Care pop exam 2, Ch. 10, 19, 34, 41, 42, 43
Occupational and environmental health nursing can best be described as which of the following? a. Enforcement of Occupational Safety and Health Administration (OSHA) requirements b. Identification and management of health and safety cases in workplace settings c. Promotion of wellness in the workplace d. Promotion, prevention, and restoration of health in the workforce aggregate
ANS: D The American Association of Occupational Health Nurses defines occupational health nursing as the specialty practice that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment. It includes the prevention of adverse health effects from occupational and environmental hazards. It provides for and delivers occupational and environmental health and safety programs and services to clients.
The incentives and pressures for cost control and improved health outcomes have promoted the development of technologies that are simpler, more reliable, and: a. more acceptable to the patient. b. more expensive. c. more complex. d. efficient.
ANS: D The increased availability of telehealth coincides with trends described in this and other chapters in this book: an aging population, increased chronic illness and costs, and changes in health care reimbursement. Home health, palliative, and hospice providers face the challenge of managing increasingly complex clients in a highly constrained fiscal environment where patterns of care and reimbursement are based on client need and agency efficiency. Telehealth has emerged as a viable and acceptable way to supplement the delivery of health care economically.
The Child Nutrition and WIC (Women, Infants, and Children) Reauthorization Act of 2004 designates that each local education agency participating in federal school meal programs have: a. accommodations for services provided to special needs children. b. normal education experience for all children. c. school-based clinic. d. school wellness policy.
ANS: D To address obesity and to promote healthy eating and physical activity through changes in school environments, Congress passed the Child Nutrition and WIC Reauthorization Act of 2004 designating that each local education agency (LEA) participating in federal school meal programs, such as the National School Lunch or Breakfast Program, must establish a local school wellness policy.
In designing a tertiary prevention intervention to address the leading cause of school absences related to chronic illness, the school nurse should focus on: a. asthma. b. attention-deficit hyperactivity disorder. c. diabetes mellitus. d. digestive system problems.
ANS: A Asthma is the leading cause of children's absence from school as a result of a chronic illness. Children may be hospitalized with an asthma attack or have been recently discharged from the hospital to home. Asthma may be caused by allergic triggers with which the child comes into contact in the school, such as chalk dust, mold/mildew, or pet dander. There may also be concerns about the air quality in the school or specific classroom activities. The nurse can help students with asthma through medication administration, coaching in asthma management, and education of the student, teachers, other children, and parents.
Community and public health nurses (PHNs) practicing in rural locales consistently note which of the following characteristics of their practice environments? a. Broad scope of practice, independence and autonomy, and opportunity for community involvement b. Expanding scope of practice, plentiful resources, and increased opportunity for less formal interactions c. Lack of autonomy and independence, along with greater flexibility than in an urban practice d. Narrower scope of practice and focus than in an urban practice
ANS: A Characteristics of nursing practice in rural environments include broad, diverse, and/or intergenerational scope of practice, greater independence, public status and autonomy, and a greater opportunity for community involvement than in many urban practice environments
9. The nurse is educating her Nigerian client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of: a. cultural accommodation. b. cultural brokering. c. cultural preservation. d. cultural repatterning.
ANS: A Culture is defined as a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. Culture is important to nurses because it helps them to understand the beliefs and practices clients bring to the clinical setting, their expression of concerns, and the type of health care they are pursuing. Quality of care means that positive health care outcomes are achieved. Failure to focus care according to the client's values and ideas is likely to increase cost and decrease quality. Care that is not culturally competent may lead to increased cost of health care and decrease the opportunity for positive client outcomes. Techniques such as cultural accommodation can ensure that a positive health outcome is achieved while providing for the cost-effective use of limited resources. Failure of clients to keep scheduled appointments with clinics may reflect a cultural preference for the type and frequency of contact with the health care system. Understanding the type of health care service that the client is seeking can ensure that opportunities to negotiate compliance with treatment can occur to the satisfaction of both parties so that precious resources can be managed effectively.
5. Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as: a. culture shock. b. prejudice. c. ignorance. d. racism.
ANS: A Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from those of the individual's own culture. There are cultures in which it is considered acceptable for men to hit their wives and/or children. The nurse can consult with the nursing supervisor or clinic social worker, who can intervene on the client's behalf with the cooperation of a community advocate from the client's culture of origin.
Host factors associated with increased risk of an adverse response to hazardous workplace exposure include: a. age, sex, and health status. b. experience and darker skin color. c. male gender and hypersusceptibility. d. employment for longer than 5 years.
ANS: A Each worker represents a host within the worker population group. Certain host factors are associated with increased risk of adverse response to hazards in the workplace. These include age, sex, health status, work practices, ethnicity, and lifestyle factors. The population at greatest risk for experiencing work-related accidents with subsequent injuries is new employees with less than 1 year of experience on the current job. Older workers may be at increased risk in the workplace because of diminished sensory abilities, the effects of chronic illnesses, and delayed reaction times. A third group that may be very susceptible to workplace exposure is women of child-bearing years. Hypersusceptible individuals are persons with specific individual differences that cause them to have adverse health reactions to low-level exposures that are otherwise considered to be safe.
4. A nurse who is ethnocentric in interacting with a client of a different culture: a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. b. is appreciative of the client's cultural beliefs. c. accommodates the client's cultural beliefs when planning care. d. imposes the nurse's value system on the client.
