Community Nursing Exam #3
A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children 15 years old and younger. What is the age-specific meningitis death rate for children age 15 years and younger for this region to date this year? a. 0.08/1000 b. 0.46/1000 c. 1/1000 d. 8/1000
A: 0.08/1,000 A rate is a measure of the frequency of a health event in a defined population in a specified period of time. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 × 1000 = 0.0833/1000.
The public health nurse is concerned about a possible multi-state outbreak of a foodborne illness. What resource will the nurse consult? a. PulseNet b. Healthy People 2020 c. CDC Yellow Book d. National Healthcare Safety Network
A: PulseNet The Foodborne Diseases Active Surveillance Network (FoodNet) is a CDC sentinel surveillance system targeting 10 sites across the country and collecting information from laboratories on disease caused by 9 enteric pathogens transmitted commonly through food. This is the resource the nurse would consult if worried about a multi-state outbreak.
The nurse epidemiologist in a local health district receives a report from a local pediatrician that a case of chickenpox has been diagnosed in a second grader at one of the local elementary schools. The nurse proceeds to contact the school to determine whether or not any other children are absent for illness or were recently seen by the school nurse. Other area pediatricians are also contacted to determine whether or not any other cases have been identified. The nurse works with the school to notify parents about what signs and symptoms they should look for and how to manage a child with such symptoms. This is an example of which type of surveillance? a. Active b. Passive c. Sentinel d. Special
A: active In an active system of surveillance, the PHN, as an employee of the health department, may begin a search for cases through contacts with the local health providers and health care agencies. The nurse names the disease or event and gathers data about existing cases to try to determine the magnitude of the problem.
When working as content experts or clinician advisers to develop injury prevention programs, the forensic nurse is doing which of the following? a. Addressing injury as a public health concern b. Differentiating intentional or unintentional injury c. Providing care to both victims and perpetrators d. Providing expert consultation for personal injury cases
A: addressing injury as a public health concern Forensic nursing care largely occurs in collaboration with professionals, both within and outside of nursing, including but not limited to public health professionals including epidemiologists, law enforcement and corrections officials, emergency department providers, and psychiatric practitioners. Forensic nurses also work collaboratively with public health nurses (PHNs) who bring a population focus to injury prevention programs. As part of a public health approach to crime, forensic nurses serve as content experts, clinical advisers, and/or the clinical managers of facilities that may contribute to a community response to injury prevention.
Many factors contribute to the fragmentation and access issues associated with the current mental health system. Which of the following is a community-oriented nursing strategy that can be used effectively to improve the quality of care for clients with persistent mental illness? a. Agency networking and interagency collaboration b. Comprehensive client history taking and family interventions c. Milieu therapy and psychobiological interventions d. Screening for signs of mental health disorders
A: agency networking and interagency collaboration Providing the range of services necessary to handle persistent mental illness is difficult without sufficient funds for health and social services. It is important for nurses and others working in community mental health centers to recognize the impact of changes in funding, changes in target populations, restructuring, and disagreements among professionals, agencies, and levels of government. This enables nurses to advocate for adequate services to meet the needs of individuals with severe and persistent mental illness. Some community-oriented nursing strategies that can be used to improve the care of clients with persistent mental illness include agency networking, interagency collaboration, and building of relationships.
An American spends several days in Mexicoeating fresh raspberries from a nearby vendor and drinking bottled water. What entity is potentially being altered? a. Agent-host-environment interaction b. Circadian rhythms c. Herd immunity d. Host resistance
A: agent-host-environment interaction The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. These three factors are known as the epidemiologic triangle. Changes in the characteristics of any of these factors may result in disease transmission.
Community health nurses conducting health education among populations vulnerable to HIV infection explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because of which issue? a. Antibody test results are typically negative. b. Antibody production by the immune system increases. c. Incubation period is prolonged. d. Symptoms include myalgias, sore throats, and rash.
A: antibody test results are typically negative Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection.
A nurse is caring for a rape victim/survivor who is initially displayed emotional withdrawal and silence, but now is repeatedly giving a description of the event. What action by the nurse is most beneficial? a. Assure the client that these reactions are normal for this event. b. Help the client process then move forward from the event. c. Offer the client short term anti-anxiety medications. d. Refer the client for posttraumatic stress disorder counseling.
A: assure the client that these reactions are normal for this event People react to rape differently, depending on personality, past experiences, background, and support received after the trauma. Some survivors cry, shout, or discuss the experience. Others withdraw and fear discussing the attack. The nurse would assure the client that these reactions are seen frequently in victims/survivors of rape.
What is the underlying reason for the use of universal precautions? a. Blood and body fluids of all clients need to be handled as if they were infected. b. Effective infection control surveillance programs are in place but not reliable. c. Health care settings are reservoirs of infection and precautions prevents spread. d. Health care workers do not always effectively use hand hygiene.
A: blood and body fluids of all clients need to be handled as if they were infected The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other bloodborne pathogens.
Which of the following are facts about marijuana of which the nurse should be aware? (Select all that apply.) a. Can be a safe therapeutic agent. b. It decreases appetite. c. May cause hyperemesis. d. Physical dependence can develop. e. Paranoia is a common side effect.
A: can be a safe therapeutic agent C: may cause hyperemesis Compared with other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. Cannabinoid hyperemesis syndrome can occur in frequent users and usually abates within 48 hours of nonuse.
When working with battered women, the nurse needs to know that research suggests that the response to abuse is a process that moves from: a. commitment to the relationship to leaving. b. emotional degradation to dependence and dominance. c. heated arguments from hitting to battering. d. self-blame to fear then to terror.
