community 20

A community health nurse suspects Munchausen syndrome by proxy when a child A) experiences "seizures" only when a parent is present, not if a third party is present. B) has stunted growth and shortened limbs that have been noticeable since birth. C) has a noticeable limp when wearing shoes but not in bare feet. D) has periods of "acting out" and misbehaving, especially when there is company.

A Feedback: Experiencing seizures only when a parent is present would be a "red flag" for this syndrome if it were occurring in a child. Stunted growth, limp, or acting out are not associated with Munchausen syndrome by proxy.

When assessing a family in crisis, which of the following would the community health nurse need to do first? A) Assess the nature of the crisis B) Determine client's perception C) Define available supports D) Assess coping abilities

A Feedback: Initially, the nurse must assess the nature of the crisis and the client's response to it. Next, the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is available for support to the individual or family. Finally the nurse assesses the clients' coping abilities.

The nursing student reads the textbook in preparation for a class meeting about primary, secondary, and tertiary prevention related to families in crisis. The student determines which one of the following statements as most accurate regarding the levels of prevention? A) Often people in crisis are temporarily helpless and unable to cope on their own but are receptive to outside influence. B) Secondary prevention interventions include taking action to prevent the unwanted event from occurring. C) Tertiary prevention focuses on moving past the crisis and returning to the precrisis state. D) Primary prevention is the least effective level of intervention in terms of promoting client's health and containing costs.

A Feedback: Often people in crisis are temporarily helpless and unable to cope on their own, but understand the need for outside help and are receptive to other people's suggestions. Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted event from occurring. Tertiary prevention focuses on moving past the crisis, although returning to the precrisis state may not be possible. Primary prevention is the most effective level of intervention in terms of promoting client's health and containing costs.

Which of the following would the community health nurse identify as an act of sexual exploitation of a child? A) Child pornography B) Child molestation C) Fondling of child's genitals D) Vaginal penetration with an object

A Feedback: Sexual exploitation of children includes conduct or activities related to pornography that depict minors in sexually explicit situations and promotion of prostitution by minors. Sexual assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration of the genital or anal opening by a foreign object, and child molestation.

Which of the following would lead a community health nurse to suspect possible child neglect? Select all that apply. A) 15-year-old Lucy misses school once a week to watch her baby sister while mom works. B) 6-year-old Sam plays in the yard with a sweater on when it is 60 degrees outside. C) Twins, Bobby and Billy arrive at school in dirty and smelly clothing most school days. D) 11-year-old Samantha comes to school without lunch or lunch money each day. E) 9-year-old Tommy misses school two or three times a month due to asthma attacks. F) 14-year-old Jennifer watches her neighbor's 2-year-old every Saturday.

A, C, D Feedback: Educational neglect involves Lucy missing school to watch her baby sister and general neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how hard and long he is playing—he may be comfortable. Although Tommy is missing a number of days of school, he has a legitimate excuse. Fourteen is an appropriate and legal age to babysit.

A community health nurse is preparing a presentation for a community center group about crisis. Which of the following concepts about situational crises should be included in the presentation? Select all that apply. A) A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. B) Situational crises can be predicted, expected, and planned. C) Situational crises are never positive. D) Situational crises often occur without warning. E) Situational crises occur to people because of where they are in time and space.

A, D, E Feedback: A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur to people because of where they are in time and space. Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.

While visiting a family in their home, a community health nurse hears a parent screaming who says, "Everything you do is wrong. Can't you do anything right ever?" The nurse suspects which of the following? A) Neglect B) Emotional abuse C) Sexual abuse D) Physical abuse

B Feedback: Emotional abuse involves psychological mistreatment or neglect and may involve verbal abuse such as statements like, "Everything you do is wrong. Can't you do anything right?" Neglect occurs when physical, emotional, medical, educational resources necessary for healthy growth and development are withheld or unavailable. Sexual abuse involves acts of sexual assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain, physical injury, or death.

After teaching a class about family and domestic violence directed toward children as a community health problem, which of the following if stated by the class indicates to the instructor that the teaching was effective? A) Family violence is new and occurs as a result of our fast-paced technological society. B) Family violence has occurred in most countries for centuries as children have been thought of as the property of their parents. C) Family violence occurs mostly in the urbanized areas of the United States mostly in the urbanized areas where exposure to crime is more prevalent. D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

B Feedback: The history of family and domestic violence is long. For centuries, children were thought of as the property of their parents, and any treatment doled out by the parents was their prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned and begun to do something about family violence. Family violence is brought to the attention of officials more frequently today than in yesteryear, especially in urban areas where more people live, but it occurs throughout the world—in urban, rural, and remote areas with no signs of decreasing. Family violence in the United States occurs mostly in the urbanized areas where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

A group of families are attending a local community group for a class on Internet safety and children. Which of the following statements by the group indicates effective teaching? A) "It's not so much the time they spend but the sites they use." B) "We'll move the computer to the family room so we can easily observe the child's internet use." C) "We'll set the Internet browser feature to medium." D) "The firewall program that we have from 2 years ago should still be good."

B Feedback: To promote Internet safety with children, the computer should be placed in a high traffic area in the home so that others can easily observe what is going on. Parents need to monitor the time as well as the sites that the child uses. The Internet security browser should be set to high. With the advances in technology, a firewall program that is 2 years old may not be adequate to protect the child. However, it would be better than no firewall program at all.

When discussing elder abuse with a senior citizen group, which of the following would the community health include? A) Older men experienced abuse at a higher rate than elderly women. B) Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. C) The majority of cases of elder abuse are perpetrated by persons unknown to the victim. D) Elders with dementia are less likely to be abused since they have less social interactions.

