Topic 3 - Chapters 21, 22, 23, and 25

A resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? a.Advanced nurse practitioner b.Allergist c.Pediatrician d.Pulmonologist

ANS: A The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). Most urban adults are more likely to seek care from a medical specialist (allergist or pulmonologist). A pediatrician would provide care specific to children which may or may not be appropriate depending on the age of the resident.

A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? a. Cancer b.Memory loss c.Skin rashes d.Headaches

ANS: A Chronic exposure to pesticides and chemicals may lead to cancer. Memory loss, skin rashes, and headaches are all potential side effects of short term exposure to pesticides and chemicals.

Multiple Response: Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) a.About 25% of all US residents live in rural settings. b.People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c.Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d.A high prevalence of poverty exists among rural families.

ANS: A, D About 25% of all US residents live in rural settings. Rural residents are less likely to engage in preventive behavior and they tend to be poorer than their urban counterparts (more than 25% of rural Americans live in or near poverty, and nearly 40% of all rural children are impoverished). Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations.

Which of the following is the most likely reason for a man to rape a woman? a.Because the woman was asking for it b.For power and control c.Provoked by the woman's dress and behavior d.Sexual pleasure and release

ANS: B The underlying issues of rape are hostility, power, and control. Sexual desire is not an underlying issue of rape, nor is provocative dress and behavior. Rape occurs because of power and control, not because the woman is asking for it.

Which of the following is the leading cause of disability for Americans 15 to 44 years of age? a.Accidents b.Arthritis c.Major depression d.Workplace injuries

ANS: C Major depressive depression is the leading cause of disability for Americans between the ages of 15 and 44 years. Accidents, arthritis, and workplace injuries are not the leading causes of disability for Americans between the ages of 15 and 44 years.

Which of the following is the top risk factor for intimate partner homicide? a.There is a gun in the house. b.The husband has made threats against wife before. c.The wife has previously called 911 because of husband's beating her. d.The woman's young daughter also lives with them.

ANS: C The top risk factor for intimate partner homicide (IPH) is previous domestic violence. Other risk factors are access to guns, estrangement, threats to kill or threats with a weapon, nonfatal strangulation, and a stepchild in the home if the victim is a female; however, these are not the top risk factor.

Which of the following persons is most likely to be assaulted? a.A young man b.A young woman c.An older man d.An older woman

ANS: A Men are far more likely to be assaulted or killed than are women. The greatest risk factor for an individual's victimization by violence is age; youths are at significantly higher risk.

Which of the following groups is most at risk for suicide? a.Adolescents under age 20 b.Men over age 85 c.Females 25 to 45 years of age d.Women over age 65

ANS: B Men over age 85 are in the highest risk category for suicide. Adolescents under age 20, females 25 to 45 years of age, and women over age 65 are all not part of the highest risk category for suicide.

Multiple Response: 1. Which of the following factors may lead to increased violence? (Select all that apply.) a.Adequate social support b.Feelings of powerlessness c.Violence shown in the media d. Living in a crowded environment

ANS: B, C, D Factors that increase violence include seeing violence in daily life or in the media, living in poverty with few opportunities for employment, and feelings of powerlessness. Crowded environments can be a factor but can also lead to banding together for the common good. Adequate social support is a positive factor and may lead to decreased violence, not increased.

A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most likely displayed? a.He has threatened harm to his school peers. b.He is between the ages of 15 and 19. c.He is depressed and has a history of being sexually abused. d.He has been accused of abusing an animal.

ANS: C Leading risk factors for suicide are depression and other mental disorders or substance-abuse disorders. Other risk factors (that are not as common as the leading risk factors) include prior suicide attempt, family history of suicide, mental disorder, substance abuse or violence, firearms in the home, incarceration, and exposure to the suicidal behavior of others (family, peers, or figures in the media). Children who threaten to harm others or who abuse an animal are more likely to hurt others than themselves.

A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern? a.Elevated blood pressure b.First prenatal visit at 5 months' gestation c.Homelessness d.Positive STD test

ANS: C Pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus, being homeless is the most dangerous sign of those listed. Elevated blood pressure, positive STD test, and seeking prenatal care late in the pregnancy are all concerns for the nurse. However, most concerning would be homelessness, as homelessness presents many challenges for the women during and after the pregnancy.

A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of the following actions should be taken by the nurse? A.Apply for a grant to fund a mobile clinic to take health care to the clients. B.Distribute flyers to the homeless that detail the location of various types of health care services. C.Refer homeless clients to areas that provide temporary housing. D.Solicit donations for food and clothing to be distributed to the homeless.

