Chapter 43: The Nurse in Occupational Health

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. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: p. 943

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. Cognitive Level: Application Associated Chapter Objective: 23-24 REF: p. 944

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. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 946

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. Cognitive Level: Analysis Associated Chapter Objective: 3 & 6 REF: p. 942

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. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 942

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. Cognitive Level: Synthesis Associated Chapter Objective: 7 REF: pp. 948-951

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. Cognitive Level: Application Associated Chapter Objective: 8 REF: p. 953

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. Cognitive Level: Analysis Associated Chapter Objective: 9 REF: p. 954

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. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: pp. 941-942

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. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 939

A nurse is pursuing certification as an occupational health nurse. Which organization will provide this certification? a. American Board for Occupational Health Nurses b. Occupational Safety and Health Education and Research Center c. National Institute for Occupational Safety and Health (NIOSH) d. Occupational Safety and Health Administration (OSHA)

a. American Board for Occupational Health Nurses Certification in occupational health nursing is provided by the American Board for Occupational Health Nurses. The Occupational Safety and Health Education and Research Center supports master's and doctoral education with emphases in occupational health nursing, industrial hygiene, occupational medicine, and safety. NIOSH examines potential hazards of new work technologies and practices. OSHA educates employers about occupational health and safety.

An occupational health nurse is assessing slippery floors as a safety hazard in the work setting. Which of the following best describes the type of hazard the nurse is assessing? a. Enviromechanical b. Physical c. Chemical d. Psychosocial

a. Enviromechanical Enviromechanical agents are those that can potentially cause injury or illness in the workplace. They are related to the work process or to working conditions, and they can cause postural or other strains that can produce adverse health effects when certain tasks are performed repeatedly. Slippery floors are known as enviromechanical hazards. They can cause or potentiate accidents, injuries, strain, or discomfort.

What is the purpose of NIOSH? a. Examine potential hazards of new work technologies and practices b. Educate employees about environmental risks and hazards c. Develop and maintain a database of work-related deaths d. Set standards that regulate workers' exposure to potentially toxic substances

a. Examine potential hazards of new work technologies and practices NIOSH examines potential hazards of new work technologies and practices. OSHA educates employees about environmental risks and hazards, develops and maintains a database of work-related deaths, and sets standards that regulate workers' exposure to potentially toxic substances.

An occupational health nurse is assessing the need for MSDSs at the worksite. Which of the following items would require an MSDS? a. Hand soap b. Eye goggles c. Aprons d. Earplugs

a. Hand soap The Hazard Communication Standard requires that all worksites with hazardous substances inventory their toxic agents, label them, and provide information sheets, called MSDSs, for each agent. Hand soap is a toxic agent. Eye goggles, aprons, and earplugs are not toxic agents and therefore, do not need an MSDS.

The nurse is doing a walk-through to identify workplace hazards. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

a. Primary prevention Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. A walk-through is part of an assessment, which is part of primary prevention. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.

An occupational health nurse is educating employees about work-related hazards. Which of the following hazards would the nurse most likely discuss in the presentation? a. Workplace stress leading to hypertension and cardiovascular disease b. Asbestos, plastics, lead, and solvents leading to dermatitis c. Cement dust and metals leading to bronchitis d. Hormones and nitroglycerine leading to reproductive effects

a. Workplace stress leading to hypertension and cardiovascular disease Work-related stress or burnout has been defined as an important problem for many individuals. Responses to negative interpersonal relationships, particularly those with authority figures in the workplace, are often the cause of vague health symptoms and increased absenteeism. Education about stress would be pertinent to all workers, regardless of specific job or setting.

The first industrial nurse is considered to be: a. Betty Moulder. b. Ada Mayo Stewart. c. Lillian Wald. d. Florence Nightingale.

b. Ada Mayo Stewart Ada Mayo Stewart was hired in 1885 by the Vermont Marble Company; she is often considered the first industrial nurse. Betty Moulder provided care of ailing coal miners and their families. Lillian Wald is known as the founder of public health nursing. Florence Nightingale is one of the pioneers of the nursing profession.

A nurse is working in an occupational health setting. Which of the following roles will the nurse most likely have? a. Administrator b. Clinicians/practitioner c. Consultant d. Educator

b. Clinicians/practitioner An occupational health nurse could be employed in any of these roles. However, the majority of occupational health nurses work as nurse clinicians/practitioners.