A: commitment to the relationship to leaving Nursing research suggests that the response to battering is a process that occurs over time in which the victim's emotional and behavioral reactions change. At first there is a great need to minimize the seriousness of the abuse, ascribe external blame, accept the partner's remorse, blame oneself, experience a moral conflict about leaving, hide the violence, placate the partner, and lose the sense of self, until finally concern about children or personal fear of death tips the balance to a decision to leave the abusive relationship.
Long-term consequences of victimization indicate that violence must be addressed as which of the following? a. Community and public health problem b. Legal and political concern c. Medical and health care concern d. Nursing concern
A: community and public health problem Violence should be considered a community and public health problem because violence results in significant mortality and morbidity, contributing to health care costs; exposure to violence as either a victim or witness can predict violent behavior in the future (violence begets violence); health care professionals have been slow to develop a response to violence; community factors contribute to violence; and evidence-based interventions have demonstrated that violence can be decreased or prevented and the community's capacity to respond to violence can be increased.
In the 1980s, a major contributor to the improvement of services for individuals with chronic and persistent mental illness was the establishment of which of the following? a. Consumer advocacy groups for people with mental illness b. Community mental health centers c. Managed mental health care d. National Institute of Mental Health (NIMH)
A: consumer advocacy groups Advocacy movements for people with mental illness, like those for other illnesses, came about to fulfill unmet needs and to attempt to decrease the stigma associated with mental illness.
Which arenas might a forensic nurse practice in? (Select all that apply.) a. Courtrooms b. Correctional facilities c. Hospital risk-management departments d. Medical examiner offices e. Police departments
A: courtrooms B: correctional facility C: hospital risk-management D: medical examiner offices E: police departments Practice settings for forensic nurses may include hospitals (risk management, clinical units, and emergency rooms), psychiatric facilities, jails, prisons, community-based urgent care, medical examiner or coroner offices, investigative units of law enforcement, criminal justice agencies (courts, attorney offices), and government programs for safety prevention.
Environmental factors that place children at risk for mental health issues include: (Select all that apply.) a. crowded living conditions. b. genetic predisposition. c. lack of consistent caregivers. d. neighborhood violence. e. separation from parents.
A: crowded living conditions C: lack of consistent caregivers D: neighborhood violence E: separation from parents Children are at risk for disruption of normal development by biological, environmental, and psychosocial factors that impair their mental health, interfere with education and social interactions, and keep them from realizing their full potential as adults. Examples of environmental factors include crowded living conditions, violence, separation from parents, and lack of consistent caregivers.
A truck driver says, "At first I was just using 'meth' at parties, but now I think about it all the time and how am I going to get some." What term best describes this individual's use behavior? a. Drug addiction b. Drug dependence c. Recreational drug use d. Substance abuse
A: drug addiction Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with using a drug (compulsive use) and securing its supply, and a strong tendency to relapse if the drug is removed.
A politically active nurse is working to have a passed in the state of residence to open and fund several substance abuse recovery centers. What action by the nurse would be most effective? a. Educating lawmakers that substance abuse is a health problem b. Finding philanthropic sources of funding to kick start the campaign c. Hiring a lobbyist who has worked on similar issues in other states d. Mobilizing recovering addicts to speak about the benefits of the program
A: educating lawmakers that substance abuse is a health problem The greatest challenge, nurses (and others) have in influencing policy makers and legislators, is convincing them to address the problem as a health care issue instead of a criminal/judicial issue.
A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: a. endemic. b. epidemic. c. pandemic. d. sporadic.
A: endemic Endemic refers to the constant presence of a disease within a geographic area or a population. Epidemic refers to the occurrence of disease in a community or region in excess of normal expectancy. Pandemic refers to an epidemic occurring worldwide and affecting large populations.
Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) a. Environmental changes b. Host behavior c. Improved surveillance d. Microbial adaptation e. Public health infrastructure deterioration
A: environmental changes B: host behavior D: microbial adaption E: public health infrastructure deterioration Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel.
Morbidity data can most easily be located in which of the following sources? (Select all that apply.) a. Environmental surveys b. Hospital discharge reports c. Medical examiners' reports d. Specialized disease registries e. Vital statistics sources
A: environmental discharge reports B: hospital discharge reports D: specialized disease registries Mortality data can be found in data sources containing vital statistics, which typically include death certificates and coroner/medical examiner reports, and birth certificates. Morbidity data are typically found in reports of notifiable disease, laboratory reports, hospital discharge reports, billing data, outpatient health care data, specialized disease registries, injury surveillance systems, environmental surveys, and sentinel surveillance systems.
The first step in initiating a surveillance strategy is to confirm the: a. existence of the event. b. magnitude of the problem. c. source of the outbreak. d. tentative hypothesis.
A: existence of the event The first step in conducting an investigation is to confirm that an occurrence/outbreak actually exists and that a supposed event is not a false alarm. The investigator must find out the nature, location, and severity of the problem. Only the investigator can make this determination. The investigator can then verify the diagnosis and develop a case definition to determine the magnitude of the problem.
Nurses working with victims of incest must be aware of the incidence of incest, its signs and symptoms, and the psychological and physical trauma it causes. Which statement is one fact about incest relevant to comprehensive nursing assessment? a. Hardly ever occurs in stepparent-child relationships. b. Occurs in all races, religious groups, and socioeconomic classes. c. Occurs only in father-daughter relationships. d. Often occurs in father-son relationships.
A: hardly ever occurs in stepparent-child relationships Incest occurs in all races, religious groups, and socioeconomic classes. Nurses must be aware of this fact to conduct comprehensive assessments that take into account the incidence of incest, signs and symptoms, and the psychological and physical trauma it causes.