ANS: A Accessibility refers to the ability of clients to obtain needed health care services. Only applying for a grant for a mobile clinic can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places. All of these options lead to opportunities for improvement in health, either directly or indirectly, but distributing flyers, referring homeless clients, and soliciting donations does not address the issue of accessibility.

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? a. Be willing to enter into a long-term relationship with families. b. Direct and control the client's care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d.Rotate assignments periodically to prevent attachment and codependency.

ANS: A Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? a.Absence of culturally competent care b.Availability of specialists c.Distance of health care facilities from the place of residence d.High cost of health care

ANS: A For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers. This is an additional barrier that is not faced by other rural residents. Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers, not just migrant workers.

Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder abuse? a."Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." b."Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us." c."She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake." d."We have to feed Mom baby food now because she has trouble chewing and swallowing regular food."

ANS: A Giving medication to induce confusion or drowsiness so that the elders will be less troublesome or will need less care is considered a form of elder abuse. Such medication may also make it easier for adult children to control the elder's assets. The incorrect responses are all examples of proper care.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate? a.Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b.Refer the man to a urologist to address the urinary bleeding. c.Suggest that the family take him to an urgent care center immediately. d.Treat the urinary infection and give the man medication to take to prevent the return of infection.

ANS: A It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups. If the family is referred to a different provider or agency, it is likely that this follow up will never occur. Only addressing the urinary infection, and not the homeless status of this family, does not provide the comprehensive services that are expected from a public health clinic.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent? a.Case management b.Client advocacy c. Holistic care d. Wrap-around services

ANS: A Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved. Client advocacy refers to actions taken on behalf of another. Because of the variety of actions being taken by the nurse, the nurse is functioning in a larger role than simply advocating for the client. Holistic care addresses providing care for phyicial as well as emotional and spirtiual needs. The nurse is not addressing all of these aspects of care through this coordination. Wrap-around services refers to when comprehensive health services are available and social and economic services are "wrapped around" these services. These services are not being necessarily all being provided by the same clinic.

A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. Which of the following actions by the nurse demonstrates the use of secondary prevention to limit caregiver stress? a.Asking caregivers how they are doing and suggesting coping strategies b.Encouraging caregivers to periodically leave the house for a couple of hours c.Establishing support groups for caregivers of older parents d.Referring some activities to neighbors and friends

ANS: A Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed. Also, encouraging caregivers to periodically leave the house for a couple of hours could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a. At the city's homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner-city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs

ANS: A The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population the homeless shelter would be an appropriate location. Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. Depending on the location of the community college, there may also be transportation issues.

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? a.Direct clients to English-as-second-language courses. b.Give immigrant clients money to help them get settled. c.Identify areas in the city where housing is less expensive. d.Solicit donations for food, clothing, and other needs

ANS: A Vulnerability can be reversed by obtaining resources to increase resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience.

A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider when providing care? a.All teen pregnancies are considered high-risk. b.Limited self-care knowledge can lead to pregnancy complications. c.Pregnant teens are likely to receive prenatal care late in the pregnancy. d.Pregnant teens may have limited financial resources to pay for care.

ANS: A It is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy. All of these statements are true; however, it is crucial to consider all pregnant teenagers as high-risk obstetric clients. Limited self care, lack of prenatal care, and limited financial resources are all contributors to the potential for all teen pregnancies to be considered high risk.

Multiple Response: A nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) a.It is very difficult to obtain continuing education, except for online programs. b.Neighbors seem to expect the nurse to know everything about all health care and illness conditions. c.Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d.People come to the health clinic before their situation becomes relatively serious.

ANS: A, B, C The boundaries between home and work blur because clients are also neighbors and friends of immediate family members. Nurses are highly regarded by the community and viewed as experts on health and illness. Residents may ask health-related questions and request recommendations whenever they see the nurse. Nurses in rural areas may also be expected to, in general, know something about everything, and this can be a demanding expectation. Some of the challenges are professional isolation, limited opportunities for continuing education, lack of other health personnel or professionals with whom the nurse can interact, heavy workloads, the need to function well in several clinical areas, lack of anonymity, and for some, a restricted social life. Rural people often develop independent and creative ways to cope because of the distance, isolation, and sparse resources they encounter. Because of the sparse resources, rural residents may seek limited preventive care and may only come to the health clinic if their situation is severe.

