exam 3 comm ch. 21-28 (-26)

21. As a nurse as well as a citizen, what is your additional responsibility in relation to disasters?

Be aware if there is an unusual increase in the number of people seeking care with similar symptoms As a nurse, you are expected to be informed regarding the Guidelines for Early Detection for Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular disease, an unusual number of persons seeking care with similar complaints, clusters of patients from a single location, or a person presenting with an uncommon disease.

20. What might be your concern when a friend who was raped and beaten appeared to be coping well until recently when she dropped out of school and shared with you that nightmares during which it happens all over again were becoming impossible to live with?

Posttraumatic stress syndrome disorder (PTSD) PTSD is a psychiatric disorder that can occur after an individual's experiencing or witnessing a life-threatening event. People who suffer from PTSD often relive the experience through nightmares and flashbacks. The social and psychological symptoms can be severe enough, and last long enough, to significantly impair a person's daily life.

6. What map is crucial to be included in any disaster plan?

Resource map showing potential resources in persons and supplies A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed).

18. Which disaster would probably cause the most long-lasting mental health concerns for its victims?

A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged.

12 of 34 Which of the following groups is the fastest-growing component of the rural population? a. Disabled adults b. Elderly women c. Hispanic children d. Retirees

c. Hispanic children Today, the proportion of Hispanic children is the fastest-growing component of the rural population, regardless of region.

13. Who should create a disaster plan including emergency supplies and where to meet in case of an emergency?

All families The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

2. How is a disaster the same as or different from an emergency?

An emergency is personal, whereas a disaster is community-wide. A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Emergencies differ from disasters in that the agency, community, family, or individual can manage an emergency using their own resources. However, a disaster event may be beyond the ability of the community to respond to and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community.

23. When does disaster management begin?

Before a disaster occurs When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.

14. How will a community know whether its disaster plan is adequate?

By following practice drills involving various feasible scenarios as an initial step of planning For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

24 of 24 Which of the following best explains why the Vaccine Adverse Event Reporting System (VAERS) was originally legislated? (Select all that apply.) a. To ensure that data are used to educate health care professionals on proper vaccine administration b. To conduct media campaigns to help convince parents to bring their children in to receive appropriate immunizations c. To determine whether changes should be made in procedures or biological agents d. To illustrate, using actual data, that vaccines are widely given to healthy people with almost no side effects e. To monitor actual and potential vaccine-related problems. To provide assistance to families who experience a vaccine-related injury

C: To determine whether changes should be made in procedures or biological agents, E: To provide assistance to families who experience a vaccine-related injury No drug is perfectly safe or effective. The VAERS allows for the monitoring of actual and potential vaccine-related problems. Changes are made on the basis of the collected data. For example, whole cell pertussis vaccine was changed to an acellular pertussis vaccine because of adverse side effects. To monitor actual and potential vaccine-related problems, health care providers must report specific postvaccination "adverse events" to the VAERS. The National Vaccine Injury Compensation Program reviews all VAERS reports and provides assistance for individuals and families who experience a vaccine-related injury, including disability and death. The VAERS does not provide education to health care professionals on proper vaccine administration or conduct media campaigns to help convince parents to bring their children in to receive appropriate immunizations. Vaccines can produce a variety of responses, both positive and negative. Thus, side effects can occur in healthy people.

3. A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. What should the hospital immediately do?

Call in physicians and nursing staff who are experts in burn care A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

1. Which disasters are NA-TECH disasters? Select all that apply.

Constant rain led to mud slides, and whole neighborhoods were buried. Earthquake caused structural collapse of bridges and highways in the area. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. Disasters are identified as natural, man-made, or a combination of both. A NA-TECH (natural-technological) disaster is a natural disaster that creates or results in a widespread technological problem. An example of a NA-TECH disaster is an earthquake that causes structural collapse of roadways or bridges that, in turn, cause downed electrical wires and subsequent fires.

5. What do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives?

Create fear to intimidate and coerce to accomplish a political goal The U.S. Code of Federal Regulations defines terrorism as "the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives."

3. What are the Department of Health and Human Services' responsibilities in relation to disasters? Select all that apply.

Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control Ensuring that drinking water, food, shelter, and medical care are available to victims After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC)—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross.

11. What should you and your family do when the national threat level is color-coded green or blue?

Develop a personal family emergency plan The actions to take build on what is done at the low-risk or green level (e.g., develop a family emergency plan) to monitoring local emergency management officials and the media for specific measures to take at the severe-risk or red level (e.g., evacuate).

19. What sorts of behavior would you expect to see when a disaster first strikes a community?

Everyone tries to help strangers, as well as their neighbors, survive The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

2. Why would earthquakes be more frightening than floods to many people, even though both can cause extensive damage? Select all that apply.

Imminence of earthquakes is unknown. It's not possible to prevent an earthquake. The predictability of earthquakes is lower. Death rate, intensity, and frequency depend on location and other factors. Hawaii, for example, has frequent earthquakes with little damage resulting. However, earthquakes cannot be predicted or prevented, whereas flooding can usually be predicted and most communities have taken steps to avoid or at least lessen the damage from floods.

12. How is the American Red Cross different from FEMA or NIMS?

It is a nongovernmental volunteer agency The American Red Cross (ARC) is not a governmental agency. The ARC, however, is chartered by Congress to provide disaster relief. It works in partnership with FEMA, HHS, the CDC, and other federal agencies to provide and manage needed services.

7. Who is responsible for assuring the safety and welfare of communities?

Local government The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

22. Which set of symptoms would be unexpected after a disaster?

No unusual feelings or behavior Common responses to disasters include all sorts of cognitive, emotional, physical, and behavioral symptoms. Therefore, to have no unusual feelings or behavior would indeed be unexpected.

8. Who should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response?

Office of Emergency Management The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response.

16. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. What should be done?

Put a yellow tag on his shirt and then await transport to a medical facility Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); black is for the deceased or for those whose injuries are is so extensive that nothing can be done to save them (e.g., multiple severe injuries).

15. An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. What should the community do first?

Send in law officials to secure the area and assure the safety of the victims Before search and rescue should begin, safety must be considered. In some instances, if a criminal action is suspected, law officials will be among the first to respond to secure the area and possibly gather evidence. While the area is being checked and then cleared of potential threats, a staging area can be set up at or near the site of the incident to direct on-site activities. Search and rescue of victims can begin once clearance is given, a disaster triage area is established, and an emergency treatment area is set up to provide first aid until transportation for victims to hospitals or health care facilities for treatment can be coordinated.

1. Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster?

The National Incident Management System Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President G. W. Bush established the National Incident Management System (NIMS) in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2009).

4. Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. How are these patients different from the first patients to arrive?

The burn patients were direct victims, whereas the firefighters are indirect victims. Both sets of victims would have inhaled smoke and have lung damage. The treatment and length of stay would be determined by the amount of damage, which may vary from victim to victim. Both sets of victims, depending on the severity of the burns, may have scarring, shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an individual who is immediately affected by the event; the indirect victim may be a family member or friend of the victim or a first responder.

10. What is the primary goal of the federal government in relation to disasters?

To ensure continuity of essential federal functions during any disruption The policy of the federal government is to have a comprehensive and effective program in place to ensure continuity of essential federal functions across a wide array of incidents. The national strategy is to develop a system connecting all levels of government without duplicating efforts.

9. When would the National Guard become involved in a disaster?

When the state has been asked to help an overwhelmed community When a disaster overwhelms the local community's resources, then the state's Department or Office of Emergency Management is called for assistance. Before an event, state officials provide technical support for prevention, preparedness, response, and recovery. State officials are on-scene at disaster events to facilitate coordination of state resources and to disseminate information. In some cases, the National Guard may be called in to aid the community.

17. What questions are asked during disaster triage?

Who are you? Are you hurt? To assess an individual within the 1-minute guideline, the system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual simple questions beginning with "Who are you?"

8 of 25 A man was crying and said, "I didn't mean to do it. She just got me so angry I lost control. It will never happen again." The woman said, "It was my fault. I shouldn't have upset him." Then, looking at the nurse, the woman added, "Please don't report this. It will never happen again." Which of the following is the most appropriate response by the nurse? a. "Abusers don't stop unless intervention occurs. I have to report it." b. "If you're sure it won't happen again, I'll let it go this time." c. "Legally, I'm required to put this in the medical record." d. "The decision is up to the physician, not me."

a. "Abusers don't stop unless intervention occurs. I have to report it." It is a common myth that abusers will stop the abuse on their own. Professional intervention is required to break the cycle of abuse. The only way to effectively begin breaking the cycle of abuse is to report the incident. The nurse has a professional responsibility to report the abuse, just as the physician does. Documenting the information in the medical record will not initiate stopping the cycle of abuse.

15 of 24 A man came for follow-up care to the free clinic, explaining that he had applied for a job based on his education and years of previous work experience, but, being in a wheelchair, he was turned down. Which of the following responses would be most appropriate for the nurse? a. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." b. "No one would want to hire a handicapped person, so you can continue to come here for free care." c. "Because it can be expensive to obtain the necessary equipment to help you do that job, the employer has every right to refuse to hire you." d. "The law says, if a handicapped person applies, he or she has to get hired even if an able-bodied person also applies."

a. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." The Americans with Disabilities Act (ADA) became law in 1990. This landmark civil rights legislation prohibits discrimination toward people with disabilities in everyday activities. The ADA guarantees equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications. A qualified individual with a disability must meet legitimate skill, experience, education, or other requirements of an employment position. The person must be able to perform the essential functions of the job.

18 of 28 Which of the following persons would be called chronically homeless? a. A person has been homeless for more than a year b. A person who lives with a roommate when between jobs c. A person who has been staying with friends or family for an extended period of time d. A person has been residing each night in a homeless shelter for almost 3 months

a. A person has been homeless for more than a year The chronically homeless individual is defined as an unaccompanied adult who has been homeless for an extended or numerous periods and has one or more disabling conditions.

34 of 34 Which of the following do expert rural nurses report as benefits of their work? (Select all that apply.) a. Ability to develop close relationships and give holistic care b. Being able to practice in the community where one lives c. Constant challenges d. Continual growth as an expert generalist e. Higher salary than in urban areas f. Intensity of purpose

a. Ability to develop close relationships and give holistic care b. Being able to practice in the community where one lives c. Constant challenges d. Continual growth as an expert generalist f. Intensity of purpose Positive aspects of rural nursing include the ability to give holistic care, to know everyone well, and to develop close relationships with the community and with coworkers. Autonomy, professional status, and being valued by the agency and community have been reported components of positive job satisfaction. The rural nurse is a generalist, and generalist is not synonymous with boring. Interviews with rural nurses show that they feel an "intensity of purpose" that makes rural nursing distinctive. Nurses living and practicing in the same place have a strong sense of integration and continuity between practice and community.

21 of 24 A nurse eagerly explained to a long-term disabled male client the most recent relevant research related to his care. The client, rather than express appreciation, said, "I prefer to have my care given this way." The nurse explained that research suggested an alternative approach was more clinically effective, but the client said, "I am more comfortable during the day if my care is given this way." Which of the following actions should be taken by the nurse? a. Accept that the client knows what works best b. Ask the nursing supervisor to review the research with the client c. Give evidence-based care according to current research findings d. Negotiate a compromise between patient preferences and research-based approach to care

a. Accept that the client knows what works best A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. The nurse must ask the client what works best for him or her and what goals the client is pursuing. Research is based on probabilities of effectiveness with large groups, but individuals may have a different unique reaction to any intervention.

30 of 34 In comparison with mental health care in urban areas, which of the following best describes how mental health care in rural areas differs? (Select all that apply.) a. Access to care is more limited or not available at all locally. b. Cost for treatment is typically reimbursed at a lower rate. c. Depression is frequently not recognized or is not treated. d. Ethnic and racial disparities exist. e. Primary health care professionals accept responsibility for mental health treatment. f. The suicide rate is notably higher.

a. Access to care is more limited or not available at all locally. c. Depression is frequently not recognized or is not treated. e. Primary health care professionals accept responsibility for mental health treatment. f. The suicide rate is notably higher. In rural areas adjacent to a small city, suicide rates were 31% higher than suburban rates and 43% higher in rural areas that were not adjacent to small cities. Decreased access to mental health services for treatment of depression may contribute to these higher rates. Because of the lack of qualified mental health care providers, rural residents often receive services from primary care providers. Ethnic and racial disparities exist whether in urban or rural health care.

22 of 25 Although violence seems endemic in human society, which of the following causative factors could be reduced if society agreed action was necessary? (Select all that apply.) a. Access to firearms b. Alcohol and other drug abuse c. Dysfunctional families with lack of emotional support d. Intolerance of those with a different religious ideology e. Media video games, television shows, and movies f. Pacifism as a belief system

a. Access to firearms b. Alcohol and other drug abuse c. Dysfunctional families with lack of emotional support d. Intolerance of those with a different religious ideology e. Media video games, television shows, and movies Pacifism is a belief in peaceful resolution of conflicts and refusal to participate in war. All other factors are universally recognized factors that contribute to violence. These factors are poverty, unemployment, economic dependency; polydrug and alcohol abuse; dysfunctional family and/or social environment and lack of emotional support; media influence (e.g., violent video games, television shows, and movies); access to firearms; political and/or religious ideology; and intolerance and ignorance.

7 of 34 Which of the following describes what has been identified by public health experts as the number one priority in rural areas? a. Access to health care b. Access to education c. Access to telecommunications d. Access to better-paying employment opportunities

a. Access to health care Bolin and Gamm (2003) reported that access to health care was the number one priority identified by the majority (73%) of rural health care leaders. Although access to education, telecommunications, and well-paying employment are important, they have not been identified as the number one priority in rural areas.

23 of 24 Which of the following guiding rules or principles would most likely be followed by a nurse caring for persons with disabilities? (Select all that apply.) a. Adopt the client's priorities b. Change care according to the most recent research findings c. Care for the disability and then for the whole person d. Know community resources thoroughly e. Support the client's decisions f. When in doubt, listen

a. Adopt the client's priorities d. Know community resources thoroughly e. Support the client's decisions f. When in doubt, listen Data from interviews conducted with nurses who provide care to persons with disabilities revealed principles such as do not assume anything; adopt the client's perspective; listen and learn from the client; gather data from the perspective of the client and family; care for the client and the family, not the disability; be well informed about community resources; and become an advocate by letting clients choose.