A client acknowledges that cocaine use is damaging career and marriage, but the client has not investigated local treatment options. Understanding change theory, what action would be best? a. Have the client weigh the pros and cons of drug use. b. Send the client to a detoxification center. c. Sign the client up for inpatient rehabilitation. d. Suggest several solutions the client could consider.
A: have the client weight the pros and cons of drug use The role of the nurse in assessing individuals is to determine their readiness for change in acknowledging a problem and seeking treatment and recovery. The stages of change are pre-contemplation, contemplation, preparation, action, and maintenance. This client is in the pre-contemplation stage; he or she is aware of a problem and is contemplating action, but has yet to do anything. Successful strategies the nurse employs include having the client weigh the pros and cons of the drug habit and having the client determine and weight some solutions him- or herself.
The nurse educates a group of students that which persons would be most at risk of reactivation of latent infections of tuberculosis (TB)? (Select all that apply.) a. Immunocompromised b. Substance abusers c. Individuals previously treated for TB d. Long-term cigarette smokers e. Diabetics
A: immunocompromised B: substance abusers E: diabetics Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy.
Which of the following measures reduce physical and emotional injury in a community? (Select all that apply.) a. Improving general health b. Lowering health risks c. Maintaining strict legal codes d. Mitigating poverty e. Reducing health disparity
A: improving general health B: lowering health risks D: mitigating poverty E: reducing health disparity The health determinants of injury, identified in Healthy People 2020, mirror disease occurrence in a community, where inequities of resources and education exist, health disparity, violence and other crimes rise, and accidental injuries occur more often. Trauma victims are overrepresented in minority, disenfranchised, and disadvantaged groups. Disparity is also seen in the prosecution, conviction, and incarceration of individuals of minority groups in many countries. Populations that experience more disease also experience more violent as well as accidental injury, and more events that lead to prosecution. The measures that improve overall health, lower risk, and reduce disparity also reduce physical and emotional injury. Injury now joins certain categories of disease, disability, and premature death as a major preventable health state. Reducing injury reflects the goals of Healthy People 2020.
A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection
A: link between HPV and cervical cancer C: need to eliminate the warts E: lack of cure for HPV infection The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts. Surgical removal and other treatments are often done.
When considering the scope of mental illness in the United States, what does the community health nurse realize about mental disorders? a. Most frequent in African Americans b. Rarely a secondary problem c. They are indiscriminate d. Treated largely by specialty services
A: most frequent in African Americans Mental disorders are indiscriminate. They occur across the life span and affect individuals of all races, cultures, genders, and educational and socioeconomic groups. Mental disorders can be a secondary problem among people with disabilities.
A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Which interventions by the nurse are most appropriate? (Select all that apply.) a. Provide comprehensive STD screening. b. Call the health department to inquire about the spouse. c. Educate the client on ceftriaxone and azythromycin. d. Instruct the client on safer sex practices. e. Perform a serum pregnancy test.
A: provide comprehensive STD screening C: educate the client on ceftriaxone and azythtromycin D: instruct the client on safer sex practices E: preform a serum pregnancy test Gonorrhea and chlamydia are the two most common STDs today. The CDC guidelines are to treat both infections at the same time with ceftriaxone and azithromycin. However, the patient needs comprehensive STD screening. The client also needs a pregnancy test as STDs can lead to fetal effects (abnormal menses does not rule out a pregnancy). The nurse would educate the client on safer sex practices.
Nurses have unique skills that can be applied in which of the following aspects of disaster management? (Select all that apply.) a. Registration as an ARC disaster responder b. Clinical management of blast lung injury c. Engagement of the BioWatch system d. Monitoring of the environment to contain infectious disease e. Planning and organization of mass prophylaxis and vaccine campaigns
A: registration as an ARC disaster responder B: clinical management of blast lung injury D: monitoring of the environment to contain infectious disease E: planning and organization of mass prophylaxis and vaccine campaigns Nurses have skills in assessment, planning, implementation, evaluation, education, priority setting, collaboration, and provision of health care services to address both preventive and acute care needs. These skills sets are important in the four stages of disaster-related work prevention (planning/drill participation), preparedness, (course work/registration), response (clinical expertise), and recovery (monitoring).
Professional nursing organizations recommend that all women be routinely screened for domestic violence. When is the most appropriate time for this screening? a. When they are in the ED with physical trauma. b. When they come to any health care setting. c. When they report increased stress in the home. d. When they visit the provider repeatedly for anxiety.
A: when they are in the ED with physical trauma Professional nursing associations recommend that all women be routinely screened for domestic violence each time they come to a health care setting. Doing so would greatly increase the number of women who could be treated for abuse.
Research articles that include epidemiologic determinants and distribution would include which questions? (Select all that apply.) a. Who is affected most by pesticide exposure? b. Where in the city are lead levels highest? c. How does herbicide runoff affect drinking water? d. What season of the year sees the most trauma? e. Why do children get injured on playgrounds?
A: who is affected most by pesticide exposure? B: where in the city are lead levels highest? C: how does herbicide runoff affect drinking water? D: what season of the year sees the most trauma? E: why do children get injured on playgrounds? "Who," "what," "when," and "where" questions address epidemiologic distribution. "How" and "why" questions address epidemiologic determinants.
During an investigation, the problem has been identified and the initial magnitude of this issue has been delineated. What action will the nurse take next? a. Check the state reportable disease list. b. Develop a tentative hypothesis. c. Initiate appropriate control measures. d. Seek additional cases.
B: develop a tentative hypothesis Once an event/outbreak has been identified, confirmed, and initially defined, early and continuously changing control measures should be initiated to contain the event and minimize further impact on the public. Then, the investigation can proceed and the proper authorities can be notified or asked for assistance and further consultation.