Multiple Response: 1. Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) a. "I always address the problem that the client believes is the most important." b."I avoid asking clients for income or financial information, because this is an invasion of privacy." c. "I try to observe the client's cultural traditions as I complete my assessment." d."I make sure to do a complete assessment, since we often don't know when the person will return to the clinic."

ANS: A, C The nurse should focus on what data are needed to help the client that day with the problem the client believes is most important. It is important to keep the client's cultural traditions in mind when completing an assessment so that the nurse is able to provide culturally competent care. Because poverty is a primary cause of vulnerability, the nurse should include questions about the client's financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used.

Multiple Response: A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) a."Community members will probably hold you in higher regard and will look up to you." b."Expect to have less autonomy in a small town than you have working as a nurse in a medical center." c."You may feel like an isolated outsider, because the community may not immediately accept you." d."You will have to be very sensitive about the differences in the rural lifestyle."

ANS: A, C, D Nurses working in rural areas usually have a prestigious status in the community and are viewed as role models. They will be experiencing a different lifestyle in the rural area and should be sensitive to these differences. Also, moving into a community does require the community to be accepting of the outsider which may or may not occur quickly. Nurses working in rural areas typically have more autonomy because of the larger geographic area that is being served.

A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following actions would the nurse most likely take? a.Assist teen mothers to learn about their body changes during pregnancy. b.Develop programs that allow teen mothers to complete their education. c.Offer courses in proper care of babies and how to be a parent. d.Monitor pregnant teens to detect early problems with pregnancy.

ANS: B A direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their non-poor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth. Teaching about body changes an proper care of babies and parenting would address short-term health outcomes. Monitoring teens to detect early problems in pregnancy addresses a short-term health outcomes as well.

According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a. $16,020 b. $24,300 c. $32,580 d. $40,890

ANS: B According to the Federal Register in January 2016, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $24,300. According to the Federal Register in January 2016, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $16,020 for a family of two, $32,580 for a family of 6, and $40,890 for a family of 8.

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child? a.Concern that the child is being mistreated by other children b.Concern that the child has developmental delays c.Concern that the child is given adequate food during lunch d.Concern that the child may need to sit in the front in order to be able to see well

ANS: B Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Homeless children may have delayed communication, more mental health problems, and histories of abuse. Because the student is attending school, the student should be eligible for free lunches and should be provided adequate food. There is nothing that suggests that this child is unable to see and poverty is not indicative of vision problems. It is possible that this child is being mistreated, and this may be something to speak with the teacher about; however, developmental delays would be of greater concern to the nurse than mistreatment.

Which of the following conditions of the rural environment provides increased opportunities for teaching? a.Increased interaction among residents due to neighbors visiting neighbors on the family farms b.Involvement in rural community activities provides more contact with community residents than in urban areas c.Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention d.Increased illnesses and injuries of rural residents require that they see nurses more often

ANS: B Rural areas have fewer churches, stores, and schools. Thus, nurses may go to the same church, shop at the same stores, and/or have children in the same schools as their clients. There are also fewer organizations, so it is easier to become involved and meet everyone while participating. Visiting neighbors does not increase opportunities for teaching. The fact that nursing responsibilities include all levels of prevention is true of both urban and rural areas. The statement about increased illness and injuries in rural residents is wrong, because although illnesses and injuries are increased, rural residents often do not seek care for these conditions.

A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? a. Evil eye b.Fallen fontanel c.Fright d.Indigestion

ANS: A A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye. Caida de mollera is known as fallen fontanel, empacho is known as indigestion, and susto is known as fright.

A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? a. Emergency department for immediate care b. Migrant Health Act clinics c. OSHA, because the man was injured by farm machinery d. Workers' Compensation, because injury was at work

ANS: A The only source the nurse can count on using is sending injured workers to emergency departments for immediate care. Farming and ranching do not often fall under OSHA guidelines, because they are considered small enterprises. Therefore, safety standards are not enforceable, nor is Workers' Compensation insurance usually available for the agricultural industry. Although there are migrant health clinics, they are not always geographically convenient.

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Secondary and tertiary prevention

ANS: B Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease. Primary prevention refers to actions taken to prevent the disease from occurring. Tertiary prevention refers to actions taken after the disease has already occurred. A screening test can not be both secondary and tertiary prevention.

Which of the following populations experiences the highest incidence of poverty? a.Those between the ages of 18 and 64 b.Those under the age of 18 c.Those over the age of 65 d.Those between the ages of 18 and 25

ANS: B In 2014, the poverty rate for children under 18 was 21.2%, which was higher than all other age groups. In 2014, the poverty rate for people between the ages 18 and 63 was 13.5 percent, and for people over 65 years, the rate was 10 percent. The textbook does not list a specific percent for those between the ages of 18 and 25.

Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation

ANS: B People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability. Breakdown of family structures, prejudice, and social isolation may all influence vulnerability to health problems, but have not been identified as a primary cause.

Multiple Response: A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) a.Cholera b.Hepatitis c.High blood level of lead d.Malaria

ANS: B, C Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis, as well as exposure to high levels of lead. Cholera and malaria are not illnesses associated with the migrant farmer population.

A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a.The child is accident-prone and clumsy. b.The child is being bullied and pushed around by other children. c.The child is more likely to have school absences. d.The child is in need of a vision screening.

ANS: C Poverty also increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. These children may also be hungry and fatigued and experience dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children may have delayed communication, more mental health problems, and histories of abuse. The priority of the nurse should be to address the potential absenteeism. Being clumsy is not related to living in poverty. Receiving screenings, such as a vision screening, is many times not a priority for those living in poverty. However, this would not be the key concern of the nurse. It is possible that this child could be bullied; however, there are also children who do not live in poverty who experience bullying as well.

Which of the following factors predisposes many migrant farmworkers to disenfranchisement? a. Being a minority group member b.Inability to attend religious services because of work requirements c.Previous experiences of physical abuse d.Short length of time in the community

ANS: D Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds. An inability to attend religious services or previous physical abuse are not specifically related to disenfranchisement of the population of migrant farmworkers.

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a.A bill that establishes policies requiring all persons to pay the same cost for services regardless of income b.A bill that promotes universal health insurance coverage c.A bill that requires all health care providers to give care to uninsured persons without charge d.A bill that requires health care workers to report undocumented immigrants who present for treatment

ANS: B Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care. Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. A bill requiring all persons to pay the same cost for services regardless of income is not feasible. Multiple factors, including the benefits provided by individual health insurance, influence the amount of money individuals pay to receive health care services. A bill for universal health insurance could potentially influence this inequality. Health care providers are obligated to provide care to individuals in an emergency regardless of citizenship in the United States; thus, this bill would not be feasible given current standards. These options would also not support the philosophy of social justice.

A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, which of the following comments by a parent would cause concern? a."I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." b."My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c."My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d."I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

ANS: B Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy. Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care.

Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child? a. "I have stopped using a switch on my child, and I am learning to count to 10 before reacting." b."I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." c."I use time-outs when my child acts out or is naughty. Sometimes my child doesn't cope well with this, but I am persistent." d."When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are."

ANS: B Emotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. Yelling at a child and threatening loss of love are devastating. Counting to 10 before reacting, using time-outs, and distraction all display positive methods of discipline.

Which of the following is the most rapidly growing group of homeless? a.Adolescents b.Families with children c.Persons in crisis d.Single men

ANS: B Families with children are the fastest-growing segment of the homeless population with the highest rates being found in rural areas. Adolescents, persons and crisis, and single men are not the fastest-growing segments of the homeless population.

The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the following would be the best action to take to improve client outcomes? a.Provide antibiotics to all homeless persons with chronic, nonhealing wounds b.Offer daily access to a room with soap, water, and bandages c.Hand out free bandaging supplies following each clinic visit d.Perform regular monitoring of the client's wound condition

ANS: B Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits. If the wound is not kept clean, it is unlikely that antibiotics will be able to prevent an infection, and the antibiotics will not promote wound healing. Handing out bandaging supplies does not address being able to wash the wound on a regular basis. Monitoring of the wound will not assist in wound healing.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Readminister the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest X-rays.

ANS: B Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results. Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working.

Which of the following best describes a principle of care that the nurse should abide by when working with abusive families? A.Confront the abuser and shame him into penitence and a desire to change. B.Demonstrate respect for all family members, including the abuser. C.Exclude the abuser from family meetings because the abuser is the one creating problems. D.Notify the abuser's clergyman, boss, and others who can exert pressure for change.

ANS: B Principles of giving care to families who are experiencing violence include the following: intolerance for violence; respect and caring for all family members; safety as the first priority; absolute honesty; and empowerment. Confrontation and exclusion would not be therapeutic techniques for the nurse to implement. Notification of others would violate HIPAA laws, as the nurse should be keeping this information confidential.

A nurse was shocked when late one night she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. Which of the following is the most likely explanation for a healthy young adult engaging in such behavior? a.He ate his meal but wanted more and had no more money. b.He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c.A friend had thrown his meal away, and he thought he could find his friend's untouched food. d.He was doing this to fulfill an obligation of fraternity initiation at the college.