ANS: A Ethnocentrism, an inhibitor to developing cultural competence, is the belief that one's own cultural beliefs are the standards that should be used to judge people from other cultures. Ethnocentric nurses are unfamiliar and uncomfortable with that which is different from their own culture. Their inability to accept different worldviews often leads them to devalue the experiences of others and judge them to be inferior, treating those that are different from themselves with suspicion or hostility. The belief in one's own superiority, or ethnocentrism, may lead to "cultural imposition." Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. By developing an approach of "cultural relativism" nurses recognize that clients have different approaches to health care, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Nurses use "cultural awareness and knowledge" to overcome unfamiliarity and discomfort with cultures outside of their own. Nurses who may have ethnocentric beliefs can avoid inhibiting behaviors/actions such as cultural imposition by developing cultural competence.
3. A nurse is conducting a diabetes self-management group-education session. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. An effective intervention is for the nurse to: a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. b. explain that everyone must learn to do foot inspection to manage their diabetes. c. loudly and slowly repeat the instructions for all participants to remove their shoes. d. stop the group session, pull the two gentlemen aside, and apologize to them.
ANS: A Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups.
The transmission of tuberculosis (TB) in health care settings has reemerged as a major public health problem. In terms of the host-agent-environment epidemiologic triad, it can best be described as involving which type of workplace agent? a. Biological b. Chemical c. Enviromechanical d. Physical
ANS: A In the epidemiologic triad of host-agent-environment, agents—factors associated with illness or injury—are classified as biological, chemical, enviromechanical, physical, or psychosocial. Biological agents are living organisms whose excretions or parts are capable of causing human disease, usually by an infectious process. Biological hazards are common in workplaces such as health care facilities and clinical laboratories where employees are potentially exposed to a variety of infectious agents, including viruses, fungi, and bacteria. Contact with blood-borne and airborne pathogens represents a significant class of exposures for U.S. health care workers at risk. Such agents may include hepatitis B and C viruses, HIV, Mycobacterium tuberculosis, and methicillin-resistant Staphylococcus aureus.
The minimum requirements for entry into home care practice should be: a. baccalaureate in nursing. b. baccalaureate in nursing and clinical nurse specialist (CNS) certification. c. master's in nursing. d. master's in nursing and CNS certification.
ANS: A Nurses come to home care from a variety of educational and practice backgrounds. Home care nurses should be educated to function at a high level of competency so that they can be relied on not only by their professional colleagues but also by the community. A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting, including home care.
When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: a. advocating for ethical choices. b. communicating risk. c. controlling environmental damage. d. volunteering for service on state boards.
ANS: A Nurses, using sound risk communication skills as trusted communicators, advocate for environmental justice. Ethical issues likely to arise in environmental health decisions are: • Who has access to information and when? • How complete and accurate is the information? • Who is included in the decision making and when? • What and whose values and priorities are given weight in decisions? • How are short-term and long-term consequences considered?
Physical agents associated with workplace hazards can best be addressed through engineering strategies and: a. practice of safe work habits. b. workplace redesign. c. blood-borne pathogen standards. d. material safety data sheets.
ANS: A Physical agents are those that produce adverse health effects through the transfer of physical energy. Commonly encountered physical agents in the workplace include temperature extremes, vibration, noise, laser beams, radiation, and electricity. The control of worker exposure to these agents is usually accomplished through engineering strategies such as eliminating or containing the hazardous agent. In addition, workers must engage in protective actions, such as practicing safe work habits and wearing personal protective equipment when needed. Safe work habits may include taking appropriate breaks from environments with temperature extremes, noise, or vibration, and not eating or smoking in radiation-contaminated areas. Personal protective equipment includes hearing protection, eye guards, protective clothing, and devices for monitoring exposures to agents such as radiation.
When determining whether a geographic area is rural or urban, the nurse should recognize that: a. rural and urban areas by their nature occur on a continuum. b. rural regions have fewer than six persons per square mile. c. rural residents feel isolated. d. rural areas are recreational, retirement, and resort communities.
ANS: A Rural and urban residencies are not opposing lifestyles. Rather, they occur on a rural-urban continuum ranging from living on a remote farm, to living in a village or small town, to residing in a larger town or city, to living in a large metropolitan area with a core inner city. Although some communities may seem geographically remote, the residents who live there may not feel isolated. For the affluent, the term rural may bring to mind recreational, retirement, and resort communities in the mountains, seashore, or lake country. For the less affluent, it may mean an impoverished Indian reservation or migrant labor camp. Therefore rural may be a state of mind.
A cultural belief and an environmental factor that may increase the risk of potential pesticide exposure for some migrant workers are: a. hot-cold balance and housing. b. cuarentena and distance from health care services. c. need to achieve high productivity and transportation challenges. d. disease causality and proximity to the farm fields.
ANS: A Some migrant workers may not shower when they return from the fields as a result of cultural beliefs about being exposed to cooler water while feeling hot from working. Inadequate housing that lacks showers and/or adequate laundry machines also prevent farmworkers from washing pesticides off themselves and their clothing in a timely manner. This exposes the farmworker and the entire family to the risk of pesticide exposure.