The focus on the need for safety during periods of emergent trauma, collective violence, or chronic abuse is based on which theoretical framework contribution? a. Haddon's Matrix b. Maslow's hierarchy of needs c. Rights of citizens d. Ways of knowing
B: Maslow's hierarchy of needs Maslow's hierarchy of needs and desires are seen as influencing the individual's development toward a high level of self-actualization and satisfaction. It is important to consider the need for safety and desire for security that may be threatened by injury. Safety is among the five basic needs of humans identified by Maslow (1943). The need for safety can become acute during emergent trauma or chronic during periods of collective violence or chronic abuse. Safety and security precedes physiological needs; meeting physiological needs can be affected by security.
Research in neurobiology demonstrates that new learning actually changes brain structure, as exemplified by the effect of traumatic experiences on brain biochemistry. The use of both somatic and psychosocial interventions in the treatment of mental illness is supported by the scientific understanding of this concept, which is: a. blood-brain barrier b. brain plasticity. c. dopamine reuptake d. serotonin reuptake
B: brain plasticity Mental illnesses are complex biopsychosocial disorders. The study of brain plasticity demonstrated that new learning actually changes brain structure. For example, traumatic experiences change brain biochemistry, as do significant positive experiences. This information supports the notion that both experience and psychosocial factors have effects on the causes and treatment of mental illnesses. Both somatic and psychosocial interventions need to be used in treating mental illness.
A nurse is assigned to teach clients STD prevention information. What information will the nurse include in the presentation? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.
B: condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use.
When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.
B: confounding When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis.
To target populations at greatest risk for suicide, a community-based prevention program should consider outreach to: a. adolescent females, adults older than age 65 years, and men. b. depressed elderly men and persons with a prior history of suicide attempt(s). c. married men, elderly women, and adolescents with a family history of suicide. d. middle-aged men and healthy females with a family history of suicide.
B: depressed elderly men and persons with a prior history of suicide attempts Suicide is the second leading cause of death of young persons between the ages of 15 and 34 years. The majority of those who commit suicide have a mental health or substance abuse disorder. Other risk factors are prior suicide attempt, stressful life events, and access to lethal methods. In the United States, older adults 75 years and older are at the highest risk for suicide.
A forensic nurse understands that which of the following health risks results from incidents of crime and victimization? a. Diabetes mellitus b. Distress c. Incarceration d. Unwanted pregnancy
B: distress Injury because of crime and victimization causes pain and suffering, and may cause disability, economic failure, and distress of the spirit. However, such injuries often take a back seat to disease and infections. The burden of injuries to individuals ranges from minimal and brief to debilitating or fatal. The economic burden worldwide is tremendous (medical treatment, productivity losses, behavioral performance, psychological distress, and premature death).
A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis in the region at this time can best be described as: a. endemic. b. epidemic. c. pandemic. d. sporadic.
B: epidemic An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition.
When conducting a nursing assessment of a child, the nurse should be aware that indicators of potential or actual child abuse may include which of the following? (Select all that apply.) a. Cognitive impairment b. Evidence of general poor care c. Injuries not mentioned in history d. Seems to need to take care of the parent e. Unusual fear of the nurse and others
B: evidence of general poor care C: injuries not mentioned in history D: seems to need to take care of the parent E: unusual fear of the nurse and others Some indicators that are symptomatic of child abuse include evidence of poor general care, injuries not mentioned in the history, seems to have the need for taking care of or speaking for the parent, and unusual fear of others.
A 6 year old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.
B: fever of 101°F was present for several days before the rash appeared Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2 to 4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs).
A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.
B: host, agent, and environment Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease.
In following the principles of nursing interventions with violent families, which action by the nurse takes priority? a. Avoid provoking the perpetrator by suggesting the victim leave. b. Indicate zero tolerance for any further violence, degradation, or exploitation. c. Provide assurances that the family's confidentiality will not be violated. d. Tell the family you will report child abuse to the authorities.
B: indicate zero tolerance for any further violence, degradation, or exploitation The five principles of providing care to families who are experiencing violence include intolerance for violence, respect and care for all family members, safety as a first priority, absolute honesty, and empowerment. Nurses must clearly indicate that any further violence, degradation, and exploitation of family members will not be tolerated, but that all family members are respected, valued human beings. However, everyone must understand that the safety of every family member is the first priority.
In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. Which approach to communicable disease control does this approach exemplify? a. Health education b. Multisystem approach c. Improved public health infrastructure d. Reduction of environmental hazards
B: multisystem approach Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed.
An extensive train derailment occurs in the suburbs of a large metropolitan area. First responders determine that although no fatalities occurred, the derailed cars contain a noxious gas that diffuses readily into the air. The event easily overwhelms the capability of the local responders and hazmat teams are required. The local office of emergency management would coordinate through the emergency operation center to request assistance through which of the following? a. Environmental Protection Agency (EPA) b. Mutual aid agreement c. NIMS d. National Response Plan
B: mutual aid agreement The first level of disaster response occurs at the locality, with mobilization of entities such as the fire department, law enforcement, public health agencies, and voluntary organizations like the Red Cross. If the disaster warrants significant local attention and overwhelms the capacity of the local responders, then the county or city office of emergency management will coordinate activities through the emergency operation center. Generally localities within a county are signatories to a regional or statewide mutual aid agreement. This agreement provides that the signatories will assist one another with needed personnel, equipment, services, and supplies. Mutual aid agreements are established between facilities and other emergency responding entities within localities, jurisdiction(s), and states; between states; and across borders to ensure seamless service in responding to disaster events, whether caused by people or by nature. When state resources and capabilities are overwhelmed, the governor may request federal assistance under a presidential declaration of disaster or emergency.