An occupational health nurse is involved in disaster planning. Which of the following actions would be most appropriate for the nurse to take? a. Assess for possible disasters b. Prevent injuries and death of workers c. Store Medical Data Sheets in a safe place d. Collaborate with government authorities to plan disaster management

b. Prevent injuries and death of workers The occupational health nurse is a key player in occupational disasters. The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of different personnel within the company and community. There are not Medical Data Sheets rather MSDSs.

A nurse is employed in an occupational health setting. Which of the following activities would be a primary role of the nurse? a. Caring for employees and their families b. Providing health promotion and emergency care c. Updating the Material Safety Data Sheets (MSDSs) d. Reporting communicable diseases

b. Providing health promotion and emergency care The customary role of the occupational health nurse extends beyond emergency treatment and prevention of illness and injury and also includes the promotion and maintenance of health, overall risk management, care for the environment, and efforts to reduce health-related costs in business. The occupational health nurse does not typically care for families of employees, update MSDSs, or report communicable diseases.

A nurse is identifying agents that are part of the epidemiologic triad. Which of the following will the nurse most likely identify? a. Environmental pollution b. Radiation c. Susceptible human beings d. High-risk groups of individuals

b. Radiation Radiation is an example of an agent. The agents, factors associated with illness and injury, are occupational exposures that are classified as biological, chemical, enviromechanical, physical, or psychosocial. Environmental pollution is part of the environmental factor in the epidemiologic triad. Susceptible human beings and high-risk groups of individuals are part of the host factor of the epidemiologic triad.

Which is a requirement of the Superfund Amendment and Reauthorization Act (SARA)? a. Applying stricter rules to determine Superfund sites b. Sharing written disaster plans with key resources in the community c. Authorizing each industry to write their own disaster plan d. Evaluating the effectiveness of a written disaster plan

b. Sharing written disaster plans with key resources in the community SARA requires that written disaster plans be shared with key resources in the community, such as fire departments and emergency departments. SARA does not apply stricter rules, authorize each industry to write their own disaster plan, or evaluate the effectiveness of a written disaster plan.

An occupational health nurse is assessing workplace hazards. Which of the following would be the best method for the nurse to use? a. Review incident reports b. Walk through the worksite c. Interview key employees d. Read the Standard Industrial Classification (SIC) Code

b. Walk through the worksite One of the best methods an occupational health nurse can use in assessing workplace hazards is to walk through the worksite. Reviewing incident reports, interviewing key employees, and reading the SIC Code do not provide the nurse with as much information as walking through the worksite.

Which population is at the greatest risk for experiencing work-related accidents with subsequent injuries? a. Workers of child-bearing age b. Workers with less than 1 year of experience c. Workers with diminished sensory abilities d. Workers with chronic illnesses

b. Workers with less than 1 year of experience New workers with less than 1 year of experience on the current job are at the greatest risk for experiencing work-related accidents with subsequent injuries. The highest percentages were in mining; agriculture, forestry, and fishing; construction; and wholesale and retail trade.

An occupational health nurse refers an employee to an employee assistance program. Which of the following problems would most likely be addressed? a. Obesity b. Smoking c. Alcohol abuse d. Lack of exercise

c. Alcohol abuse Employee assistance programs are designed to address personal problems such as marital/family issues, substance abuse, or financial difficulties. These issues are addressed because they affect the employee's productivity. These efforts are cost-effective for businesses.

Which statement about chemical agents is accurate? a. Chemicals are not ordinarily found in the body tissues of the general population. b. Most chemicals have been studied to determine the effects of exposure on humans. c. Chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk. d. Human effects of chemical exposure are associated with single agents rather than with the interaction of agents.

c. Chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk. It is true that chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. As a consequence of general environmental contamination with chemicals from work, home, and community activities, a variety of chemicals have been found in the body tissues of the general population. Predicting human responses to chemical exposures are complicated because multiple chemicals often combine and interact to create a new chemical agent.

Which population would have been the focus of care for an occupational health nurse in the early 1900s? a. Injured workers b. All workers c. Families d. The community

c. Families In the early days of occupational health nursing, the nurse's work was holistic and centered on the family. The care provided by Betty Moulder and Ada Mayo Stewart focused on both ill workers and their families.

A nurse is assessing a worker who has had a health reaction to a "safe" low-level exposure. Which of the following most likely describes what has happened? a. An allergic reaction b. A compromised immune system c. Hypersusceptibility d. Malnutrition

c. Hypersusceptibility A number of host factors appear to be associated with this hypersusceptibility: light skin, malnutrition, compromised immune system, glucose-6-phosphae dehydrogenase deficiency, serum alpha1-antritrypsin deficiency, chronic obstructive pulmonary disease, sickle cell trait, and hypertension. A worker who has a health reaction to "safe" low-level exposures is experiencing hypersusceptibility.