5 of 24 Which of the following concerns can a nurse as a citizen help address? a. Advocating for removal of environmental and social barriers to needed services b. Continuing to engage in political action to increase funding for care for the handicapped c. Recognizing that it is better to offer to help than to wait for a person with handicaps to have to ask for assistance d. Needing to not stare or ask personal questions of a person with a disability

a. Advocating for removal of environmental and social barriers to needed services In the National Agenda for the Prevention of Disabilities model, disability occurs when a person's physical or mental limitations, in interaction with physical and social barriers in the environment, prevent the person from taking equal part in the normal life of the community. Confronting environmental and social barriers to needed services can frustrate and exhaust many people with disabilities and their families. The nurse—as a citizen and a concerned professional—can advocate for removal of such barriers. This issue is the most important for the nurse to address, allowing the nurse to partner with clients and families affected by disabilities to remedy barriers that negatively affect quality of life for this population.

25 of 25 Which of the following actions should a nurse take to ensure personal safety when engaging in home visits? (Select all that apply.) a. Always sit between the client and the exit, and, when in doubt, leave the situation b. Be sure of the correct address and always have a GPS system c. Carry a cell phone and drive in a well-maintained car with a full gas tank d. Have enough money that you can buy your way out of trouble e. Only accept assignments within a few blocks of your own home f. Take self-protection courses such as karate and carry a weapon for your own defense

a. Always sit between the client and the exit, and, when in doubt, leave the situation c. Carry a cell phone and drive in a well-maintained car with a full gas tank Plan ahead with the correct address, directions, and information about who will be in the home; tell the office where you will be and check in regularly; carry a cell phone, possibly a pager, and a small amount of money; dress for function and mobility, wear a name tag, and be sure your vehicle is in good repair with a full gas tank and emergency equipment. Carrying a weapon typically results in the weapon being used against you.

5 of 25 A woman was seen in the emergency department with a greenstick broken arm and chest bruises. She explained she fell up a staircase at home while carrying laundry to the bedrooms. Besides assessing for other injuries, which of the following actions should be taken by the nurse? a. Ask about and educate regarding intimate partner violence (IPV) b. Assess for use of alcohol or other drugs that might have been a causative factor in the fall c. Get the patient an x-ray examination to determine location and severity of the break d. Immediately apply ice and immobilize in a sling

a. Ask about and educate regarding intimate partner violence (IPV) IPV, formerly known as domestic violence, is a pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim, such as a spouse, ex-spouse, boyfriend or girlfriend, ex-boyfriend or ex-girlfriend, or date. These behaviors may include battering resulting in physical injury, psychological abuse, and sexual assault that contributes to progressive social isolation and intimidation of the victim. Abuse is typically repetitive and often escalates in frequency and severity. IPV crosses all ethnic, racial, socioeconomic, and educational lines. About 30% of women and 1% of men report experiencing physical forms of IPV at some point in their lives. Thus, the nurse must assess for IPV.

22 of 34 A nurse was trying to decrease the amount of respiratory illness in the community. Which of the following approaches should be used by the nurse? a. Attend each farmworkers' meeting and listen to how they perceive and discuss their problems b. Offer to teach the farmers' spouses how to protect their families, such as having the farmer shower and change clothes before coming into the house c. Suggest the community work together to obtain a community college so farmworkers could be educated for other employment opportunities d. Teach children in the school system the importance of seeking employment in cities rather than staying on the farm

a. Attend each farmworkers' meeting and listen to how they perceive and discuss their problems Using informal networks in the community is essential. The involvement of informal networks and local leaders in planning health interventions is crucial. To be able to do that, the nurse must first listen to how the community perceives its problems.

3 of 25 For which of the following groups is homicide the leading cause of death in the United States? a. Black males aged 15 to 34 years b. Black children aged 1 to 14 years c. White children aged 1 to 14 years d. White males aged 15 to 34 years

a. Black males aged 15 to 34 years For black males aged 15 to 34 years, homicide is the leading cause of death. Homicide is the second leading cause of death among black males aged 1 to 4 and 10 to 14 years, compared with white males, where homicide is the third leading cause of death in ages 15 to 29 years.

18 of 24 Which of the following was suggested by the National Healthcare Disparities Report of 2008 (NHDR) as one reason that there are such disparities in health care outcomes inside the health care system? a. Care provider bias and poor communication exist. b. Funding is inadequate to give appropriate care to persons with disabilities. c. Many people do not seek care until it is almost too late. d. There is a national shortage of care providers.

a. Care provider bias and poor communication exist. The NHDR explains that, within the scope of health care delivery, disparities are due to differences in access to care, provider biases, poor provider-patient communication, poor health literacy, and other factors. This report did not address that there is inadequate funding to provide appropriate care, that people seek care too late, or that there is a national shortage of providers.

3 of 24 Which of the following is a fairly recent surprise regarding infectious diseases in the United States? a. Cervical cancer and coronary artery disease may be caused by infectious agents. b. Epidemics such as the H1N1 flu continue to occur. c. Mortality caused by infectious diseases continues to rise. d. Some infectious diseases remain endemic in our society.

a. Cervical cancer and coronary artery disease may be caused by infectious agents. Recent scientific discoveries on the infectious etiology of stomach ulcers, coronary artery disease, and cervical cancer, for example, suggest that infectious agents may be responsible for more morbidity and mortality than previously recognized. Mortality caused by infectious diseases has decreased. Endemic refers to a disease that is regularly found among people in a certain area. In our society today, there are no endemic infectious diseases. Advances in public health and health care have made it easier to control infectious diseases such as H1N1 flu.

5 of 34 Which of the following best describes the practical importance of the classifications of metropolitan, micropolitan, and noncare areas? a. Classifications are used for congressional policy-making and funding decisions. b. Metropolitan areas gained importance because of their large population. c. Micropolitan areas are now recognized for their crucial role in society. d. The new system emphasizes the extent of rural (noncare) areas.

a. Classifications are used for congressional policy-making and funding decisions. The new core-based statistical areas (CBSA) system includes two categories of counties: (1) metropolitan areas and (2) micropolitan areas. Counties that are neither metropolitan nor micropolitan are called "outside CBSAs," also known as noncare areas. Metropolitan areas contain at least one urbanized area of 50,000 or more people. A micropolitan area contains a cluster of 10,000 to 50,000 persons. Because the metropolitan statistical area classification is used extensively for congressional policy-making and funding decisions, there could be serious ramifications for health care financing within rural market areas.

6 of 34 Which of the following compositional factors influences rural health needs? a. Demographics of the people living in an area b. Local environment c. The geography of the area d. The political and social institutions in the community

a. Demographics of the people living in an area There is a growing emphasis on the distinction between context, which is defined by the characteristics of places of residence, and composition, which is the collective health effects that result from a concentration of persons with certain characteristics. Problems in rural areas are compositional when they derive from individual characteristics of groups of people residing in rural settings. Examples of compositional sources of health disparities include such characteristics as age, education, income, ethnicity, and health behaviors. The environment, geography, and political and social institutions are considered to be characteristics of place.

20 of 24 The charge nurse notes that two patients had communicable infectious diseases and were treated appropriately. Which of the following actions should be taken next by the nurse? a. Depends on your state health department's requirements b. Report the two cases to the Centers for Disease Control and Prevention (CDC) c. Report the two cases to your regional health department d. Send the information for inclusion in the Morbidity and Mortality Weekly Report

a. Depends on your state health department's requirements Because state health departments have the responsibility for monitoring and controlling communicable diseases within their respective states, they determine which diseases will be reported within their jurisdiction. Because the state health department requirements will dictate what action is taken next, it may not be necessary to report the cases to the CDC, regional health department, or to the Morbidity and Mortality Weekly Report

4 of 24 Which of the following insights is being stressed by advocacy groups regarding persons with disabilities today? a. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. b. Handicapped persons have as much right to social support as nonhandicapped persons. c. It is recognized that an individual may be limited by an environmental barrier in society. d. Impairment is a result of society's reaction more than mental or physical condition.

a. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. Nearly all definitions identify an individual as disabled on the basis of a physical or mental impairment that limits the person's ability to perform an important activity. The complementary possibility—that the individual is limited by a barrier in society or the environment—is never considered. Advocacy groups are stressing that environment and the reactions of others are as crucial as the actual physical or mental limitation.

13 of 34 Which of the following best explains why companies do not build work places in rural areas where people are anxious to find full-time employment? a. Employers need highly educated and skilled employees. b. Managers do not want to be transferred into a rural area where they will not fit in and will not be comfortable. c. Rural persons do not work as hard as urban dwellers. d. Smells emanating from farms are unacceptable to persons working inside.

a. Employers need highly educated and skilled employees. Counties that have a low-wage economy have difficulty providing the infrastructure needed to provide education for low-wage families. They therefore have difficulty attracting new employers who might contribute to the economic development of a rural area but need a more highly educated workforce. Rural workers are known for their strong work ethic, but they may not have the educational skills that are necessary. Smells from farms is not a typical reason as to why companies do not build in rural areas.

29 of 34 Which of the following factors results in rural residents having less access to health care than urban dwellers? (Select all that apply.) a. Employment opportunities may be low paying and seasonal. b. There are greater distances to travel and limited choice of health care providers. c. Health care providers prefer to work in higher-paying urban settings. d. Rural residents are less likely to have health insurance. e. Rural persons' economic resources are tied up in land, not easily accessible cash. f. Rural persons believe in self-sufficiency and self-care, not asking others for help.

a. Employment opportunities may be low paying and seasonal. b. There are greater distances to travel and limited choice of health care providers. c. Health care providers prefer to work in higher-paying urban settings. d. Rural residents are less likely to have health insurance. A recent Institute of Medicine study reported rural medical access problems in these areas, with some hospital and pharmacy closures; greater distances to travel for physician services; and limited, if any, choice of providers. Rural residents were more likely than urban residents to lack insurance. Two thirds of the persons living in the most rural counties are low-income families. Having economic resources invested in land and believing in self-sufficiency and self-care are not reasons why rural residents have less access to health care than urban dwellers.

11 of 25 A female student is at a fraternity party where alcohol is flowing freely, the music is loud, and people are dancing and talking. Most people seem to be having a great time. What action should the student take, if anything, when she overhears two men talking about having put ketamine in a girl's drink? a. First get out of there, then call the campus police and report what was heard b. Nothing, because she had no idea which woman was targeted or even if she drank what was given to her c. Talk to the two men about the dangers and side effects of ketamine d. Watch to see if any young women pass out or are otherwise impaired

a. First get out of there, then call the campus police and report what was heard The text talks about date rape drugs including ketamine. The first priority is to keep oneself safe, so leaving would be prudent. Ideally, the police will allow the report to be made without sharing who reported the potential problem. Doing nothing, talking to the men, and watching young women at the party will not protect the females at the party from unknowingly consuming the ketamine.

3 of 24 Which of the following best describes the problem with the viewing disability based on the Nagi model? a. Functional limitations are used to determine if an individual is disabled. b. Functional limitations are not easily objectified and measured. c. The model does not distinguish between genetic limitations and limitations imposed by injury or illness. d. Persons are or are not limited according to choices they make.

a. Functional limitations are used to determine if an individual is disabled. The Nagi model uses functional limitations, which have been defined and are measureable, to determine whether an individual is disabled. However, the current paradigm considers the environmental barriers and the perspectives of the onlooker when considering if an individual is disabled. Thus, the other options do not address the limitation of using only functional limitations.

31 of 34 Which of the following best describes why for-profit managed care organizations (MCOs) have not begun to move into rural areas to increase the number of persons served? (Select all that apply.) a. High startup and administrative costs are needed. b. A large number of elderly are on Medicare or Medicaid, which results in low reimbursement. c. Managed care has not yet had time to go beyond major population centers. d. MCOs are waiting until federal reimbursements for underserved rural health areas become higher. e. The population is too small and too spread out. f. Rural health areas are too geographically unattractive and lack any recreational possibilities for managers to want to work there.

a. High startup and administrative costs are needed. b. A large number of elderly are on Medicare or Medicaid, which results in low reimbursement. c. Managed care has not yet had time to go beyond major population centers. e. The population is too small and too spread out. MCOs recognize the risks to expanding into rural areas. Risks are probable high startup and administrative costs. Managed care has yet to move into much of rural America because of small dispersed populations, few visits per individual, and large numbers of elderly on Medicare with low-level reimbursements that do not make the aggregate financially attractive to MCOs. It is not likely that federal reimbursements for underserved rural health areas will become higher. The lack of attractive living for managers has not been a reason why MCOs have not moved into rural areas.

25 of 28 Which of the following best describes the term "literally homeless"? (Select all that apply.) a. Lacking a fixed, regular, and adequate nighttime residence b. Lacking a family residence c. Living in a place not typically used for human sleeping d. Living in a temporary living accommodation such as a hotel e. Living full-time in a recreational vehicle f. Sleeping in an extended-care facility or hospital

a. Lacking a fixed, regular, and adequate nighttime residence c. Living in a place not typically used for human sleeping Literally homeless is described as individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided. The term "literally homeless" is not used to describe those lacking a family residence, living in a temporary living accommodation such as a hotel or recreational vehicle, or sleeping in an extended care facility or hospital.

1 of 25 Which of the following best describes the risk for violence among females in the United States today? a. One of top five causes of death from age 1 to 44 years b. One of top 10 causes of death, especially among girls aged 1 to 4 years c. One of the top 10 causes of death, especially among women aged 15 to 24 years d. One of the top 10 causes of death, especially among vulnerable elderly

a. One of top five causes of death from age 1 to 44 years Among all females, homicide ranks in the top five causes of death among ages 1 to 44 years. Homicide is the third leading cause of death among females in the age groups of 1 to 4 and 20 to 29 years, is the fourth leading cause of death in the 5 to 14 year age group, and ranks fifth in the 30 to 34 year age group.

21 of 34 A nurse was becoming very frustrated at the ongoing stream of farmworkers with respiratory problems each spring. Which of the following actions should be taken by the nurse? a. Provide community education on herbicides and other chemicals spread each spring with information on self-protective measures, such as respirators. b. Fight to get farmers to quit spreading chemicals on their fields each spring. c. Suggest that farmers spray water on the fields immediately after the chemicals are spread to reduce dust in the air. d. Tell farm workers to obtain different employment. e. Try to get farmers to reduce the amount of chemicals used on their fields.

a. Provide community education on herbicides and other chemicals spread each spring with information on self-protective measures, such as respirators. Environmental health issues in rural communities, such as pesticide exposure or health hazards from point-source factory emissions, are more effectively assessed and remedied on a community level than on a case-by-case basis. Nurses' involvement in helping people understand health problems in a larger context can be the genesis of change. It is not realistic to have farmers quit or reduce the spreading of chemicals, spray water on their fields after chemical application, or ask them to obtain different employment. Nurses must work with farmers so that they are able to use safe measures when applying the chemicals to their fields.