ANS: B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills. Thus, it is most likely that he was unable to meet his basic needs through his current employer. If he had already eaten his meal, it would be unusual to get additional food out of garbage, rather he should be able to afford to purchase additional food if he was able to purchase his meal. The young adult would most likely not be pulling out half-eaten food if he was looking specifically for a friend's meal. There is no reason to assume that he was part of a fraternity.

A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? a. Avoiding touching the client except when necessary as part of the physical examination b.Calling the client by name, socializing before addressing the problem, and being very respectful c.Keeping all interactions direct, to the point, and targeted on the reason for presentation d.Maintaining a non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

ANS: B The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual's dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior. When interacting with Mexican immigrants, as well as some other cultures, establishing general rapport through conversation is expected rather than a direct, focused approach. It would be appropriate for a nurse to develop a therapeutic relationship with the client, not a non-confrontational one.

The nurse is making a postpartum visit to a teenage mother and her month-old infant. Which of the following assessments would be most important? a.Assessing for mother's ability to fulfill her own growth and development tasks b.Assessing for mother's knowledge about normal infant growth and development c.Assessing how much the teenage mother's own mother is helping her cope with child care d.Assessing whether the baby's father is being helpful to the mother

ANS: B The primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse. Although the nurse might assess for any and all of these options, however, the primary goal of a postpartum visit would be to assess knowledge regarding normal growth and development. A teenager mother's knowledge about her own growth and development and how much assistance she is receiving from her own mother and the baby's father would be secondary concerns.

The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which of the following should be the first action that is taken by the nurse? A.Arrange for the couple to attend marital counseling. B.Develop a plan for the wife's escape if the violence starts again. C.Teach the client how to avoid initiating her husband's anger. D.Work with the client on development of self-esteem.

ANS: B Unfortunately, abuse tends to escalate in frequency and severity over time, and the man's remorse tends to lessen. A nurse encountering severe abuse needs to consider the safety of the woman and her children as the priority. The woman will need an order of protection and help in getting to a safe place. At the very least, the woman must design a carefully thought-out plan for escape and arrange for someone to call the police if another violent episode occurs. Although marital counseling may be useful at an early stage of abuse, it is generally contraindicated at all other stages because of the risk to the woman's safety. After first developing an escape plan, it may be beneficial for the nurse to speak with the woman more about potential triggers for the husband's abuse as well as her own self-esteem and how that may be influencing the continuation of the relationship.

During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client indicates a lack of insight into his violent behavior? a."I have been taking out my frustrations with work on my girlfriend." b."I love my girlfriend and didn't want to hurt her; it was an accident." c."It might be a good idea for me to temporarily leave the house when I feel myself becoming angry." d."When I drink alcohol, I become more abusive toward my girlfriend."

ANS: B Violence is defined as those nonaccidental acts that result in physical or psychological injury. Although this client may now be feeling remorse, at the time the violent act was committed against the girlfriend, the intent was to inflict harm and maintain control. It was not an accident. The incorrect statements indicate an admission of a problem—at least on the surface.

Multiple Response: A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.) a.Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. b.Cuddle and hold the baby while smiling and gazing into the baby's eyes. c.Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face. d.Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes.

ANS: B, D Suggestions for promoting interaction between an adult and a baby include smiling and making eye contact. Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). The mother should be taught to use a distance of 8 to 10 inches from the infant and should not blow on the infant's face. The mother should soothe the baby and try to provide comfort before trying to let the infant "cry it out."

Which of the following is the most accurate description of a migrant farmworker? a. A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends b.A person who immigrates to the United States to "follow the crops" in performing seasonal farm work c. A person who moves from place to place to earn money performing seasonal agricultural work d.A person who specializes in the development of rural land for the purpose of farming

ANS: C The Office of Migrant Health of the U.S. Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode." The emphasis in the definition of migrant farmworkers is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

Which of the following best describes a health professional shortage area (HPSA)? a.An area with inadequate health care facilities for residents b.An isolated area of underserved populations within an urban region c.A region with insufficient numbers of health care providers d.A rural region of the United States with a population density of less than 10,000

ANS: C An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties. The incorrect responses do not fit the definition of a HPSA.

