum unit of a large urban hospital has received a grant to begin a Baby-Friendly Hospital Initiative developed by WHO. Which of the following statements would the nurse most likely make when explaining the major premises of the initiative to the unit manager? a. This program is meant to encourage sibling visits in the early postpartum period, so the adjustment to a new baby is a smooth process. b. A major goal of this program is to ensure that all infant/pediatric units have implemented basic safety initiatives. c. Improving nutrition by promoting breast-feeding of newborns through four months of age is what this program is all about. d. The purpose of this program is to make sure that all health care providers who care for newborns and children up to the age of 18 really understand basic principles of growth and development

ANS: C The purpose of the initiative is to improve newborn nutrition by promoting breast-feeding of newborns through age 4 months.

A nurse is working with UNAIDS to fight against HIV/AIDS at the global level. Which of the following activities would the nurse most likely be involved in? a. Determining prevalence rates of HIV/AIDS in African countries b. Administering antiretroviral medications to pregnant women who are HIV positive c. Providing treatment access for all HIV-positive individuals who need medication d. Reporting confirmed cases of HIV to the World Health Organization

ANS: C UNAIDS has outlined three strategic directions: revolutionizing HIV prevention; catalyzing the next generation for treatment, care, and support; and advancing human rights and gender equality in responses to HIV. Providing treatment access for all HIV-positive individuals who need medication meets the strategic direction of catalyzing the next generation for treatment, care, and support.

A nurse working in a rural location is interested in starting a weight management group for clients in the area. Which of the following interventions is most likely to ensure success? a. Using a pre-set list of topics for discussion b. Relying on printed material to relay information to the group c. Asking for a list of topics that interest the group d. Beginning each session with a 2-mile walk

ANS: C When participants plan the topics of discussion, interest is maintained. A pre-set list of topics may not meet the learning needs of this particular group. A 2-mile walk may not be realistic for participants.

The nurse working in the college health center is asked about a safe way to obtain a tan. Which of the following would be the best response by the nurse? a. There is no safe way. Be sure to stay out of the sun as much as possible. b. Tanning beds are much safer than exposure to actual sunlight. c. Be sure to use sunblock agents and do not sunbathe between 10 AM and 2 PM. d. Once you apply sunblock, you are protected all day, so be sure to use it before any outdoor activity.

ANS: C Young adults should avoid sunbathing during the 2-hour period before and after noon because two-thirds of the days ultraviolet light comes through the earths atmosphere during this time. There is no need to stay completely out of the sun. Tanning beds are not a safe way to tan. Sunblock should be reapplied if certain outdoor activities are part of the day, such as swimming.

Which of the following is a normal physiological change that occurs during middle age? a. Increase in gastric emptying resulting in acid reflux b. Reduction in height caused by kyphosis c. Reduction of glomerular filtration by 50% d. Increase in the amount of estrogen produced in both genders

ANS: C gastric emptying is decreased, kyphosis is not an expected part of aging, and estrogen levels decrease in women and increase in men as male testosterone levels decrease.

A public health nurse is interested in writing a grant to improve vaccination rates of young adults. His focus should be on trying to obtain funding to support which of the following vaccination initiatives? (select all that apply) a. Rubella prevention b. Lyme disease prevention c. Hepatitis B prevention d. Human papilloma virus (HPV) prevention

ANS: C, D Rubella in young adults is generally a minor disease; the population at risk is women of childbearing age. There is not a vaccine available for Lyme disease. Hepatitis B and HPV can both be prevented through immunization and young adults are at high risk for contracting these diseases.

A nurse using the four-step public health approach to respond to violence. Which of the following actions would occur as the nurse identifies risk and protective factors? a. Planning a community-based educational program to respond to violence b. Reviewing police reports and population-based surveys c. Interviewing local community members about their experiences with violence d. Examining characteristics in the community where violence has not occurred

ANS: D A risk factor is defined as a characteristic that increases the likelihood of a person becoming a victim or perpetrator of violence, and a protective factor as a characteristic that decreases the likelihood of a person becoming a victim or perpetrator of violence. Knowing risk and protective factors can help responsible organizations and personnel to estimate violence magnitudes and devise appropriate prevention measures.