26 of 34 Which of the following is most likely to provide public health services to Americans residing in a rural community? a. Public health nurse b. Public health physician c. Epidemiologist d. Nurse practitioner

a. Public health nurse In a study of 99 local health departments in three rural states, Rosenblatt and colleagues (2002) found that public health nurses were the core provider of public health services. Many smaller local health departments do not have the economic base to employ other professional public health providers, such as physicians, epidemiologists, sanitarians, and nutritionists at the local level.

16 of 34 As a concerned citizen and professional, a nurse encourages the local senators and representatives to support expansion of health clinics for the poverty stricken. Which of the following locations is in most desperate need? a. Rural areas where migrant and seasonal farmworkers (MSFW) labor b. Inner city poverty-stricken neighborhoods c. Near elderly low-income housing units d. Inside high schools in poverty-stricken neighborhoods

a. Rural areas where migrant and seasonal farmworkers (MSFW) labor In general, MSFW may have the poorest health of any aggregate in the United States and the least access to affordable health care. Thus, a location that serves this population would be most important.

33 of 34 Which of the following best describes why there are more long-term consequences (such as death) to a driver injured in a truck accident in a rural area than a driver injured in a truck accident in an urban area? (Select all that apply.) a. Rural drivers are more likely to speed over long distances than urban drivers. b. Rural drivers are not as skilled with vehicles as urban drivers, so they are more severely injured in a crash. c. The urban driver is taken immediately for care, whereas the rural driver might be injured on an isolated field and not found by anyone for hours. d. Urban drivers are more likely to use their seat belts than rural drivers. e. Urban drivers are probably rushed to an emergency department, whereas the rural driver lives far away from emergency services, often over bad roads and possibly through severe weather. f. Urban drivers trade their vehicles in rather frequently, whereas rural drivers keep their vehicles for as long as they can make them run, so the vehicles are much less roadworthy.

a. Rural drivers are more likely to speed over long distances than urban drivers. c. The urban driver is taken immediately for care, whereas the rural driver might be injured on an isolated field and not found by anyone for hours. d. Urban drivers are more likely to use their seat belts than rural drivers. e. Urban drivers are probably rushed to an emergency department, whereas the rural driver lives far away from emergency services, often over bad roads and possibly through severe weather. Getting patients from the place of injury to the trauma center within the "golden hour" is frequently not possible in rural areas because distance, terrain, climatic conditions, and communication methods produce barriers. Some rural facilities are more than 1 hour away by air from the nearest trauma center or tertiary care hospital. Driving at high speeds, driving long distances, driving in winter conditions, not using seat belts, and consuming alcohol have been cited as contributing to greater levels of injury deaths and disability by rural residents in the West. There is no evidence to suggest that rural drivers are not as skilled as urban drivers or that their vehicles are less roadworthy.

11 of 28 Which of the following underlying factors most likely contributes to homelessness? a. Substance abuse b. Unemployment c. Posttraumatic stress syndrome (PTSD) d. Severe mental illness

a. Substance abuse The text states that persons as active agents do make decisions that result in homelessness. These choices result in a shortage of affordable housing, insuf?9?cient income, and scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. However, these decisions are made in highly contextualized conditions, frequently addiction to alcohol and/or other substances. Substance abuse may in turn lead to unemployment which causes insufficient income. Additionally, PTSD and severe mental illness can cause substance abuse to occur.

32 of 34 A nurse was excited about being the only staff member in the public health department in a small rural area. Which of the following problems would the nurse most likely encounter? (Select all that apply.) a. There is no one with whom to collaborate or exchange ideas. b. There will be no physician available to tell the nurse what needs to be done. c. No feedback can be obtained from others. d. The nurse may only be able to offer services supported by federal funds. e. The nurse will have to raise local funds to support the department. f. There will not be any epidemiologists or sanitarians to help.

a. There is no one with whom to collaborate or exchange ideas. d. The nurse may only be able to offer services supported by federal funds. f. There will not be any epidemiologists or sanitarians to help. Many smaller local health departments do not have the economic base to employ other professional public health providers, such as physicians, epidemiologists, sanitarians, and nutritionists at the local level. The lack of additional onsite public health providers poses two problems. First, the ability to collaborate with others about potential or actual public health problems is decreased or nonexistent. Second, the ranges of services provided are less comprehensive. Often, these small facilities can only offer federally funded programs with few locally funded services. The nurse should be able to think independently to determine what needs to be done and should be able to work without physician direction. Feedback can be obtained from the population that the nurse is serving. Local, state and federal funds may all support the services that the nurse is providing. It is unlikely that the nurse will need to raise funds to support the work of the department; there should be local funding available for this nurse's position.

13 of 25 The 7-year-old boy's hands were badly burnt; it was suspected that his mother had forced his hands into boiling hot water after she caught him masturbating. The staff did not want the mother to be allowed near the boy. Which of the following statements would be made by the nurse to encourage the staff to interact more objectively with the mother? a. "If we won't let the mom near, who does the child have for support at this painful time?" b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." c. "The child may feel responsible; we have to let the mother fix their relationship." d. "We need to encourage the mother to continue parenting him or the boy will become a ward of the state."

b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." Most child maltreatment occurs within the family. Risk factors for child maltreatment include but are not limited to special needs children (children with disabilities, mental retardation, or chronic illness), children less than 4 years of age, family history of violence, substance abuse, poverty, and social isolation. Thus, it is most important that the staff provide support to the mother. The purpose of allowing the mother with the child is not for additional support for the child or mother, rather the recognition that the mother may have a history of abuse as well and needs assistance to change the patterns of behavior that have been learned through her own life experience.

19 of 24 A nurse came limping into work with a huge cast on her right leg and asked to have an assignment for a week or two that did not require driving. The nurse said, "I never realized how difficult it is to get some places without two good legs. Now I know how persons with disabilities must feel!" Which of the following would be the most appropriate response from the nursing supervisor? a. "I'm sure you'll be even more understanding and supportive now." b. "Not really; you'll be out of that cast in a few weeks." c. "What a great opportunity to attend some support groups for people with disabilities and share with us which ones are most helpful." d. "Why don't you just take some sick leave rather than try to work with that leg cast?"

b. "Not really; you'll be out of that cast in a few weeks." Those who have a temporary disability have a very different experience than those who are permanently disabled. Although they may experience frustrations, they view it as a temporary problem and a temporary setback. The other responses address this temporary disability as if it is similar to a permanent disability, which it clearly is not

27 of 28 Which of the following best describes how the Continuum of Care (CoC) concept determines the number of homeless? (Select all that apply.) a. By asking local police departments to visit areas where the homeless hide and report the number of people found there each March b. By conducting a point-in-time (PIT) homeless persons count every other January c. By making an educated guess based on anecdotal data d. By completing a statistical analysis of the Census Bureau data e. By reporting the number of homeless persons who use emergency shelters or transitional housing during the year f. By sending CoC personnel into the community to try to find hidden homeless

b. By conducting a point-in-time (PIT) homeless persons count every other January e. By reporting the number of homeless persons who use emergency shelters or transitional housing during the year CoCs are local systems responsible for providing a range of housing and related services that meet the U.S. Department of Housing and Urban Development guidelines for persons experiencing homelessness. CoCs conduct PIT counts of homeless persons on one night in January of every other year. In addition, CoCs are required to report the number of homeless persons who use emergency shelters or transitional housing throughout each federal fiscal year.

18 of 23 A patient had a distorted thought pattern, which led to very uncomfortable feelings and inappropriate behaviors. Which of the following types of therapy would most likely be successful? a. Behavioral therapy b. Cognitive-behavioral therapy c. Family therapy d. Group therapy

b. Cognitive-behavioral therapy Cognitive-behavioral therapy may be used in individual, family, couples, or group therapy. The goal is to identify and correct distorted thought patterns that can lead to troublesome feelings and behaviors. In comparison, behavioral therapy uses learning principles to change thought patterns and behaviors systematically; it is used to encourage the individual to learn specific skills to obtain satisfaction. Family therapy involves problem-solving sessions with members of the family. Group therapy involves a small group of people with similar problems who, with the guidance of a therapist, discuss individual issues and help each other with problems.

19 of 24 Which of the following would be one of the first steps in attempting to control a disease? a. Create an appropriate screening test for widespread use b. Define what the disease looks like in confirmed or probable cases c. Determine the disease's portal of entry and portal of exit d. Measure the extent of its spread geographically

b. Define what the disease looks like in confirmed or probable cases Standardized definitions of diseases are necessary for public health monitoring and surveillance across all levels of government. Diseases are defined and classified according to confirmed cases, probable cases, laboratory-confirmed cases, clinically compatible cases, epidemiologically linked cases, genetic typing, and clinical case definition. Once defined, disease occurrence can be compared across time, populations, and geographic areas; and appropriate control efforts can be implemented.

15 of 25 An 80-year-old woman lived with her eldest daughter, the daughter's husband, and their three children. On this visit, the nurse noted the woman looked dehydrated and seemed depressed. Both wrists were red and scabbed. When asked if she was all right, the woman protested she was fine and her daughter took good care of her. Which of the following actions should be taken by the nurse? a. Begin the paperwork to have the elderly woman put in a nursing home b. Discuss respite care and other stress relief measures with the daughter c. Report the elder abuse to the state department of aging d. Review with the total family how to share responsibilities for the woman's care

b. Discuss respite care and other stress relief measures with the daughter Working with victims of elder abuse, the nurse must establish rapport and trust. The nurse should remember that competent adults have the right to make decisions about their own care, including staying in an abusive situation. The nurse should support the family in examining potential respite care options and support groups for the elderly woman and her caregivers.

22 of 28 Which of the following describes a dimension of the social determinants of health (SDH) defined within Healthy People 2020? a. Employment b. Education c. Gender d. Income

b. Education Five broad dimensions of SDH are defined within Healthy People 2020 as: (a) Economic Stability, (b) Education, (c) Social and Community Context, (d) Health and Health Care, and (e) Neighborhood and Built Environment. Each of these dimensions includes key issues that identify more specific factors (U.S. Department Health and Human Services Healthy People 2020, 2013). Employment, gender, and income are not addressed as dimensions of the social determinants of health within Healthy People 2020

23 of 23 A nurse suspects that a client is depressed. Which of the following symptoms is most likely being exhibited by the client? (Select all that apply.) a. Paranoia b. Fatigue c. Irritability d. Difficulty concentrating e. Hallucinations f. Impulsivity

b. Fatigue c. Irritability d. Difficulty concentrating Symptoms of depression include the following: persistent sad, anxious, or "empty" feelings; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; irritability, restlessness; loss of interest in activities or hobbies once pleasurable, including sex; fatigue and decreased energy; difficulty concentrating, remembering details, and making decisions; insomnia, early-morning wakefulness, or excessive sleeping; overeating or appetite loss; thoughts of suicide, suicide attempts; aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

22 of 23 Which of the following are the causes of mental illness? (Select all that apply.) a. Excessive amounts of brain serotonin, dopamine, and γ-aminobutyric acid b. Genetic inheritance combined with neurochemical and metabolic changes c. Living through a severe disaster, whether manmade or natural d. Physiological abnormalities in the brain structure e. Posttraumatic stress syndrome (PTSD) f. Social isolation, rejection, and/or stress

b. Genetic inheritance combined with neurochemical and metabolic changes c. Living through a severe disaster, whether manmade or natural d. Physiological abnormalities in the brain structure e. Posttraumatic stress syndrome (PTSD) f. Social isolation, rejection, and/or stress Genetic expressions, combined with neurochemical and metabolic changes and environmental insults, may result in the display of mental disorder characteristics. Evidence indicates that structural brain abnormalities can be related to some mental illnesses, such as schizophrenia, depression, and Alzheimer disease. Natural and manmade disasters, such as hurricanes, floods, violence, terrorism, war, and the global economic crisis are profound stress-inducing events that can lead to mental illness. Researchers reported high levels of PTSD among survivors.

21 of 25 A male strong firearms advocate stressed his guns were for self-protection and he wanted all criminals to know his family had loaded guns in their home. Which of the following best explains why a nurse would not support his actions? a. Criminals carry more powerful and illegal guns. b. Guns in the home typically result in dead family members and friends. c. His children may be less careful than the adults in the family. d. Less trained individuals might think the guns were unloaded.

b. Guns in the home typically result in dead family members and friends. Concern about firearms arises when it has been shown that guns kept in the home for self-protection are more likely to kill a family member or a friend than an attacker. Furthermore, the presence of a gun in the home triples the risk for homicide in the home, increases the risk of suicide three to five times, and accidental deaths by four times.

2 of 24 Which of the following problems depends on the responses of other people and therefore cannot be measured? a. Disability b. Handicap c. Impairment d. Injury

b. Handicap In comparing these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis. Table 21-1 points out that both impairment and disability may be objective and measurable, whereas handicap is neither, because it is an experience related to the responses of other people.

8 of 24 A city that depended on tourist dollars had feedback that tourists were saying they were never returning because of the constant mosquito bites. Which of the following actions should be taken by the city? a. Do not have any tourist events at dawn or dusk. b. Have everyone in town search for and remove any standing stagnant water. c. Give free bug repellent to each tourist. d. Tell tourists to avoid wearing bright colors.

b. Have everyone in town search for and remove any standing stagnant water. Knowing the reservoirs for infectious agents is important, because, in some cases, transmission can be controlled by eliminating the reservoir, such as eliminating the standing water where mosquitoes breed. The other interventions, not having events at dusk or dawn, providing bug repellent, and wearing bright colors are ways the tourists can cope with the mosquitos that are present, but they do not eliminate the breeding and presence of the mosquitos

1 of 23 Which of the following provides the best description of severe mental illness (SMI)? a. Having been clearly diagnosed with at least two mental health disorders within the past year b. Having a diagnosable mental disorder with moderate functional behavior in a specific area of lifestyle at any time during the past year c. Being unable to function in society due to a mental illness d. Being convicted of several impulsive crimes during the past year

b. Having a diagnosable mental disorder with moderate functional behavior in a specific area of lifestyle at any time during the past year SMI occurs in adults who currently or at any time during the past yearhave a diagnosable mental, behavioral, or emotional disorder with moderate, severe, or extreme functional behavior in specific areas of lifestyle. These mental health disorders afflicting persons who are 18 years of age or older present emotional or behavioral functioning that is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration.