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education? a. "If a client who does not speak English comes in, you must obtain an interpreter right away." b. "We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns." c. "You will like working with Hispanic immigrants because they have close-knit family structures." d. "You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

ANS: C Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence. It is important for the staff member to obtain an interpreter after learning that a client does not speak English, so this statement does not indicate the need for additional education. Addressing multiple concerns within one visit is also appropriate, and does not indicate the need for additional staff education. Also, it is important for the staff member to recognize the importance of working around work schedules; thus, this action is appropriate and does not indicate the need for additional staff education.

A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? a.Appendicitis b.Bacterial gastroenteritis c.Pesticide poisoning d.Viral illness

ANS: C Because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild psychological and behavioral deficits such as memory loss, difficulty with concentration, and mood changes, abdominal pain, nausea, vomiting, diarrhea, headache, malaise, skin rashes, and eye irritation. The work setting of a migrant farmer would lead the nurse to first consider pesticide poisoning as a potential underlying cause of these symptoms. However, some of these symptoms could potentially be present with appendicitis, bacterial gastroenteritis, or a viral illness.

A migrant farmworker brings his daughter to the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a.It was a rare occurrence, which probably won't be repeated. b.The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. c.Children may work on small farms because the family may need the additional income. d.The parents were busy working and didn't realize the child was outside so long.

ANS: C Children 12 to 13 years of age can work on a farm with the parents' consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family's economic survival. This child may be at risk for this occurring again because the family needs the income that is generated by the child's employment. The child is most likely working and not going outside to play. In order for this child to work, the parents also were working on the same farm with them, but again need this child's income for survival.

A community mental health nurse is working within the community to help prevent youth violence. Which of the following interventions would most likely be implemented by the nurse? a.Distributing literature that associates violence with a lack of intelligence b.Explaining to youth why youth violence is detrimental to society c.Partnering with associations to provide alternative activities that improve social skills d.Recommending increased funding to prosecute and jail teens associated with violent activity

ANS: C Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act. Distributing literature is an ineffective intervention as community members would need to read the literature that has been provided. Based on the growth and development of youth, they are unlikely to be able to truly understand the larger scope of youth violence. Recommending increased funding for prosecution and jail does not provide any measure to prevent the problem from occurring.

A nurse is trying to decrease the risk for depression among older adults. Which of the following interventions should the nurse implement? a.Encourage moving to a nursing home where others of the same age reside. b.Monitor for signs and symptoms of depression. c.Organize an exercise and health promotion program at the local senior citizen center. d.Teach older clients to focus on their strengths rather than their weaknesses.

ANS: C Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Depression rates for older adults in nursing homes range from 15% to 25%; thus, encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

Which of the following statements best explains the primary reason why violence is so high among young African-American men? A.Men tend to be more violent than women. B.They are young and thus lack maturity. c. Unemployment is higher in this population. d. Violent tendencies are transferred genetically along racial lines.

ANS: C Most analyses conclude that the differential rates of violence between African Americans and whites in the United States have more to do with economic realities, such as poverty, unemployment, and overcrowding, than with race. Although violence among men may be higher than among women, this question specifically addresses "young African-American men." Economic realities are more indicative of this rate of violence than age and maturity. Violence is a learned behavior, it is not transferred genetically along racial lines.

A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities. Which of the following parents in attendance would be most at risk for abusing his or her own child? a.A new mother who has joined a parents' support group b.A father who is overwhelmed and exhausted by overtime work c.A depressed father who was laid off from work and is missing his work colleagues d.A mother who is missing her career challenges and friends but enjoying being home with her baby

ANS: C Parents with low social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their own children. Abusive parents often have unrealistic expectations of a child's developmental abilities. A new mother who has joined a parents' support group is displaying positive coping behaviors. Although a mother is missing her career challenges, she is finding enjoyment in being home with her child which displays that she has a positive emotional health. A father who is overwhelmed and exhausted is at risk for abusing his children; however, he is not displaying as many risk factors and stressors as the father who is depressed, laid off from work, and missing his colleagues.

Which of the following is a common factor typically found in those who abuse others? a.Fear and belief that others are "out to get them" b.Poor self-esteem and unawareness of alternatives c.Previous observations of violent behaviors to manage conflict d.Difficulty keeping commitments

ANS: C People who become involved in violence typically had previous exposure to some form of violence. Abusers were often beaten when they were children, or they witnessed siblings or one of their parents being beaten. They learned that violence is a way to manage conflict. The incorrect responses are not commonly found among those who typically abuse others.