. A nurse is planning to write a grant for a health promotion project in the community. Which of considerations should the nurse make when determining the appropriate population for this project? a. The fastest growing population is children under the age of 12. b. The fastest growing population is young Black American adults. c. The fastest growing population is White middle-age adults. d. The fastest growing population is non-White older adults age 65 and older

ANS: D Adults age 85 and older are the fastest growing population in the United States, and the percentage of White Americans greater than age of 65 is decreasing compared with other ethnic groups.

A nurse is discussing sexuality with middle-age men and women. Which of the following information should be stressed by the nurse? a. Contraception usage should be decreased as a woman nears menopause. b. Difficulty with sexual performance among men happens near age 60. c. HIV infection after age 50 is rare. d. The majority of new HIV/AIDS cases occur among middle-age adults.

ANS: D Adults in middle age represent 71% of all new cases of HIV/AIDS. Unintended pregnancy occurs most often in middle-age women. Male sexual performance issues begin between the ages of 40 to 50. HIV infection is not rare among middle-age adults.

Taking into account all of the agents that affect middle-age adults, the nurse plans a health education workshop focused on developing an individualized lifestyle change program for each participant. Which of the following actions should the nurse stress that individuals take first? a. Limiting unprotected exposure to sun b. Starting a smoking cessation program c. Exercising at least three times a week d. Scheduling a complete physical and dental exam

ANS: D Although limited unprotected exposure to the sun, starting a smoking cessation program, and regular exercise are important to overall health, assessment data must first be collected to create an effective lifestyle change program. Health care needs and issues vary according to race and ethnicity, socioeconomic status, marital status, and so on. Approaches to health care/education must be individualized.

Which of the following statements concerning nutrition and older adults is true? a. Older adults who live in their own homes are more likely to be malnourished than older adults living in a nursing home. b. Older adults lose their desire for high-fat, salty foods. c. Meals served in long-term care institutions are usually more well-balanced than foods eaten by older adults living at home. d. Many older adults are not aware of food assistance programs.

ANS: D Barriers that may interfere with the ability of independent seniors to obtain adequate nutritional food include limited transportation, income, and social support resources. Many older persons are unaware that they are eligible to participate in SNAP. The percent of older adults who live in their own homes and are malnourished is lower than that of older adults who live in a nursing home. Older adults do not lose their desire for high-fat, high-cholesterol, high-sodium foods. Fresh fruits and vegetables are not always available for older adults living in nursing homes.

The school nurse has been asked to present a workshop on CA-MRSA for high school teachers. Which of the following information would the nurse most likely include? a. CA-MRSA is a common viral infection that responds well to antiviral meds. b. CA-MRSA is a serious bacterial infection that does not spread easily. c. CA-MRSA is a fungal infection common in school settings. d. CA-MRSA is a potentially fatal skin infection that is difficult to treat.

ANS: D CA-MRSA is a highly contagious bacterial infection that is difficult to treat and can result in pneumonia and death.

The occupational health nurse is planning a health fair for employees. Which of the following information about dental health should be included? a. Drinking bottled water helps prevent tooth decay. b. Gingivitis results in bone destruction and can be eliminated by flossing daily. c. Preventive dental care requires a visit to the dentist every 4 months. d. In addition to screening for tooth decay, dentists screen for mouth cancer.

ANS: D Dental health is essential to overall health. Dental professionals may be the first to detect a symptom or irregularity that points to a potentially dangerous condition, such as cancer of the mouth and esophageal cancer. Bottled water does not contain fluoride. Periodontitis is oral bone destruction. An annual dental check-up is recommended for the average person, not a check-up every 4 months.