11 of 34 Which of the following statements best describes how firearm injuries are different in rural areas as compared with urban areas? a. In rural areas, firearm deaths occur more frequently because of purposeful, rather than accidental, shooting. b. In rural areas, firearm injuries occur more frequently in the home. c. In rural areas, firearm injuries occur more frequently during official hunting season, whereas the frequency does not vary in urban areas. d. In rural areas, firearm injuries are more frequently fatal than in urban areas.

b. In rural areas, firearm injuries occur more frequently in the home. In rural counties, nonfatal firearm injuries occur most often at home compared with urban counties, where injuries occur most often in the streets.

6 of 24 One child in a kindergarten room had a slight fever and did not eat lunch. Otherwise, the child seemed OK. Three days later, several children were absent from kindergarten. Which of the following best describes what happened? a. Another nursery school was offering the same child care at a much lower price. b. Infectious diseases can be contagious before any diagnostic symptoms occur. c. No way to tell; there are many reasons why parents keep children home. d. Parents chose to protect their children from the child with a fever, so they kept their children home for a few days.

b. Infectious diseases can be contagious before any diagnostic symptoms occur. Frequently, the communicable period begins before symptoms are present. The communicable period, or communicability, follows latency and begins with shedding of the agent. The incubation period is the time from invasion to the time when disease symptoms first appear. Thus, even if parents kept their children away from the child with the fever, this could possibly be ineffective because their children may have already been exposed before the child exhibited symptoms. It is unlikely that the children suddenly changed schools. Although, there may be many reasons why parents keep their children home from school, in this situation there is a specific reason that can be identified.

13 of 24 Which of the following best describes the current perspective on how communities should treat persons with disabilities (PWDs)? a. Be supportive of PWDs and try to reduce environmental barriers b. Maximize opportunities for PWDs to work and otherwise contribute to community life c. PWDs have civil rights just as other citizens do. d. Recognize that PWDs deserve our support both financially and otherwise

b. Maximize opportunities for PWDs to work and otherwise contribute to community life Contemporary disability policy minimizes disadvantages and maximizes opportunities for PWDs to live productively in their communities. Early American public policy viewed PWDs as "deserving poor" who required governmental protection and provision, with little capacity for self-support or independence.

8 of 23 Which of the following best explains why having parity in insurance coverage does not always help persons with depression? a. Many persons find that the medications do not relieve symptoms. b. Most depressed persons do not seek treatment. c. Most depression is situational, and having insurance does not change the situation. d. Psychotherapists will not accept the low reimbursement offered by insurance plans.

b. Most depressed persons do not seek treatment. Although effective treatments and medications exist, most people (almost two thirds) with depressive illness do not seek help. Parity in insurance coverage helps for depressed persons who are encountering situational depression to receive services and promotes care being provided by a variety of providers.

9 of 34 Which of the following facts is noteworthy about adolescent males who are driving without a license in the countryside? a. Most had driver's education classes but have not yet earned the money to pay for their driver's license test. b. Most were Hispanic or black from a rural area. c. Most were practiced in driving large farm machinery and were just going from one section of the farm to another section. d. Most were practicing their driving skills with their parent in the car.

b. Most were Hispanic or black from a rural area. Researchers studied the prevalence of unlicensed teenaged drivers compared with licensed drivers and found that they were more likely black or Hispanic and live in rural areas. There is not any research in the text that supports that the other responses are accurate.

4 of 25 For which of the following groups is suicide the second leading cause of death? a. People aged 15 to 24 years b. People aged 25 to 34 years c. People aged 35 to 65 years d. People over age 65 years

b. People aged 25 to 34 years For people between the ages of 25 and 34 years, suicide is the second leading cause of death, and it is the third leading cause of death in people aged 15 to 24 years.

15 of 24 The nurse could not find a vaccine in the refrigerator. The unopened vaccine vial had been put in a storage cabinet with the other medications. The nurse drew up the appropriate dose in the syringe and then put the vial of vaccine in the refrigerator. Which of the following would be the most likely result? a. The client will have immunity to the disease after the vaccination b. Primary vaccine failure c. Secondary vaccine failure d. The injection will not feel so cold to the client

b. Primary vaccine failure Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that may render the vaccines ineffective, improper administration route, or exposure of light-sensitive vaccines to light. Secondary vaccine failure is the waning of immunity following an initial immune response, often occurring with immunosuppressed and organ transplant patients in whom the immune memory is essentially destroyed. Although the injection will not feel so cold to the client, the problem that will result is primary vaccine failure.

6 of 25 A woman is in the emergency department for the fifth time this year, each time with more severe injuries. Which of the following is the primary responsibility of the nurse? a. Insist she be discharged to a safe shelter where the perpetrator cannot find her b. Provide information regarding safe shelters and sources of support c. Report the assault and battery to the local police department so the perpetrator is arrested for the crime d. Treat the injuries and inform the woman she may be killed if she stays with the perpetrator

b. Provide information regarding safe shelters and sources of support Working with victims of intimate partner violence (IPV) requires the nurse to establish rapport and trust; deal with issues of confidentiality honestly; provide current information regarding shelters and sources of support; and recognize and accept that clients may "choose" to stay in an abusive relationship. Because the nurse wants to establish rapport and trust, it would not be in the best interest of building this relationship if the nurse insist that she go to a safe shelter (rather the nurse should provide her the necessary information) or inform the woman she may be killed (rather the nurse should recognize and accept that the client may "choose" to stay in an abusive relationship). Additionally, the nurse should recognize that even if the assault is reported, it may be denied by the woman and will not result in an arrest of the perpetrator.

17 of 23 A family was very pleased with how well their child was doing now that he was on medication. They congratulated the nurse on getting their child help and said they were so impressed that the nurse was able to cure him. Which of the following would be the most appropriate response by the nurse? a. Congratulate them on being so supportive to their child through this ordeal. b. Stress that the medication is controlling the symptoms and their child will continue to need their support. c. Thank them for their recognition of the role you—and all nurses—play in promoting health. d. Verbalize your observations of how well their child is doing.

b. Stress that the medication is controlling the symptoms and their child will continue to need their support. Psychotherapeutic medications do not cure mental illness; they act by controlling symptoms. Thus, it is important for the nurse to stress to the family that the medication is controlling the symptoms and the child needs their continued support. Both of these factors are important for the long-term success and treatment of the child.

10 of 23 A patient with severe panic attacks refuses to come to the mental health clinic to get help even after being assured there is no charge for the initial assessment. Which of the following provides the best explanation for this behavior? a. People know that the treatment is to confront your fears in small doses, and the very idea is overwhelming and frightening. b. Such persons have anticipatory anxiety, so they try to avoid situations that may lead to a panic attack, such as leaving their house. c. The recurring symptoms such as tachycardia, chest pain, nausea, and sweating are seen as symptoms of a physical illness, not a mental illness. d. They are too depressed to take action.

b. Such persons have anticipatory anxiety, so they try to avoid situations that may lead to a panic attack, such as leaving their house. As the avoidance behavior intensifies, the client begins to withdraw further to avoid being in places or situations from which escape may be difficult. Individuals with agoraphobia frequently progress to the point where they cannot leave their homes without experiencing anxiety.

14 of 24 A professional strongly encouraged institutionalization so the parents could focus on care of their other family members. Which of the following suggestions would be appropriate for the nurse to make to the parents? a. As the expert pointed out, institutionalization will reduce family stress. b. The child has a right to an education in the least-restrictive setting. c. The child will eventually adapt to whatever choice the parents make. d. The choice of what to do is entirely the parents'.

b. The child has a right to an education in the least-restrictive setting. It is a given that it is the parents' choice. As an advocate for the child, you can explain that children have a legal right to an appropriate public education based on the child's needs in the least-restrictive setting.

14 of 25 A 6-month-old infant was brought in unresponsive by both parents. X-ray examination showed evidence of shaken baby syndrome. Which of the following persons is most likely responsible? a. The babysitter b. The dad c. The grandparents d. The mom

b. The dad In approximately 65% to 90% of abusive head trauma cases, also known as shaken baby syndrome, the father or the mother's boyfriend is the perpetrator.

2 of 23 Which of the following events occurred in 1965? a. State mental hospitals were created. b. The mentally ill were deinstitutionalized. c. Electroconvulsive therapy was discovered to help depression. d. Community mental health centers for outpatient care were established.

b. The mentally ill were deinstitutionalized. Deinstitutionalization is the release of institutionalized people, especially mental health patients, from an institution for placement and care in the community and was initiated in 1965. From 1955 to 1980, the number of mentally ill patients in state facilities fell from 559,000 to 154,000 because patients moved back out into communities. The Community Mental Health Centers Act of 1964 provided federal support for mental health services. The act supported measures to implement facilities to care for those who were mentally retarded and to construct community mental health centers. The creation of state mental hospitals and the discovery of electroconvulsive therapy occurred before 1965.

3 of 23 Which of the following best describes how brain imaging scans are being used? a. To deliver electroconvulsive therapy to high-risk individuals b. To help detect and diagnose medical disorders and illnesses c. To help determine treatment options for mental disorders d. To help determine the effects of psychotherapy

b. To help detect and diagnose medical disorders and illnesses Brain imaging scans, also called neuroimaging scans, are being used more and more to help detect and diagnose a number of medical disorders and illnesses. Currently, the main use of brain scans for mental disorders is in research studies to learn more about the disorders. These researchers study healthy brain development, effects of mental illnesses, or effects of mental health treatments on the brain. Brain scans alone cannot be used to diagnose a mental disorder, such as autism, anxiety, depression, schizophrenia, or bipolar disorder (NIMH, 2010). Brain neuroimaging helps researchers study healthy brain development, effects of mental illnesses, or effects of mental health treatments on the brain.

7 of 24 A day care center asked the nurse to come because they had several children out as a result of chickenpox. Which of the following statements should the nurse make to the staff? a. "Chickenpox has low infectivity so few children will get sick." b. "Chickenpox has low pathogenicity so the children won't be sick enough to stay home if the parents really need to go to work." c. "Chickenpox has low virulence so the children will be back at the day care center in a week or so." d. "Adults never catch chickenpox, so the staff are safe and may continue working."

c. "Chickenpox has low virulence so the children will be back at the day care center in a week or so." Other considerations for understanding the action of agents include their power to invade and infect large numbers of people (infectivity), their ability to produce disease in those infected with the agent (pathogenicity), and their ability to produce serious disease in their hosts (virulence). When the above concepts are applied, the chickenpox virus has high infectivity, high pathogenicity, and very low virulence.

17 of 24 A community health clinic put a tax levy on the ballot. An angry man asks a nurse, "How can you ask me to pay taxes to buy immunizations for parents who do not want to pay for their kids to get their shots?" Which of the following is the most appropriate response by the nurse? a. "Don't you think ethically we should help if we can?" b. "For many of us, our faith says we have to treat our neighbor as ourselves." c. "Only by getting almost everyone immunized can we prevent epidemics that can hurt us all." d. "The law requires childhood immunizations, and, if parents can't afford it, you and I will have to help pay."

c. "Only by getting almost everyone immunized can we prevent epidemics that can hurt us all." Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. If most persons are immune, it will be difficult for an infectious disease to spread.

10 of 25 A rape victim says to the nurse, "He said he loved me; he had been so nice; he said he wanted to show me how much he loved me. And then he...." Which of the following is the most appropriate response by the nurse? a. "Anyone can lose control; I'm sure he'll never do it again." b. "I'm not sure he loves you; he may just have wanted easy sex." c. "Rape isn't about love or even sex; it's about power and control." d. "You shouldn't have gone up to his room alone when the two of you had both been drinking."

c. "Rape isn't about love or even sex; it's about power and control." Intimate partner abuse is about control, not anger. The objective of abuse is to exert power and control over the victim.

13 of 23 Which of the following females would be at greatest risk for developing anorexia nervosa? a. A young woman who had been badly hurt in a car accident and is now living with her grandparents but managing to retain her high school Grade Point Average (GPA) b. A young woman who is a fantastic athlete but acts out and does what she feels is best, regardless of what others think c. A "good girl," obedient to her parents' wishes, who always agrees with peers in her clique and strives to do everything perfectly d. A student under a lot of stress from family events at home but who has good coping skills and recognizes that she is coping with major life changes

c. A "good girl," obedient to her parents' wishes, who always agrees with peers in her clique and strives to do everything perfectly Risk factors for eating disorders are perfectionism, low self-esteem, stress, poor coping skills, sexual/physical abuse, poor self-image, dependency on others' opinions and deference to others' wishes, and being emotionally reserved. Based on these descriptors and the typical characteristics of a person who has anorexia, the "good girl" demonstrates the greatest risk.

12 of 23 Which of the following females would be at greatest risk for developing bulimia nervosa? a. A 13-year-old who is constantly snacking on food from her backpack all day b. A 14-year-old student who is known as a nerd c. A 15-year-old cheerleader who wants to be a professional ballerina d. An 11-year-old student with the highest Grade Point Average (GPA) in the school

c. A 15-year-old cheerleader who wants to be a professional ballerina Bulimia nervosa typically begins in adolescence or during the early 20s, usually in conjunction with a diet. High school and college students, as well as members of certain professions that emphasize weight and/or appearance (e.g., dancers, flight attendants, cheerleaders, athletes, actors, models), are at a high risk. Based on these descriptors and the typical characteristics of a person who has bulimia, the 15-year-old cheerleader demonstrates the greatest risk.

13 of 28 Which of the following persons will have the most difficulty in obtaining adequate support services to find a long-term home? a. An alcoholic homeless person b. A homeless person who has a limited support system and is unemployed c. A homeless person who has a mental illness and is an alcoholic d. A mentally ill homeless person

c. A homeless person who has a mental illness and is an alcoholic For a sizable proportion of the homeless, severe mental illness exists along with the problems of alcohol or other types of substance use. Like physical health problems, serious mental illnesses and minor emotional problems occur more frequently among the homeless population than in the general population. High rates of alcohol and drug use exacerbate the existing acute and chronic physical and mental health problems. These coexisting problems can make it harder to assist the homeless person.

10 of 24 Which of the following best describes how many households with at least one child with a disabling condition would a school nurse working in an elementary school expect to see? a. About 5% b. About 10% c. About 15% d. About 20%

c. About 15% About 15.1% of households with children have at least one child with a special health care need (disabling condition).

21 of 28 Which of the following statements best reflects the model of justice U.S. health care is based on? a. All people are entitled to minimum standards of care. b. All people are responsible to help their neighbors. c. All people have a right to whatever their own efforts allow them to purchase. d. Like firefighting, police protection, libraries, and roads and highways, health care must be supported by tax money for the good of all who need such services.

c. All people have a right to whatever their own efforts allow them to purchase. Market justice has been the dominant model and purports that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover, this model stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. In contrast, under a social justice model, all people are equally entitled to key ends (i.e., access to health care and minimum standards of income). Consequently, all members of society must accept collective burdens to provide a fair distribution of these ends.