A rural health nurse who is planning programs to address the population's needs should recognize that, in general, rural populations: a. engage in physical activity during leisure time. b. engage in preventive health behaviors. c. perceive their overall health as less favorable. d. use seat belts.
ANS: C In general, people in rural areas have a poorer perception of their overall health and functional status than those in urban areas.
As the nature of work has changed over time, the nature of work-related illness and injury has also changed. The best example of a work-related illness/injury associated with the change from an agrarian economy to a highly technological workplace is: a. carpal tunnel syndrome. b. byssinosis (brown lung disease). c. pneumoconiosis (black lung disease). d. fatal work injuries in miners.
ANS: A The dramatic shift in the types of jobs held by workers following the evolution from an agrarian economy to a manufacturing society and then to a highly technological workplace has also created a shift in the nature of work-related illnesses and injuries. This change in the nature of work has been accompanied by many new occupational hazards, such as exposure to complex chemicals and nanoparticles and nonergonomic workstation design, as well as many other issues related to work organization, such as job stress, burnout, and exhaustion. A number of work illnesses and injuries have been drastically reduced, eliminated, or controlled, including vinyl chloride-induced liver cancer, brown lung disease (byssinosis) from cotton dust exposure, reproductive disorders associated with certain glycol ethers, and fatal work injuries and pneumoconiosis in coal miners. However, the rates of other types of illnesses and injuries, such as latex allergy, work-related stress, carpal tunnel syndrome, and tendonitis, have increased.
Since 1987, the Centers for Disease Control and Prevention (CDC) has funded the federal school health program, which today provides for: a. development of a health education curriculum that includes parents and community. b. development of school-linked programs. c. establishment of school-based health centers. d. hiring of school nurses to achieve a 1:750 nurse-to-student ratio.
ANS: A The federal school health program, an eight-part plan originally developed in 1987 with coordination and funding by the CDC, has led to the development of a comprehensive school health education program that includes the parents and the community in the children's care. By 2001, 20 states had school health programs funded by the CDC. The funding paid for the development of health education plans of study, or curricula that included policies, guidelines, and training for those programs. The states then used these courses to teach schoolchildren. The schools are actively involved in helping children practice problem solving, communication, and other life skills so they can reduce their risk factors.
6. A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. The nurse should first conduct: a. general cultural assessment. b. head-to-toe assessment. c. in-depth cultural assessment. d. nonverbal communication assessment.
ANS: A The nurse proceeds with a systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practices of individuals and groups within a holistic perspective, which includes worldview, life experiences, environmental context, ethnohistory, language, and diverse social structure influences. Cultural assessments should focus on those aspects relevant to the presenting problem, necessary intervention, and participatory education. During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview. In-depth cultural assessments are conducted over a period of time. This gives the nurse and client time to get to know each other and is especially beneficial to the client because it allows the client to see the nurse in a helping relationship.
The case manager role of the school nurse can best be described as: a. coordinating health care for children with complex health problems. b. counseling students to choose workable solutions to their problems and conflicts. c. referring students to available resources. d. screening students for common health problems.
ANS: A The school nurse's case manager role is to help coordinate the health care of children with complex health problems to ensure that students' health care appointments and visits have the minimum possible negative impact on their educational experience.
The school nurse plans a health education program on diet and nutrition for adults attending a general equivalency degree (GED) program held at the local high school in the evenings. This best exemplifies which role of the school nurse? a. Community outreach b. Consultation c. Counseling d. Provision of direct care
ANS: A When performing community outreach, school nurses can participate in community health fairs in the schools, influenza immunization programs, and blood pressure screenings for school staff, among other things. The school nurse can also serve as the liaison for coordinating educational programs in the schools provided by local health charities. School nurses also provide health education to adult learning centers that conduct GED programs, job training, or instruction in English as a second language.
The Omaha System was initially designed to address the concerns of nurses practicing in the community in the following areas: (Select all that apply.) a. Documentation b. Information management c. Nursing practice d. Telehealth e. Specialty certification
ANS: A, B, C The Omaha System was initially developed to operationalize the nursing process and provide a practical, easily understood, computer-compatible guide for daily use in community settings and is the only American Nurses Association (ANA)-recognized terminology developed inductively by and for nurses who practice in the community. As early as 1970, the nurses, other staff, and administrators of the Visiting Nurse Association (VNA) of Omaha, NE, began addressing nursing practice, documentation, and information management concerns.
The role of the nurse who wants to become more active in environmental health could include which of the following? (Select all that apply.) a. Assessing farmworkers for pesticide exposure and providing pesticide risk education b. Conducting epidemiologic investigations as a public health nurse (PHN) c. Developing corporate policy to protect workers from unsafe levels of toxic agents d. Organizing the local community to encourage landlords to remove lead-based paint e. Working as a skilled risk communicator for a local chemical manufacturer
ANS: A, B, C, D, E Nurses can have a vital role in reducing environmental risk, educating workers and/or the community, and helping to eliminate risks in the local community. As nurses learn more about the environment, opportunities for integration of such work into their practices, educational programs, research, advocacy, and policy work will become evident and will evolve.
The ANA Standards of Home Health Nursing Practice is composed of two parts: Standards of Care, which follow the six steps of the nursing process, and Standards of Professional Performance, which include which of the following? (Select all that apply.) a. Quality of care b. Performance appraisal c. Collegiality d. Outcome identification e. Resource use
ANS: A, B, C, E The ANA scope and standards publications, including those for Home Health Nursing and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance. Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, critical thinking skills, education, collegiality, ethics, collaboration, research, and resource use.
Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression? (Select all that apply.) a. Delays in seeking mental health services b. High rate of poverty c. Gaps in the continuum of mental health services d. Sufficient number of mental health services e. Tolerance for destructive coping mechanisms
ANS: A, B, C, E There appears to be more persistent, endemic depression among rural residents. Factors that relate to this level of depression are the high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.
The National Association of School Nurses (NASN) and standards of practice for school nurses set forth which of the following principles? (Select all that apply.) a. School nurses should have a bachelor's degree in nursing and a specialty certification. b. School nursing uses the nursing process. c. Credentialing is recommended but not required. d. American Academy of Pediatrics governs the school nurse's practice. e. School nurses must ensure the safety of the children, including when delegating care.
ANS: A, B, E In reality, the educational preparation of school nurses ranges from associate to master's degrees. However, the NASN, the professional organization for school nurses, recommends that school nurses be registered nurses with a bachelor's degree in nursing and specialty certification as a school nurse. The NASN identifies eight criteria for schools nurses in providing care. One of these criteria is ensuring the safety of the children, including when delegating care. The American Academy of Pediatrics is a physician organization that does not have regulatory power over nursing but has developed guidelines for providing health care to students in schools that compare well with the NASN standards of practice.
When preparing a report on work-health interactions, the occupational health nurse should include which of the following information? (Select all that apply.) a. Accidental deaths and deaths associated with occupationally acquired illness b. Numbers of workers requiring vision correction while working c. Rates and types of injuries that occurred while workers were on the job d. Worker illnesses potentially associated with workplace chemical agent exposure
ANS: A, C, D Work-health interactions relate to the influence of work on health. Work-health interactions are revealed by statistics on illnesses, injuries, and deaths associated with employment. In 2007, 3.9 work-related illnesses and injuries per 100 workers were reported. Occupational injuries alone cost billions in lost wages and lost productivity, administrative expenses, health care, and other costs and because many work-related health problems go unreported, this is only the "tip of the iceberg." However, even the reported statistics are significant in scope. Although progress in some areas has been made in improving worker protection since the 1970s, because the workplace, workforce, and work characteristics are changing, disease incidence is increasing in other areas. Healthy People 2020 identifies areas for continued improvement.
During routine nursing assessments, the nurse should ask clients about their current and past jobs, exposures to any agents that potentially relate to their symptoms and activities at work, and which of the following? (Select all that apply.) a. Disabling conditions b. Immunization history c. Lifestyle history d. Previous injuries e. Underlying illnesses
ANS: A, C, D, E The initial step in a worker assessment is the traditional history taking and physical examination, with emphasis on exposure to occupational hazards and individual characteristics that may predispose the client to the increased health risks associated with certain jobs. The occupational health history is an indispensable component of the health assessment of individuals. Because work is a part of life for most people, including an occupational health history in all routine nursing assessments is critical. Identification of workplace exposure as a source of health problems may influence the client's course of treatment and rehabilitation and may also allow prevention of similar illnesses among others with potential for exposure. Three elements that occupational health histories should include are (1) a list of current and past jobs that the client held; (2) information about exposures to specific agents and the relationship between the symptoms and activities at work, job title, or history of exposure; and (3) other factors that may influence the client's susceptibility to occupational agents (e.g., lifestyle factors such as smoking, underlying illness, previous injury, or disabling conditions). The more complete the data collected, the more likely the nurse is to notice the influence of work-health interactions.
1. A nurse overhears the doctor saying, "Let's not give the client codeine, he's Asian." The nurse reflects on the comment and determines that the doctor is which of the following? (Select all that apply.) a. Culturally competent b. Prejudiced c. Ethnocentric d. Unable to assess pain based on culture e. Planning care based on racial enzymatic differences
ANS: A, E Biological variations distinguish one racial group from another. These differences may occur in the areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from use of the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen his or her pain, and other pain-reducing medications should be explored.
The nurse case manager in a migrant farmworker clinic assesses this vulnerable population from the perspective of occupational and environmental risks related to: a. contaminated water, applied chemicals, and unfamiliar farm equipment. b. naturally occurring plant substances, pesticides, and fear of injury reporting. c. traffic accidents, weather, lack of worker supervision, and inadequate sewage. d. weather, pesticides, and strict enforcement of occupational regulations.
ANS: B Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.
2. A new group of migrant farmworkers has arrived in a community. The local public health nurse (PHN) realizes that an important step before scheduling clinic services is to: a. consult the public health staff regarding their scheduling preferences. b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. c. review written materials about the farmworkers' culture of origin. d. visit the farmworker camp and tell the camp leaders when clinic services will be available.
ANS: B Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences.
When using the health measure of death rates for working adults, the nurse could expect to find the highest death rates in which areas? a. Large metropolitan areas b. Most rural and highly populated urban areas c. Most rural and suburban areas d. Small suburban and all urban areas
ANS: B Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults are found in the most rural areas. Residents of rural areas have the highest rates of death as a result of unintentional injuries in general and because of motor vehicles injuries in particular. Homicide rates are the highest in the central counties of large metropolitan areas.