A nurse is conducting an occupational health assessment. Which of the following best describes the rationale for this assessment? a. It is required by OSHA. b. It is required by NIOSH. c. It helps to identify agent and host factors that place employees at risk. d. It helps to educate workers about potential hazards.

c. It helps to identify agent and host factors that place employees at risk. The purpose of this assessment is to become knowledgeable of the work processes and the materials, the requirements of various jobs, the presence of actual or potential hazards, and the work practices of employees. This assessment allows the nurse to identify agents and host factors that place employees at risk. An occupational health assessment is not required by any organization.

Which types of industries are noted for high degrees of hazards associated with the work? a. Data entry, animal rescue, and hospice b. Engineering, science, and laboratories c. Manufacturing, mining, and agriculture d. Aeronautics, plastics, and nursing

c. Manufacturing, mining, and agriculture Manufacturing, mines, construction, and agriculture are noted for their high degree of hazards associated with their work. However, no worksite is free of occupational health and safety hazards.

Which was the first legislation that specifically required certain prevention programs for workers? a. Occupational Safety and Health Act b. NIOSH c. Mine Safety and Health Act d. SIC Code

c. Mine Safety and Health Act The Mine Safety and Health Act was enacted in 1968. It was the first legislation that specifically required certain prevention programs for workers. The Occupational Safety and Health Act established OSHA and NIOSH to carry out the Act's purpose of ensuring "safe and healthful working conditions for working men and women." NIOSH examines potential hazards of new work technologies and practices. The SIC Code did not require certain protection programs for workers.

An occupational health nurse has conducted a walk-through assessment and has identified potential hazards in the workplace. The nurse recognizes that it will be easiest to modify exposure to which hazard? a. Bacteria b. Aerosols c. Noise d. Burnout

c. Noise Controlling physical agents, such as noise, can usually be accomplished through engineering strategies and personal protective equipment. It is much harder to change biological agents (bacteria), chemical agents (aerosols), and psychosocial agents (burnout).

A nurse in the occupational health arena is implementing a secondary prevention strategy. Which of the following best describes the action that was taken by the nurse? a. Providing education on safety in the workplace to prevent injury b. Working with chronically diabetic workers to ensure appropriate medications c. Screening for hearing loss resulting from noise levels in the plants d. Ensuring that a person with cardiovascular disease attends a rehab program

c. Screening for hearing loss resulting from noise levels in the plants Secondary prevention occurs after a disease process has already begun—screening for hearing loss. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—working with chronically diabetic workers and ensuring that a person with cardiovascular disease attends rehab. Primary prevention is aimed at prevention of a disease before it occurs—providing education on safety in the workplace to prevent injury.

An employer offers a limited duty program after an employee has experienced a cumulative trauma injury. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

c. Tertiary prevention Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—limited duty program after injury. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.

A nurse is assessing host factors as part of the epidemiologic triad. Which of the following factors would the nurse most likely assess? a. Crowding b. Shift work c. Worker's family d. Chemical exposure

c. Worker's family The worker's family is considered a part of the host factor. Crowding and shift work are environmental factors, and chemical exposure is the agent factor.

What is the purpose of OSHA? a. Educate occupational health and safety professionals b. Identify and research occupational health and safety hazards c. Distribute research findings relevant to occupational health and safety d. Educate employers about occupational health and safety

d. Educate employers about occupational health and safety OSHA educates employers about occupational health and safety. NIOSH identifies and researches occupational health and safety hazards, distributes research finding relevant to occupational health and safety, and educates occupational health and safety professionals.

An employee has come into contact with a biological agent. Which of the following considerations should be made by the nurse? a. The biological agent may cause accidents in the work environment. b. The biological agent is commonly found in the agriculture industry. c. The biological agent may potentiate stress in the workplace. d. The biological agent indicates exposure to bacteria, viruses, fungi, or parasites.

d. The biological agent indicates exposure to bacteria, viruses, fungi, or parasites. 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.

The most disabling occupational condition reported in 2011 was/were: a. cuts and punctures. b. fractures. c. bruises. d. sprains and strains.

d. sprains and strains. In 2011, sprains and strains were by far the most frequent disabling conditions, accounting for 38% of the cases of days away from work.