1 of 24 Which of the following is an accurate definition of impairment? a. A disadvantage resulting from a disability that prevents fulfillment of an expected role b. A restriction or inability to perform an activity in a normal manner c. An anatomical, mental, or psychological loss or abnormality d. A defect that affects society on a macro level

c. An anatomical, mental, or psychological loss or abnormality A disability, resulting from an impairment, involves a restriction or inability to perform an activity in a normal manner or within the normal range. An anatomical, mental, or psychological loss or abnormality is an impairment. A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role. In a comparison of these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis.

9 of 25 Which of the following best describes the incidence of abuse among pregnant women? a. It is too difficult to determine the actual incidence of abuse among this population. b. It is estimated that approximately 1 out of every 10 women experiences abuse. c. Approximately one out of every six women has been abused by a partner. d. Abuse does not occur among pregnant women.

c. Approximately one out of every six women has been abused by a partner. Pregnancy does not protect women from the danger of abuse. Indeed, pregnancy may increase stress within the family and provoke the first instances of battering. It is estimated that one in six pregnant women have been abused by a partner.

28 of 28 Which of the following disorders is experienced at a higher rate by homeless adults when compared with the general population? (Select all that apply.) a. Hepatitis b. Diabetes c. Asthma d. HIV/AIDS e. Hypertension f. Alcoholism

c. Asthma e. Hypertension f. Alcoholism Chronic disorders experienced at higher rates than in the general population include hypertension; musculoskeletal disorder; gastrointestinal problems; respiratory problems (asthma, chronic bronchitis, emphysema); neurological disorders, including seizures; and poor dentition. Like physical health problems, serious mental illnesses and minor emotional problems occur more frequently among the homeless population than in the general population. High rates of alcohol and drug use exacerbate the existing acute and chronic physical and mental health problems. The rates of hepatitis, diabetes, and HIV/AIDS are not seen at a higher rate among the homeless adult population.

9 of 23 Which of the following best summarizes the symptoms of a person with bipolar disorder? a. Chronic, unrealistic, and exaggerated worry about life b. Ongoing hallucinations and delusions c. Changes in mood from depression to mania d. A persistent abnormally elevated or irritable mood

c. Changes in mood from depression to mania Bipolar disorder refers to a group of mood disorders that present with changes in mood from depression to mania. The depressed phase is manifested by symptoms seen in major depressive disorder. The manic phase is characterized by a persistent abnormally elevated or irritable mood, impaired judgment, flight of ideas, pressured speech, grandiosity, distractibility, excessive involvement in goal-directed activities, few hours sleeping, and impulsivity. These symptoms may co-occur with psychotic features, such as hallucinations and delusions. Generalized anxiety disorder is characterized by chronic, unrealistic, and exaggerated worry and tension about one or more life circumstances lasting 6 months or longer.

24 of 25 Which of the following actions would public health professionals want to use as primary prevention against widespread community violence? (Select all that apply.) a. Women seen in emergency departments should be asked about abuse b. Courses for prisoners about avoiding violence and resolving conflict c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence f. Home visits to elderly clients should include screening for elder abuse

c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence The goal of primary prevention is to stop violence, abuse, or neglect before it occurs. Education plays a major part in primary prevention and may include parenting and family wellness, and anger management or conflict resolution. Professionals should increase their awareness of violence, identification of cases, and provision of early treatment. The nurse can work in or with the community to educate citizens about the problem of violence, potential causes of violence, and available community services. Screening is secondary prevention, and courses for those already known to be violent are tertiary prevention.

26 of 28 Which of the following strategies have been used to improve the collection of prevalence data for the homeless population? (Select all that apply.) a. Urban Institute study b. Homeless Assistance Report c. Continuum of Care (CoC) concept d. Homeless Information Management System (HMIS) e. Census Bureau f. Education for Homeless Children and Youth program

c. Continuum of Care (CoC) concept d. Homeless Information Management System (HMIS Two strategies used by the U.S. Department of Housing and Urban Development in the efforts to strengthen the nation's efforts to reduce homelessness, including improvement in collecting prevalence data, are the CoC concept and the HMIS. The Census Bureau and Urban Institute study were historically used to collect data on the homeless population. Data collection improvements have been made since these studies were completed. The Department of Education uses the Education for Homeless Children and Youth program to collect data on homeless youth.

7 of 23 Which of the following mental illnesses is most frequently diagnosed among adults in the United States? a. Acute stress disorder b. Bipolar disorder c. Depression d. Schizophrenia

c. Depression Depression is the most frequently diagnosed and one of the most disabling mental illnesses in the United States. Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. Acute stress disorder, bipolar disorder, and schizophrenia are not diagnosed as frequently as depression.

23 of 25 In which of the following clinical areas are nurses most at risk for workplace violence? (Select all that apply.) a. Acute care/intensive care units b. Community health clinics c. Emergency departments d. Geriatric units e. Psychiatric units f. Rehabilitation units

c. Emergency departments d. Geriatric units e. Psychiatric units In the health care field, the most frequent areas for the occurrence of violence are the emergency departments, psychiatric units, geriatric units, and waiting rooms.

20 of 23 A nurse is working in a community setting caring for persons with mental health problems and their families. Which of the following is the most important and critical task for this nurse? a. Be an advocate by writing letters to legislators demanding more resources for care for the mentally ill b. Encourage all those involved to fight the community's tendency to stigmatize the mentally ill and their families c. Establish supportive interpersonal relationships with all those involved d. Lobby for increased funding for care of the mentally ill

c. Establish supportive interpersonal relationships with all those involved Perhaps the most critical impact made by the nurse in a community setting is through the establishment of interpersonal relationships with clients. Establishing supportive relationships is the first step in the role of the community mental health nurse as coach for mental and physical health promotion. After a supportive relationship has been established, the nurse will be more knowledgeable about the needs of the population and will be a better advocate and lobbyist for the population.

Which of the following best describes why some advocacy groups have taken a strong stand against physician-assisted suicide? a. Ethical belief that life is always preferable to death b. Emphasis that there is always hope for a research breakthrough or discovery of a new treatment intervention c. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions d. Helping someone die is murder, plain and simple

c. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions Because people have previously been killed because they had a disability, some advocacy groups, such as Not Dead Yet, have taken a strong stance against physician-assisted suicide, fearing it will lead to the early or forced death of people with disability. Ethical and personal beliefs and emphasizing the hope for a new treatment have not been stands taken by advocacy groups against physician-assisted suicide.

20 of 25 Which of the following must be involved for an act to be considered a terrorist act? a. A commitment to a political or religious belief b. An attempt to force compliance with a particular set of religious or political beliefs and behaviors c. Fear, intimidation, and violence d. Violence resulting in plural deaths

c. Fear, intimidation, and violence

18 of 25 Which of the following best describes why all citizens should care about young people joining gangs? a. Gangs are beginning to be seen in suburban areas. b. Gangs are responsible for destroying lives and property in inner cities. c. Gangs commit as much as 90% of all crime in some communities. d. Gangs help give the young person protection, respect, and sense of belonging.

c. Gangs commit as much as 90% of all crime in some communities. It is estimated that gangs are responsible for approximately 48% of all crime and up to 90% in some areas. These crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder. Gangs exist throughout the country, in urban and suburban areas. Destruction of lives and property is not the major reason why citizens should be concerned with gangs. Although gangs do give young persons protection, respect, and sense of belonging, the major concern would be the amount of crime that is associated with gangs.

21 of 23 Which of the following behaviors best represent the definition of mental health? (Select all that apply.) a. Currently enjoys receiving unemployment benefits b. Frequent dates, although most relationships are short term c. Happily married and successful parent of three children d. Just promoted with more responsibilities and increased salary e. Lives alone in a small apartment f. Set up a memorial fund for research after death of a family member

c. Happily married and successful parent of three children d. Just promoted with more responsibilities and increased salary f. Set up a memorial fund for research after death of a family member In 1999, the Surgeon General's Report on Mental Health defined mental health as a state of successful performance of mental function that results in productive activities, fulfilling relationships with others, and an ability to adapt to change and cope with adversity. The correct behaviors represent the ability to maintain employment and relationships, and to adapt to change, including adversity. The incorrect responses demonstrate behaviors that do not support mental health - enjoyment in receiving unemployment benefits, short-term relationships, and living alone.

4 of 24 A female client develops a fungal vaginal infection after being treated with antibiotics for strep throat. Which of the following components of the epidemiological triangle is primarily responsible? a. Agent b. Environment c. Host d. Interaction of agent and environment

c. Host Infectious diseases are the result of interaction among the human host, an infectious agent, and the environment, which surrounds the human host and where transmission is occurring. This interaction is pictured in the epidemiological triad of agent, host, and environment also discussed in Chapter 5. The antibiotic therapy eliminated a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which caused a change in the vaginal environment, allowing normally present fungi to proliferate, resulting in a yeast infection

11 of 23 A person with obsessive-compulsive disorder (OCD) knows the ritual is senseless, but is unable to stop. Which of the following best explains why he does not quit doing the ritual? a. As rituals become habit, others will worry about the person if he or she suddenly stops engaging in the ritual behavior. b. Engaging in rituals allows the individual to feel in control. c. If the compulsion is resisted, anxiety increases. d. Rituals, even if nonsensical, are comforting and reassuring.

c. If the compulsion is resisted, anxiety increases. The person with OCD feels compelled to engage in some ritual to avoid a persistent frightening thought, idea, image, or event. Obsessions are recurrent thoughts, emotions, or impulses that cannot be dismissed. Compulsions are the rituals or behaviors that are repeatedly performed to prevent, neutralize, or dispel the dreaded obsession. When the individual tries to resist the compulsion, anxiety increases.

1 of 28 A family will most likely lose their primary nighttime residence within the next week. Which of the following terms best describes their situation in relation to homelessness? a. Homeless under other federal statutes b. Literally homeless c. Imminent risk of homelessness d. Fleeing/attempting to flee domestic violence (DV)

c. Imminent risk of homelessness The U.S. Department of Housing and Urban Development has issued regulations that summarized the statutory definitions in four descriptive categories. These four categories with their respective definitions include: LITERALLY HOMELESS: Individuals and families who lack a fixed, regular, and adequate nighttime residence, including a subset for individuals who resided in an emergency shelter or a place not meant for human habitation and who are exiting an institution where he or she temporarily resided; IMMINENT RISK OF HOMELESSNESS: Individuals and families who will imminently lose their primary nighttime residence; HOMELESS UNDER OTHER FEDERAL STATUTES: Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; and FLEEING/ATTEMPTING TO FLEE DOMESTIC VIOLENCE: Individuals and families who are fleeing, or are attempting to flee, DV, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.

17 of 25 Where is youth violence most likely to occur? a. At home b. At recreational facilities c. In inner city schools d. In fast-food facilities where young adults are employed

c. In inner city schools Youth-related violence is more concentrated in minority communities and inner cities, causing a disproportionate burden on these communities. Children are often not taught peaceful ways of resolving differences and learn by default from what they observe on television and in movies. Consequently, schools have become a common site for violence.

7 of 28 Which of the following factors would prevent a homeless person from accepting employment adequate to pay for housing? a. Could not complete an employment application because of lack of mailing address b. Hope for a better position than the service positions available c. Lack of adequate resources to pay for other necessities d. Prefer to receive a handout than to have to work

c. Lack of adequate resources to pay for other necessities There are homeless people who are able to function in the workforce. The lack of affordable housing in combination with insufficient income results in people having to spend much of their income on rent and leaves them without adequate resources for other necessities, such as food, clothing, and health care. This situation substantially increases their risk for homelessness.

4 of 23 Which of the following best describes how people with mental illness are viewed by the general public? a. Individuals in need of assistance b. Criminals who need to be institutionalized c. Lazy, weak, and immoral d. Contributing members of society

c. Lazy, weak, and immoral Throughout history, the symptoms of mental illness have been perceived as permanent, dangerous, frightening, and shameful. People with a diagnosis of mental illness have been described as lazy, idle, weak, immoral, irrational, and, too often, criminal.

14 of 28 Which of the following best describes a major difference between women who have always had shelter and women who have been homeless? a. Educational opportunities and attainment b. History of gender relationships (marriages, divorces) c. Level of involvement with physical and/or sexual abuse d. Skills necessary for paid employment

c. Level of involvement with physical and/or sexual abuse In the 1990s, research clearly documented the extraordinary histories of violence, from childhood through adulthood, among women experiencing homelessness. High numbers of homeless women report histories of foster placement as children and exposure to violence as both children and adults. This research has not documented the differences in educational opportunities, gender relationships, and skills necessary for paid employment.

16 of 28 A school nurse was asked to see Lisa, a student in the fourth grade who was rumored to be living in a car with her mother. Which of the following would most likely have caused the teacher to become concerned? a. Lisa is not always respectful of the teacher. b. Lisa has not been doing her homework. c. Lisa may be developmentally delayed. d. Lisa may have behaved in a sexually inappropriate manner.

c. Lisa may be developmentally delayed. Homeless children have higher rates of physical, mental health and behavior, and educational problems than children in the general population. All children are not always respectful and do not always have their homework done and may act out behaviors seen on television.

24 of 24 Which of the following would be good rules to use when interacting with a person with disabilities? (Select all that apply.) a. Apologize for slips of the tongue such as saying "Do you see?" to a blind person b. Be friendly to guide dogs, including petting them and offering to get them fresh water c. Notice similarities between yourself and the person with a disability d. Take hold of a blind person's arm to assist them in dangerous situations, such as crossing a busy street e. Volunteer the most recent research findings related to the person's disability f. With someone who is blind, announce who you are and why you are there when you enter the room

c. Notice similarities between yourself and the person with a disability f. With someone who is blind, announce who you are and why you are there when you enter the room Rules include do not offer expert advice or assistance based on what you think the person needs or can do; do not grab the arm of a person who is blind but let the person take your arm so the person does not lose his or her balance; do not pet a working dog; do seek out similarities and shared interests; do inform the person who is present; say goodbye when leaving; and treat the person very much like an able-bodied person.

10 of 34 Which of the following are particularly prevalent in rural areas (more so than in urban areas) of the South? a. Falls and motor vehicle accidents b. Less use of seatbelts and more drinking of alcohol c. Obesity and sedentary lifestyle d. Suicide and homicide

c. Obesity and sedentary lifestyle Rural residents in the southern states are more likely to be obese, smoke more heavily if they do smoke, use smokeless tobacco, and engage in sedentary lifestyles. Rates of motor vehicle accidents and suicide are higher in rural areas, although not necessarily the South. Additionally, there is a decreased use of seatbelts and increased use of alcohol in rural areas; however, the textbook mentions that these rates are higher in the rural West than in the rural South. The rates of falls and homicide are not addressed in the textbook.