The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: a. compliance and enforcement. b. environmental epidemiology. c. secondary prevention. d. toxicology.
ANS: B Epidemiologic studies enable us to understand the strength of the association between exposures and health effects, such as the relation between air pollution and asthma exacerbation.
A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are: a. natives of Guatemala. b. natives of Mexico. c. natives of Panama. d. newly arrived from Haiti.
ANS: B Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel). Symptoms and folk treatments may vary depending on the individual's or family's place of origin in Mexico. When experiencing a folk illness, the traditional Mexican individual would prefer to seek care from a folk healer. The more common healers are curanderos, herbalists, and espiritualistas. The most common herbs used by the folk healers are chamomile (manzanilla), peppermint (yerba buena), aloe vera, nopales (cactus), and epazote. The nurse needs to ask clients what herbs and other remedies they have tried to help with their symptoms. Use of some herbs with prescribed medication may be contraindicated, and the nurse needs to include that information in client counseling. Any client counseling should incorporate awareness of and sensitivity to the client's culture.
Nurses practicing in rural communities often observe that protecting client confidentiality is a unique challenge because: a. nurses' family members expect nurses to share client information when something serious is happening to a community member. b. nurses in rural areas are well known to their service populations and are often approached by their clients in social and other settings with requests for counsel and advice. c. professional nurses in rural areas often work in more than one role in the community, which reduces their professional credibility. d. rural residents do not expect nurses to keep client information confidential because "everyone knows everyone" and his or her family.
ANS: B Nurses practicing in rural areas are obligated to maintain client confidentiality just as they would in an urban setting. However, nurses are often asked for health information and advice in nonclinical settings. Nurses must be especially sensitive and exercise creativity to maintain client confidentiality when approached in public settings.
A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach? a. Assessment b. Case management c. Geriatrics d. Tertiary prevention
ANS: B Nurses working in rural areas, including those working with migrant workers, have opportunities to use community-oriented nursing skills. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models for addressing some of these deficits and reducing rural health disparities.
The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: a. provided for the appointment of state emergency response commissions. b. increased focus on the human health problems related to hazardous waste sites. c. established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. d. reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.
ANS: B SARA changes included an increase in the size of the trust fund; encouraged greater citizen participation in decision making on how sites should be cleaned up; increased state involvement in every phase of the Superfund program; increased focus on human health problems related to hazardous waste sites; established new enforcement authorities and settlement tools; stressed the importance of permanent remedies and innovative treatment technologies in the cleanup of hazardous waste sites; provided for Superfund actions to consider standards in other federal and state regulations; and established the federal Agency for Toxic Substances and Disease Registry. This act amended the Comprehensive Environmental Response, Compensation, and Liability Act with provisions for a broader community-level involvement and public health mission to address the effects of hazardous waste sites on people.
To promote quality improvement, the documented plan of care for an elderly home care patient should include which of the following? a. Listing of community resources available to meet the patient's needs b. Expected patient outcomes for each identified problem or diagnosis c. Formulated nursing diagnosis d. Objective physical assessment data
ANS: B Setting short- and long-term goals provides criteria for evaluation, and increases continuity of care and the potential for improved outcomes.
Research to identify occupational and safety hazards and determine recommended exposure limits for occupational hazards is the function of: a. North American Industry Classification System (NAICS). b. National Institute for Occupational Safety and Health (NIOSH). c. National Occupational Research Agenda (NORA). d. OSHA.
ANS: B The Occupational Safety and Health Act of 1970 created two agencies, OSHA and NIOSH. OSHA, a federal agency within the Department of Labor (DOL), was created to develop and enforce workplace safety and health standards and regulations that regulate workers' exposure to potentially toxic substances. NIOSH, a part of the Centers for Disease Control and Prevention (CDC), identifies, monitors, and educates about the incidence, prevalence, and prevention of work-related illnesses and injuries and examines potential hazards of new work technologies and practices. It provides recommendations regarding exposure limits for occupational hazards to OSHA.
A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? a. Encourage the use of electric cars and scooters on campus b. Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus c. Make the entire campus a no-smoking zone d. Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78° in the summer and lowering the thermostat to 70°in the winter
ANS: B The burning of fossil fuels to power automobiles and buses and to generate electricity is the single greatest source of air pollution in the United States. While reducing the use of electricity on campus is helpful, the single biggest source of campus air pollution is the cars and buses used to drive to and around campus. Decreasing their use is also an application of the precautionary principle.
A community-oriented nurse newly assigned to a rural community learns that the characteristics of rural and small town life include: a. consistent employment, formalized professional interactions, and openness to people new to the community. b. informal social and professional relationships, acquaintance of residents with most other members of the community, work of many residents in high-risk occupations, and often a lack of openness to newcomers. c. lack of anonymity, fractured family systems, role of churches as socialization centers, and mistrust of newcomers. d. tendency of residents to work in safety-oriented occupations, preference for autonomy rather than working as a community, and work in agriculture-related factories.
ANS: B The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").
A middle school student approaches the school nurse and says, "Can I talk to you about something important?" The school nurse responds affirmatively but should clarify: a. "Anything you tell me will be kept private and confidential." b. "If anything you tell me indicates that you or someone else is in danger, I must tell the parents and school officials." c. "It may be best for me to set up an appointment with the school counselor." d. "You can always speak to me if you are in trouble or when you need someone to talk to."