A PHN uses the state health department's reportable disease system to complete a community assessment of a rural county with issues of access to primary care services. This can best be described as what type of surveillance system? a. Active b. Passive c. Sentinel d. Special
B: passive In a passive system of surveillance, health care providers, agencies, or laboratories send case reports to local health departments. The case reports are summarized and forwarded to the state health department, national governmental agency, or organization responsible for monitoring the problem, or to an international organization like the World Health Organization. This system can then be used to derive disease-specific demographic, geographic, and seasonal trends for reported events.
A forensic nurse maintains an awareness of human behavior and environment which is then interpreted by knowledge and lived experience in making expert decisions. What concept of forensic nursing theory does this represent? a. Justice b. Perceptivity c. Presence d. Victimization
B: perceptivity Perceptivity, as an element of intuitiveness, is one tool used by the forensic nurse to investigate injury. Perceptivity involves an increased awareness of human behavior and environment, which is then interpreted by knowledge and lived experience in making expert decisions. This concept guides knowledge, skills, and attitudes found in forensic nursing practice.
An occupational health nurse establishes a local business-sponsored smoking cessation clinic that incorporates the use of nicotine replacement therapy, behavioral treatments, and support groups. What description fits this program most appropriately? a. Individual-focused primary prevention b. Population-focused tertiary prevention c. Primary prevention education d. Secondary early detection
B: population-focused tertiary prevention Tertiary prevention related to substance abuse focuses on the development of programs to help reduce or end substance abuse. Interventions that include medications (nicotine replacement therapy) and behavioral treatments appear most promising. The population of focus in the business's employees.
The nurse teaches all clients primary prevention for STDs. Which topic does the nurse include? a. Partner notification b. Safer sex c. Standard precautions d. STD testing
B: safer sex Primary prevention activities are those that prevent the onset of diseases or injuries. Teaching safer sex practices are an example of primary prevention.
A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability
B: sensitivity The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important.
A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2016 = 2/100,000; 2017 = 3/100,000; 2018 = 1/100,000 b. 2016 = 4/100,000; 2017 = 8/100,000; 2018 = 6/100,000 c. 2016 = 12/100,000; 2017 = 8/100,000; 2018 = 31/100,000 d. 2016 = 16/100,000; 2017 = 24/100,000; 2018 = 9/100,000
C: 2016 = 12/100,000 2017 = 8/100,000 2018 = 31/100,000 n this community's report, the incidence of hepatitis A in 2018 was more than double the incidence in 2016. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated.
A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. What is the prevalence proportion of meningitis in this region thus far in the current year? a. 4.1/100,000 b. 5/100,000 c. 46/100,000 d. 50/100,000
C: 46/100,000 The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 × 100,000 = 46.42/100,000.
Healthy People 2020 has a number of objectives aimed at reducing which trend in infectious diseases? a. Identification of multi-state outbreak of Escherichia coli 0157:H7 b. The failure of the multisystem approach to containing diseases c. A rapid and serious rise in health care-associated infections d. Emergence of a new strain of severe acute respiratory syndrome
C: a rapid and serious rise in health care-associated infections Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff.
Which is the public health practice domain that best describes the ability to collaborate effectively? a. Communication b. Analytical assessment skills c. Community dimensions of practice d. Policy and program development
C: community dimensions of practice The Core Competencies for public health are divided into eight practice domains: analytical assessment skills, policy/program development, communication, cultural competency, community dimensions of practice, basic public health sciences, financial planning/management, and leadership. The practice domain for community dimensions of practice addresses the establishment and maintenance of links during an investigation; collaboration with partners; and development, implementation, and evaluation of an assessment to define a problem.
The Community Mental Health Centers Act of 1963 provided matching funds to states for the establishment of community-based mental health clinics that provided five basic services. In addition to these basic five services, states were encouraged to offer which of the following additional services? a. 24-hour emergency services and inpatient care b. Consultation/education for community agencies and professionals c. Diagnostic and rehabilitative precare and aftercare services d. Partial hospitalization and outpatient care
C: diagnostic and rehabilitative precare and aftercare services The Community Mental Health Centers Act formalized the concept of community mental health centers and mandated that these programs provide five basic services: inpatient services, outpatient services, partial hospitalization, 24-hour emergency services, and consultation and education services for community agencies and professionals. However, states were also encouraged to offer diagnostic and rehabilitative precare and aftercare services.
Which of the following are community-level factors that influence violence and human abuse? (Select all that apply.) a. Bullying b. Corporal punishment c. Diversity d. Population density e. Sense of cohesiveness
C: diversity D: population density E: sense of cohesiveness A community's population, resources, and facilities can influence violence and human abuse. Density, poverty, and diversity are population-level factors that affect the incidence of violence and are related to issues such as overcrowding, lack of economic opportunity, racial tension, and overt racism. A community sense of cohesiveness may reduce crime, provide support, and promote harmony. Community resources and facilities provided to residents offer socially acceptable outlets for a variety of feelings, including aggression, but their presence alone does not prevent violence or crime.
A client receiving morphine on a regular basis for pain management must be gradually weaned off the drug to avoid withdrawal symptoms. What state of neuroadaptation does this illustrate? a. Biopsychosocial effect b. Drug addiction c. Drug dependence d. Substance abuse
C: drug dependence Drug dependence is a state of neuroadaptation—a physiological change in the central nervous system—caused by the long-term administration of a drug. In drug dependence, continued use of the drug becomes necessary to prevent withdrawal symptoms.