A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect? a.Bruises in various stages of healing b.Failure of parent to attend parent-teacher conferences or return teacher phone calls c.Lack of weight gain and wearing dirty clothes d.Lice in the hair

ANS: C Physical neglect refers to failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect refers to the omission of basic nurturing, acceptance, and caring essential for health development. Lice are a common problem among school children, and the presence of lice does not indicate neglect. Failure to attend parent-teacher conferences should not be construed as neglect, because various reasons, such as employment requirements, may prevent parents who care from attending. Bruising is a sign of physical abuse rather than neglect.

A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking? A.Encouraging others to interfere when they see children hit or hurt in a public place B.Referring caregivers to community respite centers if abuse is beginning to occur C.Lobbying for passage of legislation to outlaw physical punishment in schools D.Screening each pregnant woman privately for intimate partner abuse

ANS: C Primary prevention involves action before damage has occurred. The other options are all screening for abuse or reactions to abuse that has already taken place. Encouraging others to interfere when they see children hit or hurt in a public place and referring caregivers to community respite if abuse is beginning to occur are examples of tertiary prevention because the abuse is already occurring. Screening pregnant women for intimate partner abuse is secondary prevention as it is a screening aimed at early detection of the problem.

A nurse is working to improve her self-awareness in order to provide better client-centered care to clients living in poverty. Which of the following questions should the nurse ask herself? a.What would I do if I lived in poverty? b.What can be done to get poor people motivated to work? c.How have the media images of poor persons shaped my image of poverty? d.How can community resources assist those living in poverty?

ANS: C Self-awareness is a key component of providing authentic, genuine client-centered care. To clarify their own values and perspectives about poverty, nurses should ask themselves questions about poverty and persons living in poverty. These questions should cause the nurse to reflect on how his or her ideas of poverty have been developed. The only question that relates to the nurse reflecting on how personal values and perspectives have been developed is, "How have the media images of poor persons shaped my image of poverty?" The incorrect responses address how to address the issue of poverty or concerns of the nurse but do not address increasing the nurse's self-awareness.

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? a.Administration of skin tests to identify persons who have been infected with tubercle bacilli b.Assessing for signs and symptoms of active tuberculosis c.Directly observing clients with active tuberculosis as they take their antitubercular medications d.Interpretation of tuberculosis skin test findings

ANS: C Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB. Administration of skin tests, assessing for signs and symptoms, and interpreting tuberculosis skin test findings are all examples of secondary prevention as these interventions are all focused on screening or the follow up on a screening test.

Multiple Response: A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describe why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a.Her friends were suggesting ways to make the problem go away. b.She knew she could not be pregnant because her boyfriend said he used a condom. c.She was afraid her parents would pressure her to terminate the pregnancy. d.She kept hoping the pregnancy would just go away.

ANS: C, D Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, because they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Having friends suggest that the pregnancy will just go away is not a common reason why pregnant teens do not seek prenatal care; it is more likely that the teen herself is thinking that the pregnancy will just go away. Being told that a condom was used doesn't make it so. The girl should know whether a condom was used or not without relying on verbal statements.

Which of the following statements best describes why health care of the homeless is so expensive to the community? a.Health conditions of the homeless require increased preventive services. b.Homeless clients typically make more clinic visits for multiple health problems. c.Homeless people spread contagious diseases to those they pass on the street. d.Most care to homeless people takes place in hospital emergency departments.

ANS: D Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore, health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics. It is likely that most homeless people do not seek preventive care, thus, it is not that they require increased services, but they are less likely to seek these preventive services. Homeless clients are likely to not be seen in the clinic setting. Homeless people may spread contagious diseases, but this does not explain why providing health care to this population is expensive.

A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while being raped? a.Confusion b.Satisfaction c.Sexual release d.Helplessness

ANS: D During the act of rape, survivors are often hit, kicked, stabbed, and severely beaten. It is this violence, as well as the violation of the sense of self, that most traumatizes the person because of the fear for her life and her feelings of helplessness, lack of control, and vulnerability. Because of the violence associated with rape, it is highly unlikely that the victim will report satisfaction or sexual release. The woman may be confused about what to do next, but it is more likely that the trauma will cause feelings of helplessness which could contribute to the confusion.

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. d. Strongly consider not applying, because this population will be expensive to treat.

ANS: D Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care). Because of the major costs associated with providing care to this population and risks related to reimbursement, it would not be in the best interest of the agency to want to eagerly apply to provide care to this group.

A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mother asks, "Do you think my son is crazy?" Which of the following is the most appropriate response by the nurse? a."Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b."Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c."Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." d."Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

ANS: D Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. In order to respond therapeutically to the mother, the nurse should not use the words absolutely (which implies that there may not be a problem with the son at all) or crazy (which is not a positive word to describe the son's behavior).