ANS: B The school nurse may be the person whom children trust to be told important secrets about health. It is important that, as a counselor, the school nurse have a reputation as a trustworthy person to whom children can go when they are in trouble or when they need someone to talk to. Nurses in this situation should tell children that if anything they reveal indicates that they are in danger, the parents, and school officials must be told. However, privacy and confidentiality, as in all health care, are important.
In designing a substance abuse primary prevention education program for the secondary schools in the community, it would be most important for the school nurse to include content related to the latest trend in the use of: a. cocaine. b. ecstasy. c. heroin. d. marijuana.
ANS: B There has been an increase in the use of "club drugs" such as lysergic acid (LSD), ketamine, gamma hydroxybutyrate (GHB), Rohypnol, and ecstasy (MDMA). The school nurse can teach students about the serious side effects of ecstasy, especially that it causes a very high body temperature, which can lead to death. Teaching students about the dangers of using all drugs is the responsibility of the school nurse. The school nurse can also teach parents and other members of the community about the latest drug use trends, increasing everyone's awareness of these dangerous trends.
A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: a. community strengths and weaknesses. b. environment and human health/disease. c. toxicology studies conducted by the Environmental Protection Agency and the environment. d. federal and state environmental regulations.
ANS: B Understanding the relationship between the environment and human health and disease has become more important over the years. The environment is now known to play a role as a determinant of health status, an explanation of disease, an influence on health risk, and a cause of human toxicity and the ever-increasing burden of potentially toxic synthetic chemicals that our bodies carry.
The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps
ANS: B, C, D Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policymakers at local, state, and national levels are necessary actions that nurses are prepared to undertake.
The definition of a migrant farmworker includes which of the following? a. Farmer who helps his neighbors on their farms after his own crop fails b. High school student who works part time at his uncle's rose farm c. Teenager who moved with his family ten times in 2 years to work different crops d. Woman who works in the crop fields in the summer and at a grocery store in thewinter
ANS: C According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day. A seasonal farmworker returns to his permanent residence, worked in agriculture for at least 25 days or parts of days and did not work year round only in agriculture.
From August through May, an inner city school district provides primary health care services, including mental health and dental care, to children and youth. This is a specific example of which of the following? a. Child health improvement program b. Primary care clinic c. School-based health center d. School health system
ANS: C Because many children may not receive health care services other than screening and first aid care from the school nurse, the federal government began funding school-based health centers. School-based health centers are family-centered, community-based clinics run within schools. These clinics provide expanded health services, including mental health and dental care, as well as the more traditional health care services like primary care. They can be small or large and may provide services during the school year, during certain hours throughout the year, or 24/7 all year.
8. A community-based hospice nurse has an Asian male client with terminal-stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care physician (PCP). Because this nurse is culturally competent with Asian clients, the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: a. cultural accommodation. b. cultural assessment. c. cultural brokering. d. cultural repatterning.
ANS: C Cultural brokering is an action used by nurses in delivering culturally competent care. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of the client.
The shift of home care away from its charitable and public health-oriented roots toward current models in use can be attributed to: a. consolidation of voluntary and official home health agencies. b. expansion of home care to include community health needs. c. integration of home care into benefit programs. d. passage of the Medicare prospective payment system.
ANS: C Home care began changing from its charitable and public health-oriented beginnings when it was added to benefit plans by payers, starting with the Metropolitan Life Insurance Company in the early 1900s; Medicare included it as a benefit for enrollees in 1965. Inclusion of home care benefits began to change the nature of the services provided. Services were focused on individuals with specific functional and health problems who could not be cared for elsewhere, and the care provided became more technical, opening the door for population-focused home care, transitional care, home-based primary care, traditional home health care, and hospice care.
In home health care, the use of performance improvement programs, evidence-based practice guidelines, and appropriate communication, documentation, and telehealth technologies are strategies to address the issue of: a. agency accreditation. b. professional performance standards. c. malpractice risk reduction. d. regulatory compliance.
ANS: C Home health and hospice nurses are at risk for malpractice claims related to the complexity of care, failure to adhere to standards of practice, and other errors. Nurses and their employers need to be proactive by taking responsibility for personal and agency actions. A focus on communication with clients, families, and the health care team; commitment to providing quality care; documentation refresher sessions; performance improvement programs; use of evidence-based practice guidelines; and appropriate use of information technology and telehealth are strategies that can help reduce risks.
An effective industrial disaster plan is a written document that is shared with all who will be involved, such as the internal first responders, external community-based emergency personnel, and other key personnel and agencies in the community. Another factor that helps improve the effectiveness of the community response to a potential industrial disaster is: a. addressing activities for work areas that are at greater risk. b. conducting an all-responders disaster drill every 5 years. c. conducting a response agency worksite walk-through. d. training specific employees in fire brigade procedures.