A nurse is working with a disaster medical assistance team as it responds to a disaster. A new team member excitedly insists on not taking scheduled. What intervention by the nurse is best? a. Arrange for the team member to be transferred to another assignment in the team. b. Educate the rescuer about necessary stress-management techniques. c. Help the team member to call home to speak with his or her family or support system. d. Insist that the team member takes breaks as directed.
C: help the team member to call home to speak with his or her family or support system The nurse needs to be aware that rescue workers are repeatedly exposed to stress and, despite their training in managing such situations, have a higher than normal risk of developing post-traumatic stress syndromes. The nurse can assist the new team member by educating the rescuer about the importance of stress-management and self-management techniques.
The nurse's knowledge and understanding of the disease surveillance systems is critical to perform which activity? a. Detecting epidemics and pandemics b. Facilitating planning and policy changes c. Improving the quality and usefulness of the data collected d. Understanding the relationship between epidemiologic principles
C: improving the quality and usefulness of data collected Surveillance is a critical role for the nurses practicing in the community. A comprehensive understanding and knowledge of surveillance systems and how they work will help nurses improve the quality and the usefulness of the data collected for the purpose of making decisions about needed community services, community actions, and public health programming.
The sexual assault nurse examiner (SANE) works in collaboration with the emergency department providers and which other community partner? a. Clergy b. Epidemiologists c. Law enforcement d. Psychiatric practitioner
C: law enforcement SANE nurse examiners help examine the victim of sexual assault and collect evidence for law enforcement.
A forensic nurse who provides expert consultation regarding back injury disabilities and functional limitations on a workman's compensation case in a civil hearing but did not provide direct client care, is practicing in what role? a. Forensic nurse advocate b. Forensic nurse examiner c. Legal nurse consultant d. Nurse attorney
C: legal nurse consultant Legal nurse consultants provide expert consultation regarding health care to attorneys in either civil or criminal court but do not render direct client care in that setting. Some of these situations might include medical malpractice, personal injury, worker's compensation, and probate.
The nurse would consult the National Program of Cancer Registries for morbidity data for the types of cancer found in a state as well as what other information? a. Key centers for the specialized treatment of certain cancers b. Links to current National Institutes of Health cancer research projects c. Locations of cancer risks and health problems within the state d. Major genetic determinants of cancer by age and sex
C: locations of cancer risks and heath problems within the state A good example of a process in place to collect morbidity data is the National Program of Cancer Registries. This program provides for monitoring the types of cancer found in a state and the locations of the cancer risks and health problems in the state.
Which of the following is a very toxic drug that is a stimulant, causes tolerance to develop within hours, and has dangerous health impacts for those in the vicinity during use? a. Alcohol b. Crack cocaine c. Nicotine d. Volatile solvents
C: nicotine Nicotine is a stimulant to which the body quickly develops a tolerance. For regular smokers, tolerance develops within hours, compared with days for heroin or months for alcohol. Smoke is damaging when inhaled directly. Sidestream smoke, also called second-hand smoke, contains greater concentrations of toxic and carcinogenic compounds than mainstream or firsthand smoke, making it dangerous to those in the vicinity of the smoker.
One of the unique advantage of using data reporting such as a spatial map to analyze and present data is that such a tool provides a graphical way of determining which of the following? a. Characteristics of the population b. Potential hypothesis c. Priority prevention target areas d. Trends for the spread of the disease
C: priority prevention target areas A spatial map is a data-reporting tool that graphically presents the distribution of an event/outbreak in such a way that priority prevention target areas can easily be identified, because it shows graphically what is happening and where it is happening.
A forensic nurse works to provide care at the secondary level of prevention. What action by the nurse is most representative of this level of prevention? a. Developing a self-awareness and self-protection course for women b. Lobbying for random checks for seat belt use and lack of use being a misdemeanor c. Providing direct care to a victim of sexual assault in the Emergency Department d. Referring a victim of a home invasion and physical assault to a trauma counselor
C: providing direct care to a victim of sexual assault in the emergency department Secondary prevention is practiced following the occurrence of injuries or crimes. Forensic nurses provide direct care to both victims and perpetrators.
Which is an example of secondary prevention of infectious disease? a. Malaria chemoprophylaxis b. Immunizations c. Quarantine d. Restaurant inspections
C: quarantine Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza.
A nurse has obtained state funding for the development of an adolescent treatment program that supports Healthy People 2020 mental health objectives. What will this program address? a. Reduction of adolescent suicide attempts and prevention of teen obesity and depression. b. Reduction of eating disorder relapses and stress-related hypertension in teens and preteens. c. Reduction of suicide attempts and assessment and treatment for adolescents in the juvenile justice system. d. Treatment of eating disorders and increased access to mental health treatment in middle and high schools.
C: reduction of suicide attempts and assessment and treatment for adolescents in the juvenile justice system Healthy People 2020 objectives that specifically address adolescents include: (1) reducing the rate of suicide attempts by adolescents, (2) reducing the relapse rates for persons with eating disorders, and (3) ensuring that children in the juvenile justice system receive access to mental health assessment and treatment.
A client newly diagnosed with herpes simplex virus 2 (HSV-2) infection and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that which topic is essential to address? a. Correct use of condoms to prevent transmission of all STDs. b. Cures for each of the STDs identified. c. Risk of skin-to-skin contact in transmitting the identified STDs. d. Safety of sexual contact in the absence of lesions.
C: risk of skin-to-skin contact in transmitting the identified STDs Among other things, clients need to understand how STDs are transmitted, including by body fluids and through skin-to-skin contact. HSV2 can be transmitted in the absence of skin lesions.