20 of 24 A family has recently learned that their child will be permanently disabled. The parents do not deny the disability, but do not fully realize its impact. Which of the following levels of adjustment are the parents experiencing? a. Self-actualization b. Normalization c. Ostrich phase d. Special designation

c. Ostrich phase Ulrich and Bauer (2003) propose that the adjustment to disability experience occurs in four levels as parents gradually become aware of the impact of their child's disability. These levels include: (1) the ostrich phase, where parents do not deny a disability, but do not fully realize its impact; (2) special designation, when parents begin to realize their child has a special need and seek help; (3) normalization, when parents try to make the differences between their child and children without disabilities less apparent, and may actually request a decrease in services; and (4) self-actualization, when parents do not view being different as better or worse, just different, and support their child in learning about his or her disability, along with how to be a self-advocate.

12 of 24 A case of severe acute respiratory syndrome (SARS) was diagnosed immediately on signs of illness at a tourist site in China. Which of the following actions should be taken to protect the badly needed income from tourist dollars? a. Close the airports and refuse to let the tourists in the area leave b. Begin to immunize everyone in the immediate area with protective vaccine as soon as possible c. Quarantine the ill person and use isolation techniques when providing care d. Screen everyone in the area by requiring a blood and urine sample

c. Quarantine the ill person and use isolation techniques when providing care Quarantine is an enforced isolation or restriction of movement of those who have been exposed to an infectious agent during the incubation period; this is another method of controlling the reservoir. Quarantine was used effectively during the outbreak of SARS in 2003, when some hospitals required that their staff exposed to SARS patients remain at the hospital until proved to be symptom free at the end of the incubation period. Immunization and screening would not protect the population from exposure to this infectious disease. It is likely that others besides tourists could be exposed or infected by this disease, thus, closing airports would be ineffective in controlling the spread of the disease.

27 of 34 Which of the following best describes how the federal government tries to both encourage and support rural health clinics under the Community Health Centers (CHC) program? a. Allowing tax deductions for charitable contributions to rural health clinics (RHCs) b. Donating equipment and supplies to establish such clinics c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise d. Requiring recipients to serve in a rural health clinic for 3 years in exchange for financial assistance while in school

c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise The CHC program, administered by the U.S. Public Health Service, benefits underserved areas and populations. RHCs are designed to improve access to primary care. As an incentive to rural communities to apply for RHCs, Medicare and Medicaid are reimbursed at a higher rate than usual.

7 of 25 A 4-year-old child is seen in the emergency department with a spiral fracture of the right arm. X-ray examination shows previously broken and healed bones. Which of the following is the immediate responsibility of the nurse? a. Call social services to immediately set up foster care for the child b. Provide information about parenting and anger management classes c. Report the child abuse to the local legal authorities d. Try to establish rapport and trust with the child's family

c. Report the child abuse to the local legal authorities Spiral fractures are only possible from abuse, because they require a wringing motion to occur. When working with victims of child abuse, the primary obligation of all health care providers is to protect the child. The abuse must be reported as a legal and ethical obligation.

2 of 34 Which of the following best explains why there are so few hospitals in rural areas? a. Few nurses and physicians enjoy the rural lifestyle. b. Historically, hospitals began in large urban areas and have slowly expanded outward but have not yet reached all rural areas. c. Rural areas have very low population density. d. Rural residents do not trust hospitals, preferring to receive care from neighbors and friends.

c. Rural areas have very low population density. Although 75% of U.S. counties are classified as rural, they contain only 20% of the U.S. population. The population density is too low to support a large hospital. There are providers available to serve the population and residents are accepting of health care services, but not as many services are needed because of the lower population density.

10 of 28 Which of the following factors are most likely to contribute to homelessness? a. Domestic violence and substance abuse b. Scarcity of support systems and recent job loss c. Shortage of affordable housing and insufficient income d. Substance abuse and serious mental illness

c. Shortage of affordable housing and insufficient income The text addresses three broad factors: (1) shortage of affordable housing, (2) insufficient income, and (3) scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. Domestic abuse, substance abuse, and serious mental illness are not identified as the broad factor contributing to homelessness.

28 of 34 Which of the following best describes how Migrant Health Centers (MHCs) under the Migrant Health Program are often different from other clinics? a. Care is restricted to those who can document that they are employed in agriculture. b. They are much better funded than typical rural clinics. c. Staff are typically bilingual and bicultural. d. They welcome illegal immigrants to receive care.

c. Staff are typically bilingual and bicultural. The MHCs and the Migrant Health Program provide comprehensive nursing and medical care and support services to migrant and seasonal farm workers and their families from many countries in Latin America and the Caribbean. Bilingual, bicultural health personnel, including lay outreach workers, use culturally appropriate protocols for providing primary care, preventive health care, transportation, dental care, pharmaceuticals, and environmental health. The funding at the MHC may not be any different than other rural clinics. Their primary purpose is not to provide care to illegal immigrants, rather to migrant and seasonal workers.

22 of 24 Which of the following groups is especially at risk for sexually transmitted diseases (STDs)? a. Recently divorced adults b. Single young women between 19 and 24 years of age c. Teenaged girls d. Young males between the ages of 15 and 19 years

c. Teenaged girls Teenaged girls in particular may be more susceptible to STDs because they have fewer protective antibodies to STDs and a cervix that is biologically immature. Of the estimated 20 million cases of STDs occurring each year in the United States, almost half of them are in persons aged 15 to 24 years. Women are at higher risk for contracting STDs than men because they have anatomical differences that enhance transmission of disease and make diagnosis difficult. The population of recently divorced adults does not address the increased incidence seen among females and the young adult/adolescent population

6 of 23 Which of the following was required by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008? a. That alcoholism be recognized as a disease and treatment be given in residential facilities b. That drug addiction be accepted as a mental health diagnosis and addicts be treated rather than jailed when caught c. That health insurance must cover treatment for mental illness on the same terms and conditions as physical illness d. That community clinics must treat clients for mental illness just as they treat prisoners who have a physical illness

c. That health insurance must cover treatment for mental illness on the same terms and conditions as physical illness In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted. The law requires health insurance to cover treatment for mental illness on the same terms and conditions as physical illness. This law does not require that alcoholism be recognized as a disease, that drug addiction be accepted as a mental health diagnosis, or that community clinics must treat clients for mental illness.

17 of 28 The male home health nurse parked his marked car in preparation for visiting the next client when a young female walked over to the car and asked him if he would like to have some fun. Which of the following provides the best explanation for this behavior? a. The girl was skipping school and wanted money for entertainment. b. The male nurse was extremely young and attractive and looked like he had money. c. The girl may have hoped a nurse would give her enough money to eat. d. Young girls often engage in thrilling, if high-risk, behaviors.

c. The girl may have hoped a nurse would give her enough money to eat. Homeless youth experience sexually-transmitted diseases, physical and sexual abuse, skin disorders, anemia, drug and alcohol abuse, and unintentional injuries at higher rates than in the general population. Depression, suicidal ideation, and disorders of behavior, personality, or thought also occur at higher rates among homeless. Family disruption, school failures, prostitution or "survival sex," and involvement with the legal system indicate that homeless social health is severely compromised. Thus, it is most likely that the girl is hoping that the nurse would provide her enough money to eat.

2 of 28 Which of the following best describes the recent trends in homelessness? a. The number of homeless individuals in school is decreasing. b. The number of homeless individuals is increasing. c. The number of people in homeless families is increasing. d. The number of people in homeless families is decreasing.

c. The number of people in homeless families is increasing. The U.S. Department of Housing and Urban Development reported the following numbers of people in the total population and subpopulations who used shelters or transitional housing between October 1, 2010, and September 30, 2011: 4,469 individuals, a decrease of 11% since 2007; 537,414 people in families, an increase of 13.5% since 2007. According to the U.S. Department of Education: 1,065,794 homeless students were enrolled during the 2010-2011 school year an increase of 11% over the 3-year period 2008-2009 to 2010-2011.

5 of 23 Which of the following would be most upsetting for American families when their loved one, after serving in Iraq or some other battlefield, returns home? a. Many families, especially those with children, do not want guns in the house. b. Reabsorbing them into the family structure is challenging and difficult. c. The suicide rate is twice as high as among nonveteran adults. d. They must use the Veterans Affairs medical system for medical care.

c. The suicide rate is twice as high as among nonveteran adults. Male veterans in communities are twice as likely to die by suicide as their civilian counterparts. There is nothing to support that these veterans will have guns in their homes. The veterans will be able to use the Veteran Affairs system for medical care and there may be challenges with their return home, but that should not be as upsetting as the risk for suicide for their loved one.

18 of 34 Which of the following statements best describes how working on a farm is different from working in a factory? a. Factories have more dangerous dust than farming dust. b. Farm chemicals are more immediately fatal than most industrial chemicals. c. The worksite and the home are the same. d. Workers on farms, unlike those in factories, can bring dangerous substances home on their clothing, which expose their families.

c. The worksite and the home are the same. Farming is unusual because the home and the worksite are the same. Several types of farming activities are associated with higher-than-expected occurrences of acute and chronic respiratory conditions. Individuals with long-term exposure to grain dusts, such as grain elevator workers and dairy workers, have diminished respiratory function and increased frequency of respiratory symptoms. Occupational asthma and more exotic fungal or toxic gas-related conditions occur in higher frequency in agricultural than nonagricultural populations. Exposure risks to children and spouses may be heightened when farmers wear contaminated clothing and boots into the home, but the same can happen in several industries.

8 of 28 Which of the following groups of people is most likely to experience homelessness? a. Those who have a supportive family b. Those who have recently become unemployed c. Those who have substance abuse problems d. Those who frequently change jobs

c. Those who have substance abuse problems Some people experiencing homelessness have individual characteristics that, in interaction with the structural conditions of a shortage of affordable housing and insufficient income, perpetuate their homeless conditions. Supportive services for these people are deficient in quality and quantity. Some people need services to work and earn money. They are able to function in the workforce, whereas others need services to maintain their housing status. Included in this latter group are people whose serious chronic mental health and/or substance abuse problems preclude their functioning in the workforce and whose behaviors interfere frequently with their ability to obtain housing stability. People in this group need income assistance and comprehensive and accessible behavioral and physical health care.

6 of 28 Which of the following best describes what happens when persons who work full-time and receive the typical minimum wage seek an apartment? a. Few clean and decent low-rent apartments exist. b. People do not like to rent to low-income persons. c. To afford housing, they need a job that pays at least three times minimum wage. d. There are not many trailer parks near their employment.

c. To afford housing, they need a job that pays at least three times minimum wage. In many areas of the country, wages needed to afford housing are three to five times higher than the federal minimum wage of $7.25 per hour.

10 of 24 Which of the following best describes why clinical areas are so careful to ensure sanitization of surfaces and equipment between each patient? a. To avoid direct patient-to-patient transmission of infection b. To provide a clean environment for clients and staff c. To decrease transmission by fomites d. To decrease transmission by vectors

c. To decrease transmission by fomites Indirect transmission is the spread of infection through a vehicle of transmission outside the host. These may be contaminated fomites or vectors. Fomites can be any inanimate object, material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a contaminated tissue).

19 of 28 Which of the following best describes the purpose of the Vulnerability Index? a. To identify those most at risk of becoming homeless b. To determine the underlying cause of homelessness among vulnerable populations c. To identify and prioritize the need for housing among the homeless d. To determine what resources should be provided for vulnerable populations

c. To identify and prioritize the need for housing among the homeless Homeless service providers, concerned about the high risk for mortality among "street" homeless population constructed the Vulnerability Index, a screening tool for identifying and prioritizing the need for housing

20 of 34 A nurse is explaining why migrant farmworkers experience cultural barriers when trying to receive care. Which of the following would the nurse include in this explanation? a. "As illegal immigrants, they are not eligible for tax-paid health care." b. "Families who travel in isolation seeking agricultural work do not mix with their employers or other members of the community." c. "Mexicans who speak primarily Spanish and cannot understand English." d. "Usually perceived as outsiders, they are from many countries and cultures."

d. "Usually perceived as outsiders, they are from many countries and cultures." Cultural, linguistic, economic, and mobility barriers all contribute to the nature and magnitude of health problems observed in farmworkers. Cultural and linguistic barriers are the most overt because many of the communities where farmworkers work consider them outsiders. A common misconception among U.S. health care providers is that these farmworkers are from Mexico, with Spanish as their primary language. Farmworkers originate from many communities in Mexico, the Caribbean, and Central and South America, and they may speak English, the language of their home country, or several languages.

7 of 24 A young man rolled his wheelchair up the ramp into the clinic to the desk where the intake nurse greeted him. After welcoming him to the clinic, which of the following should be the initial question asked by the nurse? a. "Are you a vet home from the war?" b. "Can I help you into the treatment room to see the nurse practitioner?" c. "Do you have any family with you to help today?" d. "What brings you to the clinic today?"

d. "What brings you to the clinic today?" The client should be asked what is needed just as any other client would be. A veteran would more probably be at a Veterans Affairs (VA) clinic, and there is nothing in the statement to imply that the clinic is part of the VA medical system. Because the man made it into the clinic, it is doubtful he would need help into the treatment room. Not all persons live with families. The handicap may be unrelated to why he is at the clinic. He may be ill or merely need immunization or other health promotion activity.

11 of 24 The mother confided in the nurse, "I don't think my child is improving." Which of the following statements would be the best response by the nurse? a. "My assessment shows your child is improving." b. "The children seem to be playing with and accepting your child." c. "The teacher reported to me that your child is doing much better." d. "What is causing your concern?"

d. "What is causing your concern?" Nurses should pay attention, particularly when parents intuitively whisper, "Something is not right." A well-meaning health care provider may attempt to reassure a concerned mother. However, this kind of response may create silence and delay further questions by the parent. Rather than decrease parental concern, it may increase anxiety. The nurse can serve as an intermediary, working among the family and the health care team, to address parental concerns and client goals.