ANS: C In occupational health, the goals of a disaster plan are to prevent or minimize injuries and deaths of workers and community residents, minimize property damage, provide effective triage, and facilitate necessary business activities. Formulation of a disaster plan requires the cooperation of different personnel within the company and community. The first step is conducting a comprehensive worksite survey, which includes an exhaustive chemical and hazard inventory of the workplace, examination of material safety data sheets, and inspection of plant blueprints. Specific steps must be detailed for actions to be carried out by specific individuals in the event of a disaster. The written plan must be shared with all who will be involved. Employees should be prepared in first aid, cardiopulmonary resuscitation, and fire brigade procedures. Plans must be clear, specific, and comprehensive, covering all shifts and all work areas. Transportation, fire response, and emergency response services should be coordinated with the agencies that would be involved in an actual disaster. The disaster plan, emergency and safety equipment, and the first-response teams' abilities should be tested at least annually through a drill. Practice results should be evaluated, and the plan updated and revised as necessary. It is imperative to keep community-based emergency responders updated with clinical information on exposures and appropriate treatment. Representatives of these responding agencies should visit the worksite and accompany the nurse on a worksite walk-through, so that they are familiar with the operation.
An undocumented migrant farmworker has been diagnosed with TB. The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6-12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.
ANS: C Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.
The local hospital emergency department has recently noted an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of the rise in cases and schedules a case mapping of: a. bars frequented by migrant workers. b. farm fields employing migrant workers. c. housing for migrant workers. d. restaurants frequented by migrant workers.
ANS: C Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.
Recent trends in the characteristics of the U.S. workforce that will present new challenges to protecting worker safety and health include: a. better job security, more equitable work hours, and compressed work weeks. b. decrease in the retirement age and increase in the number of people with chronic illness. c. increase in the numbers of people with chronic illness, women, and older workers, and increase in racial diversity. d. increased racial diversity and better health, longer period of productivity, and longer life expectancy of workers.
ANS: C The U.S. workforce is becoming older and more racially and ethnically diverse. More women and people with chronic illness are joining the workforce. In 2008, Black and Hispanic minorities represented 25% of the workforce and women represented 48%. These changes will present new challenges to protecting worker safety and health. In an era in which the demand for workers is expected to outstrip the available supply, businesses must be concerned about strategies to increase health status, employment longevity, and satisfaction of workers. The workforce is more educated and mobile. Employers are also challenged to provide services such as child care and elder care.
Hospice care would be an appropriate option to discuss with which of the following patients? a. Patient with stage II lung cancer who is undergoing chemotherapy b. Patient with early Alzheimer's disease whose caregiver needs respite care c. Patient with metastatic breast cancer who has discontinued chemotherapy and radiation treatment d. Patient with severe debilitating osteoporosis
ANS: C The criterion for entry into hospice care is that the disease process or condition has progressed to the point that further treatment cannot cure and death within 6 months would not be unexpected. This does not mean that the patient will die within the next 6 months, only that if death occurred, it would not have been unexpected. Hospice care services can be provided in the home and/or institutional setting. Multidisciplinary teams have the knowledge, skill, compassion, and experience to address the unique needs of the patient at the end of life as well as the needs of his or her family.
The increased use of telehealth in the school system will be driven largely by: a. Healthy People 2020 objectives related to school health. b. increasing need for efficiency, documentation, and successful clinical outcomes in providing care to students. c. increasing need to provide health care services in the schools. d. National Association of School Nurses guidelines.
ANS: C The future of school nursing is strong. The amount of health care being given in the schools is increasing. In the future, school nursing will involve telehealth and telecounseling to teach health education. The internet will be used by school nurses to work with children and parents. Teleclinics operated out of the schools will be seen more frequently.
A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. An evidence-based strategy that would be effective for this mobile population is educating: a. advocacy groups for migrant farmworkers. b. local policymakers. c. migrant lay health workers. d. workers seeking care at the migrant health clinic.
ANS: C The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.
7. A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands the need for the client to use traditional healing practices. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.
ANS: C The nurse understands that in the client's culture, disease is often perceived as a disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. Clients may use the mind-body-spirit connection to heal from within. Such cultures rely on naturalistic solutions such as herbs, hot and cold treatments, and acupuncture to resolve or cure a cancerous condition.
Medicare regulations, professional organizations, and state licensing boards dictate the responsibilities and functions of health professionals in providing home care, and a variety of specialized services can be included in home care either through direct care service, staff education, or consultation. Because of this need for various knowledge, skills, and perspectives, successful functioning in the provision of services requires: a. certified advance practice home health nurses. b. integration of home health aide and homemaker roles. c. interprofessional teams. d. physician certification of the medical problem and plan of care.
ANS: C The responsibilities and functions of health professionals in home care are determined by Medicare regulations, professional organizations, and state licensing boards. Many specialized services can be provided in home care, such as enterostomal therapy, podiatric care, pharmaceutical therapy, nutritional counseling, intravenous therapy, respiratory therapy, and psychiatric or mental health services. Many of these services can be provided on a consulting basis, either through staff education or through direct provision of services. This requires the use of an interprofessional team model, so that the specialized knowledge, skills, and perspectives of each team member can be integrated and will be implemented and reinforced by those in all involved disciplines to achieve successful patient outcomes.
The migrant clinic's mobile van program provides health education through lay health workers; screening for pesticide illness, tuberculosis (TB), and diabetes; pregnancy testing; and treatment for some acute and chronic illnesses typically seen in this vulnerable population. In dealing with this population's beliefs about disease causality, this program demonstrates the application of the health promotion and disease prevention principle of: a. advocacy. b. cultural competency. c. outreach. d. primary prevention.