An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a.Their personal belongings may be stolen while they are at the clinic. b.Immigration officials will send them back to their home country. c.The clinic personnel will look down on them and be biased against them. d.They weren't getting paid for that day, and continued employment is never certain.

ANS: D Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain. Most migrant farmworkers are legal residents or U.S. citizens, not illegal immigrants. If the clinic personnel provide culturally competent care, they should not be biased or look down on this family when providing care. They should not be at any greater risk to have their belongings be stolen than on any other day when they leave their home.

A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? A.Abide by the mother's wishes because this information was provided in confidence. B.Arrange for counseling for the boyfriend at the earliest possible availability. C.Encourage the mother to take the child and find alternate housing right away. D.Report the incident to child protective services or other appropriate legal authority.

ANS: D Nurses are mandatory reporters of child abuse, even when only suspected, in all states. The incorrect options put the child's welfare at risk, including encouraging the mother to seek alternatives, since encouraging an action will not ensure that it will happen.

A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse? A.The daughter's inability to do well in school B.Intimacy problems with the daughter's boyfriend C.The mother's abuse of the daughter over a long period of time D.Sexual abuse by the father

ANS: D Nurses must be aware of the incidence, signs and symptoms, and psychological and physical trauma of incest. Symptoms include headaches, as well as other physiological problems. Children often try to avoid or escape the abusive behavior. Intimacy problems with her boyfriend, abuse by the mother, and the daughter's inability to do well in school could all be potential reasons why the daughter ran away. However, the nurses primary concern should be the potential for sexual abuse because of the behaviors that are being displayed by the daughter.

Which of the following statements is the best explanation as to why some countries are more violent than others? a.Civilized societies are less violent than primitive societies. b.Geographical differences are the primary factor. c.Population differences are the main determinant—for example, having more males than females. d.Violence is a learned behavior controlled or allowed by social norms.

ANS: D Some societies are basically nonviolent, and for them violence is not a significant health problem. Violence is a learned behavior, and social norms can keep violence at low levels or even eliminate it. The learned culture of the society is the best indicator for violence, not the differentiation between civilized or primitive, geographic location, or population differences among males and females.

A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? a.Observe farmworkers for evidence of unsafe handling of pesticides. b.Provide teaching on how to handle pesticides to avoid or decrease exposure. c.Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. d.Treat a client who has pesticide exposure to prevent complications.

ANS: D Tertiary prevention involves actions taken when a person already has a condition so that complications and worsening of the condition are avoided. Thus, treating a client with exposure is tertiary prevention. Observing farmers for evidence of unsafe handling of pesticides is an example of secondary prevention as the nurse is assessing to detect a problem at the earliest stage possible. Primary prevention occurs when the nurse aims to prevent the problem form occurring which is accomplished when the nurse teaches about safe handling of pesticides and recognition of signs and symptoms of pesticide poisoning.

Which of the following statements best describes an outcome of the Balanced Budget Act of 1997? a.Additional funding was provided to the State Children's Health Insurance Program (SCHIP). b.Individuals were able to keep their health insurance when moving from one place to another. c.Patient privacy and security of health information was enhanced. d.A prospective payment system for home health services was created.

ANS: D The Balanced Budget Act of 1997 had some shifts in payment with the stipulations related to home health. In an attempt to curb the rapid growth in spending on home health and financial fraud in that industry, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective payment for home health services. The Health Insurance Portability and Accountability Act of 1996 was intended to help people keep their health insurance when moving from one place to another as well as provide privacy and security of personal health information. The State Children's Health Insurance Program (SCHIP) was created by Title XXI of the Social Security Act in 1998

A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would most likely have a positive effect? a. Being assertive and taking control of decisions because family members cannot be expected to have this ability b.Focusing attention on family weaknesses that need to be fixed before healing can begin c.Pointing out things that victims should do differently to avoid antagonizing the abuser d.Soliciting ideas from the family regarding what they feel will improve their situation

ANS: D To empower the family, the nurse needs to recognize and capitalize on the violent family's strengths and to guide the family in recognizing and dealing with its problems. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach. Families often can generate many of their own solutions—in fact, the family's own solutions tend to be more culturally suitable and individualized than those the nurse generates.

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a.Disadvantaged families b.Multiproblem families c.Resilient populations d.Vulnerable populations

ANS: D Vulnerable populations are groups(aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations and do not appropriately fit the definition of "aggregates". Resilience refers to the ability to resist poor health outcomes, not to succumb to them.