Which of the following people has exceeded the recommended guidelines for activity? a. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during activity b. A 45-year-old woman who swims and has a pulse rate of 145 during activity c. A 50-year-old man who jogs and has a pulse rate of 120 during activity d. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity

ANS: D During activity, the persons pulse rate should not exceed 220 minus the age times 0.75. Thus the woman who is 60 years old would subtract (220 60 = 180); then multiply 180 by 0.75 to give 120 for the optimal heart rate for this client. A pulse rate of 125 exceeds the recommended optimal rate of 120.

A 19-year-old college student is seen by the health services nurse. The young woman is distraught that she had unprotected sex 4 days ago and is afraid she may have become pregnant. Which of the following statements should be made by the nurse? a. Lets talk about your options because you must be 21 years of age to purchase emergency contraception. b. Dont worry; you can purchase Plan B, an emergency contraception drug, without a prescription and it will terminate the pregnancy. c. I know you are upset, but we are in one of the 40 states that allow drugstores to carry Plan B, an emergency contraception drug. Lets talk about how to use the medication. d. You have several options. Lets discuss what would be the best thing for you to do next.

ANS: D Emergency contraception can reduce the number of unintended pregnancies. There is a generic two-dose form Next Choice, and a one-dose form, Plan B One-Step. Both require a prescription for girls under 17. Emergency contraception must be used within three days of unprotected sex. It works by either altering tubal transport of either sperm or ova, inhibiting implantation. It will not terminate an existing pregnancy and does not provide protection against sexually transmitted diseases

Which of the following statements should be considered by a nurse working in occupational health who organizes a stress reduction workshop? a. Women generally experience less workplace stress than do men. b. Ones first job is exciting and leads to numerous opportunities, and therefore causes little stress. c. Young adults adapt easily to changing job demands such as telecommuting and long work hours. d. Work is of primary importance to young adults and helps form their self-image.

ANS: D Employment is more than a source of income to young adults; it provides self-esteem and social interaction. Women experience as much, and sometimes more, stress than do men because of child care issues. The demands of work are stressful and sometimes lead to unhealthy behavior.

Which of the following adults has transitioned to Eriksons intimacy versus isolation and loneliness stage of development? a. A 21-year-old man who has a part-time job, spends most of his leisure time with his buddies, and has numerous short-term intimate relationships b. A 25-year-old woman who is very concerned with how she is perceived by her coworkers and friends c. A 30-year-old man who just graduated with a PhD and is looking for his first full-time job d. A 26-year-old woman who has a long-term relationship with a female companion

ANS: D Eriksons intimacy versus isolation and loneliness stage of development involves reciprocal expressions of affection and trust. Promiscuous behavior is not characteristic of this stage of development. Reliance on a positive perception by friends and coworkers for self-esteem is not characteristic of this stage of development.

A person is preparing to return home following a 2-week hospital stay for congestive heart failure and pneumonia. Which of the following referrals would be most beneficial for the person? a. Transportation assistance b. Home-delivered meals c. Adult day care d. Home health nursing

ANS: D Home care nurses provide health care information and services to individuals and families. The resources available to community health nurses frequently are rich and enable the nurses to draw on a variety of sources to assist in promoting the health of community-dwelling older adults. Although all of the referrals listed may be of benefit to the person, the home health nurse will provide the most comprehensive services and be able to connect the person to necessary community resources.

A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of the following responses should be made by the nurse? a. Older adults need as much sleep as middle-age and younger adults. Lets talk about your sleep patterns. b. Ill ask the nurse practitioner to prescribe a sleeping pill for you. c. Taking naps during the day can help relieve excessive fatigue and will help you sleep better. d. Lets talk about your sleep schedule and things that may prevent you from getting a restful nights sleep.

ANS: D Nurses should assist older adults in achieving a good nights sleep through assessment that might reveal possible causes of sleep disturbances. Older adults need less sleep than younger adults. Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not the initial therapy choice because of side effects.