The nurse is establishing a secondary prevention program for adolescents at risk for ATOD. The nurse will include a focus on: a. encouraging competitiveness and success in sports. b. focusing on short-term goals and solutions. c. screening and referring for psychiatric disorders. d. teaching adolescents to "just say no."
C: screening and referring for psychiatric disorders Secondary prevention includes screening in order to obtain prompt treatment. A program focusing on secondary prevention would use evidence-based screening tools and a referral network.
A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.
C: secondary prevention Secondary prevention usually encompasses interventions designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. However, nurses often use health education interventions when caring for individuals with a diagnosed health problem with the aim of preventing further complications or exacerbations.
A nurse wishes to become actively involved in disaster management and is extremely interested in providing first aid and delivering aggregate health promotion, disease prevention, and emotional support. It would be ideal for the nurse to train and volunteer as which of the following? a. Community emergency response team member b. Disaster medical assistance team member c. Member of the Medical Reserve Corps d. Red Cross shelter manager
D: Red Cross shelter manager Creation and operation of shelters are generally the responsibility of the local Red Cross chapter, although the military may be charged with setting up "tent cities" or mobile home parks for large groups of people needing temporary shelter. Because nurses are comfortable performing tasks such as aggregate health promotion, disease prevention, and provision of emotional support, they make ideal shelter managers and team members. The Red Cross provides training in shelter support and use of appropriate protocols.
An assessment reveals a high incidence of alcohol-related chronic liver disease and cirrhosis in the local community. A primary prevention harm-reduction program would focus primarily on which of the following? a. Addiction treatment b. Detoxification c. Drug education d. Polysubstance abuse
D: drug education The harm reduction approach to alcohol, tobacco, and other drug (ATOD) problems focuses on health promotion and disease prevention. Primary prevention for ATOD problems includes the promotion of healthy lifestyles and resiliency factors, and education about drugs and guidelines for their use. Nurses are ideally prepared to use health-promotion strategies such as encouraging healthy alternatives to indiscriminate, careless, and often dangerous drug use practices and providing education about drugs to decrease harm from irresponsible or unsafe drug use.
The major factor that has led to sharply increased insurance payouts following disasters in the United States in recent decades has been: a. El Niño. b. geography. c. technology. d. human development.
D: human development The cost in more developed countries is higher because of the extent of material possessions and complex infrastructures, including technology. In the United States, increases in population and development in areas vulnerable to natural disasters, especially coastal areas, have led to sharply increased insurance payouts.
A nurse is among the first responders to a disaster. What action by the nurse takes priority? a. Arranging for shelter for disaster providers b. Beginning community assessment as soon as possible c. Beginning disease surveillance and planning health education d. Immediately developing plans for effective triage and client management.
D: immediately developing plans for effective triage and client management The first priority when responding to a disaster is to immediately plan for, coordinate, and carry out effective triage. Disaster response includes community assessment, surveillance, health education, and coordination of shelter arrangements. However, the first task is to provide care for life-threatening injuries and conditions.
What is the one common factor shared by ethnic and cultural groups such as African Americans, Asian and Pacific Islander Americans, and Native Americans with regard to mental health care? a. Care-seeking behavior for symptoms of depression b. Higher than normal rates of anxiety disorders c. Increasing incidence of eating disorders d. Low utilization of mental health services
D: low utilization of mental health services Different populations use mental health services in unique ways. People may not seek mental health services in a formal system, they may drop out of care, or they may seek care at a much later stage of illness, which drives up the service costs. Such patterns of use appear to be the result of a community-based mental health system that is not culturally relevant, responsive, or accessible to select populations. African Americans, Asian and Pacific Islander Americans, and Native Americans all have low rates of utilization of available mental health services.
A PHN utilizes the data in available surveillance systems to make a presentation to a community planning committee that is interested in the problem of childhood obesity. This use of the data for facilitating community planning is a good example of helping the community to do which of the following? a. Avert a health care epidemic. b. Evaluate prevention and control measures. c. Identify cases for fact finding. d. Manage endemic health problems.
D: manage endemic health problems A nurse can contribute to surveillance systems and can best use the data collected through such systems to help manage endemic health problems and those that are emerging, such as evolving infectious diseases and bioterrorist (human-created) health problems.
A nurse takes the time to read and understand the community's disaster plans and participates in mock disaster drills as a leader of the triage team. The nurse obtained disaster management training through the local Red Cross chapter and registered with the state as a disaster management nurse. Which description of the nurse's activities is accurate? a. American Red Cross disaster training b. Community preparedness c. Personal preparedness d. Professional preparedness
D: professional preparedness Preparedness takes place at three levels: personal, professional, and community. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community.
To provide the most effective primary prevention intervention to reduce the incidence of child abuse, the nurse would do which of the following? a. Allow adolescent role playing the realities of parenting. b. Creating parenting and conflict-management classes for survivors of child abuse. c. Educating grandparents on the indicators of child abuse. d. Providing parenting classes for college students.
D: providing parenting classes for college students Parents who were themselves abused or witnessed abuse or other types of family violence are at markedly higher risk of abusing their own children. Primary prevention of abuse includes strengthening individuals and families so they can cope more effectively with multiple life stressors and demands, and reducing the destructive elements in the community that support and encourage violence. Strengthening parenting skills and teaching successful conflict resolution are specific areas to target to provide new learning and correct earlier childhood influences.
A unique competency of forensic nursing is the collection of trace evidence to be used in clinical investigations. This competency is related to which standard of practice for the specialty? a. Collaboration b. Ethics c. Leadership d. Scientific process
D: scientific process The standards of practice are delineated in each of the recognized areas: scientific process, quality of practice, education, professional practiced evaluation, collaboration, ethics, research, resource utilization, and leadership. The scientific process or nursing process includes assessment. For forensic nurses, assessment includes the collection of evidence which may involve interviewing the client for evidentiary purposes, reviewing medical legal documents, and collecting trace evidence to be used in a criminal investigation.
Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends.
D: secular trends Long-term patterns of morbidity or mortality rates (i.e., over years or decades) are called secular trends. Secular trends may reflect changes in social behavior or health practices.
Which of the following is a population-level tertiary prevention intervention for those with HIV in the community? a. HIV test results counseling b. Needle exchange c. Partner notification d. Standard precautions education
D: standard precautions education Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions.
A nurse is assigned to provide community outreach to a small town that was partially destroyed by a tornado 3 years earlier and has been rebuilt. The first client is a family who lost their home and their best friend in the tornado. Which intervention by the nurse is best? a. Assessment of the family's home environment to rule out safety issues b. Avoidance of discussion of the disaster of 3 years ago c. Consideration that the family will have worked through the emotional aftermath by now d. Support of the family in preparing a personal disaster response plan
D: support of the family in preparing a personal disaster response plan The approach of relief activities needs to shift from short-term aid to long-term support. Promoting individual, family, and community preparedness increases safety in the event of disaster and can help children and adults feel empowered and more in control. This builds on the resilience of the individual, family, and/or community.
The role of the community mental health nurse on a multidisciplinary team caring for clients with mental illness is best exemplified by which of the following? a. Providing psychometric testing, case management, and advocacy services b. Role-playing conflict management skills, dispensing medication, working with insurance companies to maximize reimbursement c. Teaching medication self-management, providing therapeutic counseling, providing family intervention d. Teaching medication management and self-management skills, coordinating care including assessment, referral, and follow-up
D: teaching medication management and self-management skills, coordinating care including assessment, referral, and follow-up The role of the nurse in community mental health includes serving as clinician, educator, and coordinator. The clinician role includes helping the client maintain or regain coping abilities that promote maximum functioning. The educator role includes teaching symptom self-management and medication management. The role of the coordinator must include case finding, referral, and follow-up to evaluate system breakdown and deficits.
A nurse sees many clients who use multiple medications or other substances to relieve or mask anxiety, tension, fatigue, and physical or emotional pain. When working with these clients, what myth does the nurse attempt to correct? a. Alcoholism is a disease. b. Any drug can be abused. c. Biopsychosocial factors affect addiction. d. There are good drugs and bad drugs.
D: there are good drugs and bad drugs Attitudes are developed through cultural learning and personal experiences. Attitudes toward ATOD problems are influenced by the way society inappropriately categorizes drugs as either good or bad. In the United States, "good" drugs are over-the-counter drugs or those prescribed by a health care provider as medicine, yet this makes them no less problematic or addictive. "Bad" drugs are illegal drugs, and people who use these drugs are considered criminals, regardless of whether or not the drug use has caused problems.
A school nurse is teaching students about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. Which key point will the nurse include? a. All STDs are easily preventable with consistent condom use. b. Once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. Use of alcohol and drugs makes a student more likely to make risky decisions.
D: use of alcohol and drugs makes a student more likely to make risky decisions Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk.
John Snow played a critical role in the development of modern disease surveillance when he did which of the following? a. Devised a more statistically valid method of analyzing epidemiologic data b. Discovered causal agents for anthrax, tuberculosis, and cholera c. Tracked the incidence of tuberculosis in the tenements of New York City d. Used geographic mapping to demonstrate the connection between water supply and cholera
D: used geographic mapping to demonstrate the connection between water supply and cholera John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river.
A home health nurse is assessing the parents of an infant. What information does the nurse consider most relevant when screening for child abuse? a. Lack of legal marital status b. Living in temporary housing c. Mother's history of adolescent depression d. Verbal aggressiveness toward spouse
D: verbal aggressiveness toward spouse The behavior of potential abusers reflects a low tolerance for frustration, emotional instability, and the onset of aggressive feelings with minimal provocation. One spouse's aggressive outburst toward the other is a red flag warning the nurse of a potentially abusive situation.
A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse inquires as to the client's employment and job duties. Which response would the nurse view as most important? a. Identifies as bi-sexual. b. Is a strict pesco-vegetarian. c. Occasionally uses intravenous drugs. d. Works in a daycare center and changes diapers.
D: works in a daycare center and changes diapers This patient has symptoms of hepatitis A. Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic.
The nurse demonstrating disaster-related recovery competencies would do which of the following? a. Determine local mental health resources. b. Establish a mass medication distribution center. c. Restock personal preparedness supplies. d. Write and distribute an after-action report.
D: write and distribute an after-action report There are competencies for all phases of the disaster response cycle. Recovery competencies include after-action participation, disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact.
What emergency support functions do the National Response Framework (NRF) and the National Incident Management System (NIMS) provide? a. Authority to step in and take control of state, local, and voluntary organizations during disasters b. Command and control for American Red Cross and Disaster Medical Assistance teams c. Oversight of federal and state response operations, with minimal interaction with other organizations d. Written approach, protocol, and common language for responders from federal agencies and other voluntary organizations
D: written approach, protocol, and common language for responders from federal agencies and other voluntary organizations The NRF was written to approach a domestic incident in a unified, well-coordinated manner that enables all responding entities to work together more effectively and efficiently. All member organizations of the responding teams, including all relevant branches of the federal government, are assigned functions that are listed in the plan as emergency support functions. When large disasters require the services of a variety of emergency responding units with personnel coming from different parts of the country, the challenge of working together in unison may require the use of the NIMS, which provides all responders with a protocol and common language for working together. The importance of interoperable communication equipment is stressed by the NIMS.