14 of 23 A nurse is picking up her child from nursery school when the day care teacher says to her, "One of the boys we care for does not seem able to sit still and listen, but is always running around and getting into things. His parents are not worried. His mother said her brother was the same way when he was a kid. Since you are a nurse, do you have any ideas on how I can calm him down?" Which of the following would be the most appropriate response by the nurse? a. "I'm not a pediatric nurse; I really don't know what to tell you." b. "I'm sorry you're concerned, but being impulsive and very physically active is quite normal for 3- to 4-year-old children." c. "Tell the parents he has to see the doctor as he's not doing well in nursery school." d. "Why not suggest that it's time for him to have a complete assessment and suggest the physician call you for an update on how he is doing in nursery school?"

d. "Why not suggest that it's time for him to have a complete assessment and suggest the physician call you for an update on how he is doing in nursery school?" The three major characteristics of attention-deficit hyperactivity disorder/attention-deficit disorder (ADHD/ADD) are inattention, hyperactivity, and impulsivity. Although parents may notice symptoms and signs, it is often teachers who recognize the behaviors consistent with ADHD/ADD and suggest referral for assessment and treatment. Suggesting a referral is the most appropriate response for the nurse because of the symptoms that have been reported.

12 of 28 Which of the following individuals would be described as being "doubled up"? a. An individual who has two chronic conditions b. An individual who has recently been released from prison c. An individual who maintains two jobs to avoid being homeless d. An individual who is forced to live with friends

d. An individual who is forced to live with friends An individual may be considered to be homeless if that person is "doubled up," a term that refers to a situation where individuals are unable to maintain their housing situation and are forced to stay with a series of friends and/or extended family members. The other responses do not accurately describe being "doubled up".

12 of 24 Which of the following describes the most important need of every school-aged child with a disability? a. A teacher who understands the child's needs b. An advocate within the school system c. An assessment with comparison with developmental milestones d. An individualized education plan (IEP)

d. An individualized education plan (IEP) A child should have all of the above items, an advocate in the school nurse, a teacher who understands, an assessment including comparison with developmental milestones, as all of these are components of an IEP with goals, cooperatively developed with the parents, to help the child succeed in school. The IEP describes the goals, as well as any special support needed to help achieve them. The IEP is the most comprehensive answer.

2 of 25 Which of the following best describes the typical perpetrator of homicide? a. A person trying to engage in rape with the woman fighting back b. A person who wanted money and she refused to give it to him c. A stranger d. An intimate partner

d. An intimate partner Over 50% of the victims were killed by someone they knew. Notably 37% of female murder victims are killed by an intimate partner. Thus, the typical perpetrator would be an intimate partner. It would be less likely to be a stranger, someone who wanted money, or someone trying to engage in rape.

16 of 25 Which of the following best explains why more nurses do not report violence against themselves to authorities? a. Assumption that the nurse somehow "asked for it" by not being cautious enough or alert enough to avoid it b. Assumption that nothing would be done about the situation anyway c. Assumption that nurses can accept anything, from taking blame to being scapegoats for when outcomes are not positive d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job

d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job Workplace violence tends to be higher in some service-oriented work environments, including health care. Such violence is widely believed to be underreported, perhaps in part because of beliefs that it is an expected part of certain jobs.

8 of 34 Which of the following would be true for a county to be defined as having persistent poverty? a. At least 10% of the population has been in poverty for at least the last 10 years. b. At least 10% of the population has been in poverty for at least the last 20 years. c. At least 20% of the population has been in poverty for at least the last 20 years. d. At least 20% of the population has been in poverty for at least the last 30 years.

d. At least 20% of the population has been in poverty for at least the last 30 years. Persistent poverty is defined as counties in which 20% of the population has been in poverty over the last 30 years.

19 of 25 Which of the following best describes why hate crimes involving violence are often considered worse than other crimes involving violence? a. Because hate crimes cannot be avoided because one cannot change one's race or religious or sexual orientation b. Because hate crimes often are committed by groups rather than individuals c. Because more damage is typically done in a hate crime than in a typical assault and battery d. Because the crime is personal, attacking the victim's identity

d. Because the crime is personal, attacking the victim's identity Hate crimes are crimes based on an individual's race, sexual orientation, religious beliefs, ethnic background, or national origin. Hate crimes may include rape, sexual or physical assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate crimes attack an individual's identity, the emotional effects are compounded.

15 of 28 Which of the following factors is strongly predictive for homelessness among women veterans? a. Having a previous criminal conviction b. Being a mother c. Having a high school education d. Being unmarried

d. Being unmarried Additional research has demonstrated that being unemployed, disabled, or unmarried strongly predicts homelessness among women veterans. Having a high school education, being a mother, and having a previous criminal conviction are less predictive of homelessness than marital status.

19 of 23 Which of the following was the primary recommendation of the New Freedom Commission on Mental Health report for the mental health service delivery system? a. Advised the president to drastically increase funding for mental health b. Increased scholarships and grants to health care professionals willing to specialize in care of the mentally ill c. Suggested the federal government take over responsibility for mental health care for all citizens d. Called for a shift from a fragmented nonsystem to an integrated comprehensive approach to care delivery

d. Called for a shift from a fragmented nonsystem to an integrated comprehensive approach to care delivery The commission acknowledged that mental illness comprises the only type of illness that defies a comprehensive delivery approach. This is due to the way the state and local governments organize, manage, and carry out distinct treatment systems, making comprehensive care impossible in the larger health care system. Thus, the commission called for a shift in the fragmented system to an integrated comprehensive approach to mental health care delivery. The commission did not suggest a drastic increase in funding or scholarships or suggest that the federal government take over responsibility for mental health care for all citizens.

24 of 28 A nurse is using an upstream intervention when working with the homeless population. Which of the following public health interventions will the nurse most likely use? a. Case management b. Outreach c. Surveillance d. Community organizing

d. Community organizing Although nurses may use all interventions at all three levels, community/public health nurses working more upstream, at the system level, employ collaboration, coalition building, community organizing, advocacy, social marketing, and policy development and enforcement. In contrast, community/public health nurses—working downstream with individuals, families, or groups—use surveillance, disease and other health event investigation, outreach, screening, case finding referral and follow-up, case management, delegated functions, health teaching, counseling, and consultation.

16 of 24 A school had tried very hard to uphold the requirement for all children to be vaccinated. However, state law allowed parents to exempt their child if they had a religious reason for refusal. Two children have been diagnosed with chickenpox. Which of the following will be the most likely result? a. Adults as well as children in the neighborhood will get chickenpox. b. All the children who played with the two sick children will probably get chickenpox. c. All the unimmunized children will probably come down with chickenpox. d. Few children will get chickenpox because of herd immunity.

d. Few children will get chickenpox because of herd immunity. Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. Because most children in the school are immune, it will be difficult for the chickenpox to spread

23 of 28 Which of the following best describes a downstream intervention to solve the problem of homelessness? a. Improved use of community resources b. Increased employment opportunities c. Increased affordable housing d. Improved treatment of mental illness

d. Improved treatment of mental illness Building on McKinlay's "river" metaphor, McKinlay and Marceau (2000) purport that government and private efforts to address homeless health care problems largely focus on "pulling the bodies out of the river of homelessness." Such downstream interventions aimed at treating or alleviating health care problems, such as physical disease and mental illnesses, are worthy and needed. However, these interventions when used alone are far less adequate in alleviating homeless people's social health problems. To improve the social health of the homeless, it is necessary to go upstream and focus on the primary contributors to homelessness itself (i.e., lack of affordable housing, inadequate income, and insufficient services).

18 of 24 Which of the following statements best explains how infectious diseases are different from any other health problem? a. Infectious diseases are easier to treat by using pharmaceuticals. b. Infectious diseases are more prevalent now than in the past. c. Infectious diseases are acute illnesses that catch clients unprepared. d. Infectious diseases have the potential to spread, creating a community emergency

d. Infectious diseases have the potential to spread, creating a community emergency. Because of their potential to spread and cause communitywide or worldwide emergencies, infectious diseases require organized, public efforts for their prevention and control. Most human diseases (e.g., cancer or diabetes) can be classified as personal health problems. Individuals with a personal health problem can be treated by the health care system one person at a time. By contrast, infectious diseases are categorized as public or community health problems.

17 of 24 Which of the following was the result of the passage of the American Recovery and Reinvestment Act of 2009? a. A few employers accepted the extra funds and employed more people with disabilities (PWDs). b. Large numbers of employers accepted the extra funds and employed more PWDs. c. Employers still refused to employ PWDs. d. Little change has occurred.

d. Little change has occurred. Employers willing to hire PWDs may receive monies provided through the American Recovery and Reinvestment Act (2009). However, little improvement in employment levels has been seen.

4 of 28 Which of the following represents the largest group of homeless adults? a. Minorities b. Disabled c. Females d. Males

d. Males Among all sheltered homeless adults, approximately 63% were men; 37% were women. Men were overrepresented compared with the general population. The sheltered homeless population is younger than the general population. Most homeless adults were between 31 and 61years of age; 22.1% were less than 18 years of age; and 3% were older than 62. In the general population, 16% were over age of 62. Minorities comprised 60% of the total sheltered population. More sheltered homeless people had disabilities than did members of the general population: 38.1% versus 15%

15 of 34 A public health nurse is working in a rural clinic. On the basis of risk, which of the following would be the priority group for care? a. African American adults b. Adolescents c. Elderly women who live alone d. Migrant and seasonal farmworkers (MSFW)

d. Migrant and seasonal farmworkers (MSFW) In general, MSFW may have the poorest health of any aggregate in the United States, and the least access to affordable health care. Eighty-?9?ve percent of the MSFW are Hispanic, Latino, or African American.

14 of 34 Which of the following employment opportunities are among the most dangerous? a. Food processing, textiles, and transportation b. Highway construction, ranching, and public utilities c. Large mechanized factory positions d. Mining, forestry, and fishing

d. Mining, forestry, and fishing Industries with the highest death rates were mining, agriculture, forestry, and fishing, followed by construction, transportation, and public utilities.

14 of 24 During an outbreak in the hospital, all staff members were given immunoglobulin if they were not already immune to the disease. Which of the following types of immunity will the staff who received the immunoglobulin have? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

d. Passive immunity Passive immunity is the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, or antitoxins, or transplacentally from mother to neonate. Passive immunity lasts only as long as these substances remain in the bloodstream. Active immunity is when the body produces its own antibodies against an antigen, from either infection with the pathogen or introduction of the pathogen in a vaccine.

16 of 24 Which of the following problems was the Ticket to Work and Work Incentives Improvement Act (TWWIIA) designed to address? a. Employers trying to avoid hiring persons with disabilities b. Employers resenting being forced to hire persons with disabilities c. Persons with disabilities not being able to receive on-the-job training d. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports

d. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports Typically, people with disabilities could qualify for such benefits as health care, income assistance programs, and personal care attendant services only if they chose not to work. To address employment and benefit issues for persons with disabilities, in December 1999, the TWWIIA was signed into law. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work.

4 of 34 Which of the following factors would cause a geographic area to be called a frontier area? a. Arbitrary distinction recognizing the Great Plains, Intermountain areas, and Alaska b. Geographically located in the West, specifically the Great Plains states c. High death rate from use of guns (homicide or suicide) d. Population of fewer than six persons per square mile

d. Population of fewer than six persons per square mile Areas are classified as rural for populations with fewer than 45 persons per square mile and as frontier for geographic areas with fewer than six people per square mile. Many counties of the Great Plains, Intermountain West, and Alaska are designated frontier. Not all mountain areas are rural (the Appalachian mountain area is not), and geographic location alone does not make an area rural.

1 of 34 Which of the following best explains why the rural population is growing when young persons from rural areas consistently are moving to urban areas to seek employment? a. Adults engaged in all the physically demanding farming tasks have longer life spans than people in urban areas. b. Farm families continue to have a higher birth rate than urban families. c. Many formerly migrant worker Hispanics are settling in rural counties. d. Retirees and other urbanites able to conduct business through telecommunication and travel are moving in.

d. Retirees and other urbanites able to conduct business through telecommunication and travel are moving in. Recent demographic changes in rural areas have also included an influx of retirees and others from urban areas who are able to live in rural areas and conduct business through telecommunication and travel. The other responses do not support the current reason for the increase in the rural population.

24 of 34 Which of the following differences is found in parish nursing in a rural area as opposed to parish nursing in an urban area? a. Rural parish nurses are less likely to be involved in case management or care coordination than their urban counterparts. b. Rural residents are more grateful for the nurse's assistance because there are so few health resources in rural areas. c. Rural residents are typically less committed to traditional values or a strong religious faith. d. Rural residents may discuss health concerns with the nurse wherever they meet, whether in church or the local market.

d. Rural residents may discuss health concerns with the nurse wherever they meet, whether in church or the local market. In urban settings, contact with parishioners was primarily at the church, whereas contacts in rural settings were most often in the home, on the phone, or in other community-based settings.

25 of 34 A nurse saw there was a need for a hospice facility in a rural area, because so many of the residents were quite elderly and death was common. Which of the following best explains why the community would not immediately see the wisdom of the nurse's suggestion? a. Change is always difficult; the nurse just needs to keep reinforcing the need for such a facility. b. The nurse did not tell residents how much their taxes would need to go up to support such a facility. c. Residents were fearful of confronting death in such an open way. d. Rural residents prefer to use their informal social support networks when help is needed.

d. Rural residents prefer to use their informal social support networks when help is needed. Limited availability and accessibility of formal health care resources in rural areas combined with self-reliance and self-help traits of rural residents have resulted in the development of strong rural community informal care and social support networks. Rural residents are more apt to entrust care to established informal networks than to new formal care systems. It is unlikely that creation of such a facility would impact their taxes. The nurse needs to partner with the community to implement the change process while building upon the community's strengths, beliefs, and values systems.

9 of 28 Which of the following best describes how health care professionals are involved in the problem of homelessness? a. Homeless persons make everyone uncomfortable when they beg for handouts. b. Homeless persons often live in emergency departments and clinics. c. Poverty leads to crimes, and health care professionals can be attacked and robbed outside health care facilities. d. Serious illnesses or disability creates high medical bills, which may lead to homelessness.

d. Serious illnesses or disability creates high medical bills, which may lead to homelessness. In 2011, of households with an annual income less than $25,000, 25.4% had no health insurance. Lack of health insurance is a significant factor in creating homelessness. A serious illness or disability can lead to a downward spiral as a result of job loss, use of savings to pay for care, and inability to pay rent

20 of 28 Which of the following are the most frequent problems suffered by the chronically homeless? a. Chronic conditions such as hypertension, bronchitis, and emphysema b. HIV/AIDS and other sexually transmitted diseases, tuberculosis, and hepatitis C c. Respiratory infections, trauma, and skin disorders d. Severe mental illness and substance abuse disorders

d. Severe mental illness and substance abuse disorders Chronically homeless people may well have many physical conditions, but the primary problems that lead to their homelessness are severe mental illness and substance use disorders.