B Feedback: Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder abuse may be either known or unknown to the elder. Some elders are especially vulnerable to elder abuse.

A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which of the following as developmental crises? Select all that apply. A) A windstorm that damaged 20 homes in a community B) Grandpa Jones dying at age 82 years C) A couple getting engaged D) The Smiths getting a divorce E) The Jones experiencing a home invasion F) Seven people dying in an automobile crash

B, C, D Feedback: Developmental crises are periods of disruption that occur at transition points during normal growth and development. Developmental crises, as a rule, do not occur suddenly. They are more evolutionary than revolutionary. Even the advancing, age, illness, or death of a grandparent or parent is a developmental expectation. However, the actual event may occur suddenly. Experiencing damage from a windstorm, a home invasion, or an automobile crash are situational crises.

A community health nurse assesses a child during a home visit. Which of the following would lead the nurse to suspect that the child is a victim of sexual abuse? A) Bruising of the arms and back B) Evidence of numerous dental caries C) Complaints of pain on urination D) Burns on the hands and feet

C Feedback: A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising on the arms and back and burns on the hands and feet would suggest physical abuse. Numerous dental caries may suggest neglect.

Which of the following would a community health nurse expect to assess in a perpetrator of intimate partner violence? A) Occasional marijuana use B) High academic achievement C) Belief in male dominance D) Desire for complacency

C Feedback: Characteristics of perpetrators of intimate partner violence include a belief in strict gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement, and desire for power and control in relationships

After teaching a group of students about abuse and families, the instructor determines that the students have an understanding of this issue when they state which of the following? A) Less than 10% of women worldwide reported being physically abused by an intimate partner at some point in their lives. B) A woman's risk of intimate partner violence decreases during pregnancy, but increases once the baby is born. C) Intimate partner violence is a leading cause of morbidity and mortality in women worldwide. D) Intimate partner violence is a private matter and not a public health issue

C Feedback: Intimate partner violence is a leading cause of morbidity and mortality in women worldwide and is a public health issue. It is estimated that between 10% and 52% of women report being physically abused by an intimate partner at some point in their lives worldwide. A woman's risk of intimate partner violence increases during pregnancy with 44% to 48% of all women being abused at least once during the pregnancy.

Which one of the following statements about primary prevention for family violence is most accurate? A) The cycle of violence within the family cannot be interrupted. B) Persons who have been victims of family violence will repeat the behavior with others. C) Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. D) It is not possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

C Feedback: Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. The cycle of violence within the family can be interrupted, and persons who have been victims of family violence can learn to use more appropriate coping strategies. It is possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

When describing the cycle of violence to a group of students, the instructor includes which of the following as occurring as the cycle continues? A) Frequency of the cycle slows B) Tension-building occurs less often C) Loving reconciliation lasts longer D) Acute battering occurs more often

D Feedback: As the cycle of violence continues, the frequency of the cycle increases, with the tension-building phase and the acute battering incident occurring more often, and elimination of the loving reconciliation phase. Without intervention, this shorter, more violent cycle becomes increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner, incarceration, or death of a partner.

Which of the following would be least appropriate for a community health nurse to include in a plan of care at the secondary prevention level for families who may need to respond in a case of crisis in the future? A) Teaching social problem-solving skills B) Helping women develop assertiveness skills C) Providing parenting classes D) Helping to reestablish as sense of safety

D Feedback: Helping to reestablish a sense of safety would be appropriate at the secondary level of prevention. Teaching social problem-solving skills, helping women develop assertiveness skills, and providing parenting classes are appropriate primary prevention level activities.

In preparation for an examination on the history of family violence, a group of students reviews the various laws enacted for protection. The students demonstrate understanding when they identify which of the following as one of the earliest laws enacted? A) Child Abuse Prevention and Treatment Act B) Family Violence Prevention and Services Act C) Keeping Children and Families Safe Act D) Child Abuse Prevention and Treatment and Adoption Reform Act

D Feedback: In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as the Keeping Children and Families Safe Act.

A community health nurse is developing a plan of care for families in crisis. Which of the following would be most appropriate for the nurse to include? A) Encourage clients to suppress feelings to minimize pain B) Avoid correcting distorted facts to reduce stress C) Allow clients to blame others for the crisis D) Help clients confront crisis

D Feedback: In a crisis, the community health nurse encourages clients to accept help by acknowledging the problem. The nurse should encourage clients to express their feelings openly, assist them in finding facts (distortions create additional tension that may lead to maladaptive responses), and avoid blaming others to promote responsibility for problem solving.

A community health nurse is designated as a "mandated reporter." Which of the following best describes this designation? A) The nurse must witness abuse and neglect before being mandated to report. B) The nurse commands that battered women report the abuse. C) The supervising community health nurse is responsible for reporting only known cases of elder abuse. D) The nurse must report any case of known or suspected abuse and neglect in children or elders.

D Feedback: The abuse or neglect simply needs to be suspected in order for the nurse to report. In most states the nurse can receive a jail sentence and a fine for not reporting suspected abuse. Reporters may never witness the actual abusive event, but they can often see the resulting damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects according to the community's laws.

A community health nurse is providing a community education program about suicide. Which of the following would the nurse include as a common method used by women? A) Hanging B) Firearms C) Vehicle crash D) Overdose

D Feedback: Women usually choose less violent methods, such as overdosing on medications. Men choose more violent forms of suicide, such as hanging, use of firearms, or vehicle crashes.