A nurse is encouraging members of the community to advocate for the prevention of premature deaths in children under the age of 5 at the international level. Which of the following interventions would most likely be discussed by the nurse? a. Using mosquito netting in sleeping areas b. Participating in international vaccination programs c. Implementing accident prevention programs d. Providing nutritional supplements

ANS: D Protein-energy malnutrition can be severely harmful to the mental and physical development of individuals, especially young children under the age of 5. Worldwide, one out of two deaths among children younger than 5 years old stems from protein-energy malnutrition.

A nurse is completing a health counseling session with a 25-year-old woman. Which of the following statements should be made by the nurse during this session? a. A yearly Pap test is recommended for detection of ovarian cancer. b. Research supports that breast self-exams reduce breast cancer mortality. c. The incidence of cervical cancer is very low in your age group. d. Daily physical activity and weight control is one way to stay healthy.

ANS: D Screening is strongly recommended for cervical cancer in women who have been sexually active (Papanicolaou [Pap] smears). The incidence of carcinoma in situ is high in young adults. The US Preventative Services Task Force recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the additional benefits and harm of clinical breast examination beyond screening mammography for women 40 and older. After age 25, the preventive emphasis is on modifying coronary disease risk factors, which would be accomplished by discussing activity and weight control.

A nurse is assisting with development of menu items at a long-term care facility. Which of the following menus would the nurse most likely recommend? a. One egg over easy, one slice of whole wheat toast with sugar-free jam, 4 oz orange juice b. 5-oz cheeseburger cooked medium well with lettuce and tomato, 10 baked potato chips, and 1 cup of decaf coffee with low-fat milk and artificial sweetener c. Chef salad with 2 oz each ham and turkey, lettuce, tomato, bean sprouts, onion, green pepper with low-fat dressing, and one small roll with low-fat spread d. Turkey bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips, and ice tea with artificial sweetener

ANS: D The United States Department of Agriculture recommends that infants and young children, pregnant women, older adults, and those who are immune compromised should not consume raw (unpasteurized) milk or any products from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, or raw sprouts.

A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop osteoporosis like her mother did. Which of the following statements is the most appropriate response by the nurse? a. The American diet is much better now than when your mother was your age, so you have enough calcium in your diet to keep your bones strong. b. You have a strong genetic risk factor. There is not much we can do to stop the process. c. You need about 1000 mg of calcium a day to keep your bones strong. Lets talk about your diet. d. Tell me about your diet, how much walking you do each day, and what medications you take.

ANS: D The postmenopausal woman needs 1500 mg of calcium a day if she is not taking estrogen. Dietary calcium and vitamin D intake, and walking, can help prevent osteoporosis.

The community health nurse has obtained a grant to offer a Safe Driving series for older adults. Which of the following information should the nurse stress during the series? a. Traffic fatalities involving older adults occur mainly at dusk. b. The cause of two-vehicle accidents is frequently an older driver striking another car. c. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in accidents. d. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident.

ANS: D Traffic fatalities involving older adults occur mainly during the daytime. The cause of two vehicle accidents is frequently a younger driver striking the car driven by an older adult. The average blood alcohol level in older adults involved in accidents is lower than the blood alcohol level of younger drivers involved in accidents.

A nurse is determining if children with severe acute malnutrition (SAM) should receive facility-based or community-based care. Which of the following children should receive care in the community? a. 3-year-old male who has a history of dehydration b. 9-month-old male whose family has adequate support and resources to obtain the recommended treatment c. 4-year-old female who has sensitivity to milk products d. 6-month-old female who has a good appetite and no underlying medical conditions

ANS: D When a child has a good appetite with no medical conditions (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, and/or infections), Ready-to-Use Therapeutic Foods (RUTF) under community-based care are appropriate. RUTF are special milk-based foods which are soft, crushable, and tasty nutrient- and energy-rich foods that can be consumed by children six months or older.