1 of 24 Which of the following infections continues to increase in the United States? a. Measles b. Pertussis c. Hepatitis A, B, and C d. Sexually transmitted diseases (STDs)

d. Sexually transmitted diseases (STDs) Treatable STDs, such as gonorrhea, chlamydia, and syphilis, are still occurring at significant rates. Gonorrhea had plateaued or declined until 2009 but increased steadily since that time. Reported infections with chlamydia reached an all-time high in 2011 (CDC, 2012c).

8 of 24 A young woman rolled her wheelchair up the ramp into the clinic to the desk where the intake nurse greeted her. Which of the following should be the nurse's first response? a. "How can I help you?" b. "Who came with you today?" c. Compliment her on her skill with the wheelchair d. Sit so the nurse is on eye level with the young woman

d. Sit so the nurse is on eye level with the young woman Nurses who demonstrate understanding of the issues confronting people with disabilities should approach them on an eye-to-eye level, listening to understand. Moving to eye level should be the first action that the nurse takes before beginning a conversation with the client.

6 of 24 When a person was brought into the clinic in a wheelchair, the new nurse asked the patient if he felt a need for a priest. Which of the following best explains why the nurse would ask about spiritual health during the intake assessment? a. All patients have spiritual as well as physical needs. b. Medical personnel have to collaborate with religious leaders. c. People reach out for spiritual care when they have suddenly become ill. d. Some people perceive disabilities as punishment for sin.

d. Some people perceive disabilities as punishment for sin. There are four models for viewing disability including: (1) the medical model, (2) the rehabilitation model, (3) the socially constructed disability model, and (4) the moral model, which connects disability with sin and shame. The nurse apparently perceived disability as a result of sin not yet repented

9 of 24 The daily patrons of a local town restaurant became ill with nausea, vomiting, and diarrhea. Without knowing the cause, which of the following actions should be taken immediately to help avoid future problems? a. Establish a series of cooking classes for all citizens b. Have a citywide campaign to cover your mouth when sneezing c. Use bleach to clean the entire restaurant d. Strongly emphasize the importance of proper hand washing to staff

d. Strongly emphasize the importance of proper hand washing to staff Agents leave the human host through a portal of exit and invade through a portal of entry. Portals of exit include respiratory secretions, vaginal secretions, semen, saliva, lesion exudates, blood, and feces. Portals of entry are associated with the portal of exit and include the respiratory passages, mucous membranes, skin and blood vessels, oral cavity, and the placenta. Because it was food poisoning of some sort, until the cause is known, it can be assumed to probably be a fecal-oral transmission. Thus, the interventions of cooking classes, covering your mouth when sneezing, and using bleach to clean the entire restaurant would be ineffective. Therefore, staff need to again be reminded of the importance of careful hand washing after using the facilities

23 of 24 A young woman is panic-stricken. She had not realized how much she was drinking, and she thinks she had unprotected sex with several men last night. She is petrified and wants an HIV test immediately. Which of the following actions should be taken by the nurse? a. Give her a strong lengthy lecture about the dangers of alcohol b. Administer the HIV test c. Provide a physical examination, testing for all sexually transmitted diseases (STDs) d. Suggest she be treated immediately to be safe

d. Suggest she be treated immediately to be safe The young woman should be aware that treating HIV exposure with HIV medications has been shown to decrease the incidence of seroconversion and HIV infection. Thus, she should be treated immediately to be safe. HIV infection is usually determined by the HIV antibody test, most commonly the enzyme-linked immunosorbent assay. False-negative findings may occur, especially before the body produces antibodies after exposure. So a negative reading on an HIV test now would not negate starting the HIV medications. Giving her a strong lecture about the dangers of alcohol will not change that she was possibly exposed to HIV. Although it would be appropriate to provide an examination and test for all STDs, it is still most important that she receive HIV medications.

5 of 28 Which of the following best describes the problem with the Section 8 housing program? a. Direct access to an apartment in a public housing facility is faster and easier. b. Most renters prefer the program to make direct payment to apartment owners willing to rent to them. c. Section 8 housing is essentially slum housing, and no one wants to live there. d. Supply is vastly less than the demand

d. Supply is vastly less than the demand. Although these programs are intended to alleviate housing problems for low-income renters, the demand for these assisted housing programs has far exceeded the supply. Section 8 housing does not provide direct access to an apartment in a public housing facility or provide payment directly from the program to apartment owners. Section 8 housing provides affordable housing through the U.S. Department of Housing and Urban Development, and is not slum housing.

23 of 34 Which of the following best describes a proposed strategy to address the lack of health care professionals in rural communities? a. Advertise that there are more men than women in many rural areas to attract female nurses who want to be wives and mothers b. Offer free housing and office space to a professional who will come to live in the community c. Pay extremely high salaries to professionals willing to relocate d. Support local students obtaining an education while continuing to live at home

d. Support local students obtaining an education while continuing to live at home A solution proposed for the shortage of health care providers is for rural communities to "grow their own." A rural community, a group of small communities, or a county could support local students attending college and recruit students currently attending professional schools. The students make a commitment to work in the community in return for monetary support for their educations.

15 of 23 A student said she wanted to discuss an issue with the nurse but that it was confidential. Therefore, she asks the nurse to promise as a professional to keep this a secret. She then shares that her roommate is very depressed; her older sister committed suicide, and she is planning on killing herself if she does not pass her final examinations. Which of the following actions should be taken by the nurse? a. As a professional who made a promise, the nurse teaches the student how to recognize if her roommate is getting ready to actually do it and the phone number of the suicide hot line. b. As secrecy was promised, the nurse can only encourage the student to encourage her roommate to seek help. c. The nurse should give the student brochures and information plus the suicide hotline phone number to share with her roommate. d. The nurse should stress that one cannot keep a secret when someone's life is at stake and immediately go to assess the roommate.

d. The nurse should stress that one cannot keep a secret when someone's life is at stake and immediately go to assess the roommate. Suicide is preventable. Most people want to live but sometimes cannot see any other alternative. Now that the nurse knows the roommate is talking about suicide, the nurse cannot agree to keep the secret but must intervene and seek immediate help.

9 of 24 Which of the following best describes the proportion of the U.S. population that is made up of persons with a long-lasting condition or disability? a. The number is about 5% and increasing. b. The number is about 10% and stable. c. The proportion is about 15% and stable. d. The proportion is almost 20% and increasing

d. The proportion is almost 20% and increasing. In 2010, approximately 56.7 million (18.7%) of the 303.9 million civilian noninstitutionalized population aged 5 years and older had a long-lasting condition or disability. Further, it is important for health care policy makers and health care providers to recognize that the prevalence of disability is increasing

2 of 24 Which of the following best describes what is happening with infectious diseases in the United States? a. There is a continuing decrease in vector-borne infections. b. There is a continuing increase in food-borne and waterborne infections. c. Many airborne diseases are being spread by bioterrorists. d. The rate of infection varies extensively by income and ethnic groups.

d. The rate of infection varies extensively by income and ethnic groups. Probably one of the most profound failures in infectious disease control in the United States and elsewhere is that the successes are not equally distributed in the general population. Infectious diseases continue to be differentially distributed by income and ethnic groups, and the poor and minorities continue to experience the greater burden. There continues to be an increase in vector-borne infections, but there has been a decrease in food-borne and waterborne infections. There is concern that deadly pathogens will be weaponized by terrorists.

3 of 28 On the basis of all the work done by social scientists, approximately how many homeless persons should be expected and tolerated in our society? a. No more than 5% b. No more than 10% c. No more than 15% d. There should not be homeless persons in America.

d. There should not be homeless persons in America. Kozol (1988) argued: "We would be wise to avoid the numbers game. Any search for the 'right number' carries the assumption that we may at last arrived at an acceptable number. There is no acceptable number. Whether the number is 1 million or 4 million, there are too many homeless people in America."

17 of 34 Which of the following is the most frequent cause of farm fatalities and nonfatal injuries? a. Manure pits (methane poison) b. Power take-off augers c. Storage silos d. Tractors e. Very old and barely functioning trucks

d. Tractors Agricultural machinery is the most common cause of fatalities and nonfatal injuries of U.S. agricultural workers, including on-farm fatalities among youth under 20 years of age (CDC, NIOSH Program, 2012). Tractor-related accidents, especially rollovers, are the most frequent causes of farm accidents and account for more than one fourth of farm fatalities.

11 of 24 Which of the following is the first step in preventing further spread of a particular sexually transmitted disease (STD)? a. Have a citywide free screening program in all high schools and colleges b. Provide public education about safe sex from abstinence to monogamous relationships c. Require all public facilities to sanitize all restrooms with a stronger, more effective agent d. Treat each infected person with the appropriate pharmaceutical agent

d. Treat each infected person with the appropriate pharmaceutical agent Antiinfective drugs, such as antibiotics, antivirals, antiretrovirals, and antimalarials, play important roles in controlling infectious diseases. Not only do they permit recovery of the infected person, but they also play a major role in preventing transmission of the pathogens to another. The first step in preventing transmission of tuberculosis and syphilis is to treat the infected person with antibiotics. Because the question asks about further spread, infection in a person has been diagnosed, so education is needed, but it is too late for that person. Adults not in school also are infected with STDs. A stronger, more effective sanitizing agent would not be the most effective strategy to prevent spread of STDs.

5 of 24 Which of the following statements is true concerning tuberculosis (TB) infections in the United States? a. Subclinical cases of TB can occur in patients who fight off the infection and thus are not a danger to themselves or others. b. TB can be cured by a 6-month period of treatment with INH. c. TB can only be caused by the Mycobacterium bovis bacillus. d. Under certain conditions, susceptible hosts may be infected by the TB bacillus.

d. Under certain conditions, susceptible hosts may be infected by the TB bacillus. The principle of multicausation emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Mycobacterium tuberculosis kills cells. M. tuberculosis has low infectivity, low pathogenicity, but high virulence if untreated.

3 of 34 From which of the following causes are rural residents twice as likely to die from in comparison with urban residents? a. Chronic diseases, especially cardiac problems and cancers b. Diabetes from the higher incidence of obesity c. Respiratory diseases (from pesticides and herbicides) d. Unintentional injuries

d. Unintentional injuries Residents of rural areas are nearly twice as likely to die of unintentional injuries, including motor vehicle accidents, when compared with their urban counterparts. The rates of chronic diseases, diabetes, and respiratory diseases are more similar to that of urban residents

13 of 24 A patient walks into a community clinic complaining of severe intestinal cramps and diarrhea. Which of the following actions can be taken to protect the staff at the clinic? a. Refuse to see anyone that sick as clinics have a different mission than secondary and tertiary care of the obviously ill b. Send the patient immediately to the closest hospital emergency department c. Treat the patient with broad-spectrum antibiotics and lots of fluids d. Use universal precautions with all patients regardless of the situation

d. Use universal precautions with all patients regardless of the situation In the late 1980s, the Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called universal precautions, to prevent transmission of diseases found in blood and other body fluids. These guidelines were developed because infected people may be asymptomatic and have no knowledge of their conditions; therefore, health care workers must assume that all patients are infectious and protect themselves. Refusing to treat the patient, sending the patient to an emergency department, or treating the patient with antibiotics and fluids would not be appropriate measures to protect the staff.

12 of 25 Some of the medical staff thought an abused woman deserved what she got when she told them she was not going to a safe house following discharge from the emergency department. Which of the following information should the nurse stress to the medical staff? a. When the woman leaves the emergency department, her abuser will most likely be arrested. b. The woman probably feels fearful and helpless and, until her life is clearly threatened, nothing will probably change. c. The woman needs additional reinforcement that she would be safer in a domestic violence shelter. d. When a woman attempts to leave the situation, it is often when the abuser kills her.

d. When a woman attempts to leave the situation, it is often when the abuser kills her. The most dangerous time for the victim is when the victim leaves or attempts to leave the relationship, because it is seen as an erosion of the abuser's control. The victim is more likely to be killed at this time than at any other time in the relationship. It is unlikely the abuser will be arrested, even following this incident of violence. Because the woman is fearful for her life and recognizes the dangers that occur with leaving, she most likely will not leave the relationship. Additional education about the domestic violence shelter will most likely not change her mind to leave the situation.

19 of 34 A woman stumbled into the rural health clinic and explained that she had an incredible headache. She was sweating and began vomiting into the wastebasket by the intake nurse's desk. Which of the following diagnoses should be anticipated by the nurse? a. Acute adult panic disorder b. Acute alcohol intoxication c. Acute appendicitis d. Acute meningitis e. Acute pesticide poisoning

e. Acute pesticide poisoning Signs and symptoms of acute pesticide poisoning are fairly clear, and most health providers in rural communities would recognize them. Common symptoms include headache, dizziness, diaphoresis, nausea, and vomiting. If left untreated, those affected may experience a progression of symptoms including dyspnea, bronchospasm, and muscle twitching. Deaths are relatively uncommon, but they do occur. The nurse is reminded that not all farm laborers are men. The symptoms that are being displayed are not typical of acute panic disorder, acute alcohol intoxication, acute appendicitis, or acute meningitis.

21 of 24 Parents have requested that their child be brought up to date on appropriate immunizations. After reviewing the child's medical history, the nurse prepares to give the two immunizations. What additional action should be taken by the nurse before administration of the immunization? a. Ask if there is any chance the girl child could be pregnant b. Ask the child if she consents to the immunizations c. Assess whether the child has a fever or other illness that would require the immunization be postponed d. Explain the pros and cons of obtaining immunizations to the parents e. Give the parents the Vaccine Information Statement (VIS)

e. Give the parents the Vaccine Information Statement (VIS) The Centers for Disease Control and Prevention produces VISs that explain the benefits and risks of vaccine to vaccine recipients, their parents, or their legal representatives. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given. Because the parents have previously had the child receive immunizations, they clearly have chosen to continue with immunizations so they do not need to hear the pros and cons of children being immunized. Children cannot give consent, only assent, to procedures. Because the child is a minor, the child's parents make the decisions.

16 of 23 A college student visits the student health center and tells the nurse that his roommate is talking about killing himself, has given some of his possessions away, and he believes the roommate has a gun. Which of the following actions should be taken by the nurse? a. Ask the student why he is telling this story; what does he expect the nurse to do? b. Call the police immediately, and have the student tell them the story. c. Call the roommate, and set up an appointment for him to come to the student health center to discuss how things are going in his life right now. d. Call the roommate, ask if he is thinking of killing himself, and, if so, how is he thinking of doing that? e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive.

e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive. Whenever an individual exhibits suicide warning signs, nurses should refer the person to a mental health clinic or provider as soon as possible. This may involve taking emergency action by calling the local emergency services number in the community and staying with the person until help arrives.