ANS: C The same principles of health promotion and prevention apply to migrant farmworkers as to the rest of the U.S. population. However, health promotion and disease prevention as presented by nurses may be difficult concepts for migrant workers to embrace because of their beliefs regarding disease causality, their irregular and episodic contact with the health system, and their lower educational level. Health promotion begins by informing the farmworker family about health topics and the resources available to improve health. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers.
In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle, especially their current: a. communicable diseases. b. educational level. c. housing arrangements. d. pesticide exposure.
ANS: C The way of life of migrant farmworkers and their families is stressful. They often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.
An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: a. contact factory senior management, educate workers about their exposure, and clean the area. b. contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. c. immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. d. treat the client and obtain a comprehensive exposure history; if an on-site environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.
ANS: D A careful history should be taken using the I PREPARE (Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, Educate) model. The client should be appropriately treated. If an on-site environmental exposure is suspected, other at-risk workers should be screened and treated as needed. The environmental cause should be resolved, either by removing the offending chemical or reducing it to safer levels. Factory safety policies should be followed, reviewed, and changed if needed. State and federal agencies should be notified as required.
A community health nurse is prioritizing health-promotion activities with the local rural community. An understanding of the health status and health risks of the rural community would lead the nurse to give priority to: a. aerobic exercise classes and an exercise class for seniors with arthritis. b. English as a second language program using health promotion literature as reading materials. c. mentoring program to increase adult literacy. d. motor vehicle and farm accident prevention project and prenatal care outreach program.
ANS: D All of the health-promotion activities mentioned would be helpful for a rural community. However, health-promotion activities should be prioritized according to the most common causes of morbidity and mortality for the population served. Rural residents are at increased risk of injury and death secondary to motor vehicle accident and farm-related occupational injuries. Rural residents also have increased rates of infant and maternal morbidity and mortality.
1. A nurse asks a couple who are new parents for their baby's full name. The parents reply that they are only supposed to give the baby its first name. The most appropriate response for the nurse is to: a. tell the couple that they are the child's parents and it is up to them to name their baby. b. explain to the couple the state's bureau of vital statistics deadline for completing the birth certificate. c. give the couple the paperwork and ask when the baby will have a name. d. express interest and ask the couple to share how their new baby will receive its name.
ANS: D Dealing effectively with immigrant populations includes learning about how the community deals with common events and what their traditional practices are. In some cultures, it is not the parents but their spiritual leader or a more senior family member who gives a baby its name. Nurses should engage in cultural encounters to learn about a client's culture and practices.
Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: a. societal justice. b. nonmaleficence. c. compliance and enforcement of the Environmental Protection Agency Regulatory Act. d. environmental justice.
ANS: D Environmental health risks notably have disproportionately affected poor people and people of color in the United States. Low-income citizens and people of color are more likely to live near a hazardous waste site, and increased incidence of childhood lead poisoning and increased rates of childhood asthma are seen in these groups. Environmental justice is the principle of assuring that no group is more at risk of harmful exposure than another.
1. A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: a. epidemiologist, pediatric specialist, and sanitarian. b. laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. c. public health sanitarian, pediatric generalist, and plumbing inspector. d. specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood.
ANS: D Environmental health-risk identification and risk-reduction intervention require a multidisciplinary team. The team members needed to address an elevated lead level in a child include a specially trained housing inspector, a sanitarian familiar with lead health risks, a nurse practitioner and/or physician trained to intervene in cases of pediatric lead exposure, and housing specialists trained to reduce lead-based paint risk in the home.
A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, nonmetropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding? a. Client who lives next to a ranch in a town of 1200 people b. 70-year-old client residing in an assisted living facility in a rural area c. Apple grower who lives in a 100-square-mile county with a population of 19,900 d. Soybean grower and his wife who live in a 400-square-mile county with a population of 39,501
ANS: D Farm residency denotes living outside "city limits" and involvement in agriculture. Frontier regions have fewer than six persons per square mile; rural communities have fewer than 20,000 residents or fewer than 99 persons per square mile. Nonmetropolitan statistical areas are regions without a central city of 50,000 or more citizens. The soybean grower and his wife make their living in agriculture (farm resident), and the county where they live has fewer than 99 persons per square mile (rural).
When applying the nursing process to environmental health, the nurse would: a. conduct an assessment focused on the client's presenting problem. b. coordinate interventions with the primary care provider of record. c. examine criteria that are limited to the client's immediate responses. d. include outcome measures that involve mitigation and elimination of the contributing factors.
ANS: D If the nurse suspects that the client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse should include outcome measures that relate to mitigation and elimination of the environmental factors.
A home health nurse is charged with identifying opportunities for health promotion and illness primary prevention. The activity that bests demonstrate this focus is: a. collaborating with the chaplain to address the spiritual needs of a hospice patient. b. educating a school nurse on the care regime of a returning student newly diagnosed with asthma. c. referring a newly diagnosed diabetic patient to the nutritionist for dietary teaching. d. tracking the immunization status of patients
ANS: D Immunizations prevent disease, a function of primary prevention. Patients requiring home health care may be more at risk of complications of diseases like influenza and pneumonia. Keeping immunizations current is a critical aspect of health promotion and illness primary prevention for these patients. Home health nursing involves the same primary prevention focus in the care of aggregates as does other community-oriented nursing. It also requires a focus on secondary and tertiary prevention in the care of individuals in collaboration with the family and other caregivers.
