12, 13, 18, 21, 22, 23, 24, 25

Which industry has the highest number of fatal injuries? A) Agriculture B) Construction C) Mining D) Transportation

D) Transportation Ans: D Feedback: The number of fatal injuries related to transportation is the highest.

A client has been prescribed opioid analgesics. The client asks the nurse how long before the sedation will subside. The nurse should tell the client what time frame? A) 24 to 48 hours B) 48 to72 hours C) 72 to 96 hour D) 1 week

A) 24 to 48 hours Ans: A Feedback: Many clients experience sedation when opioid analgesics are initiated; however, this effect should subside within 24 to 48 hours. If this condition continues after 24 to 48 hours, and clinicians have checked and managed other correctable causes, the client may require a psychostimulant.

According to the U.S. Bureau of Labor Statistics, how many workers in all industries, including state and local governments, had a reportable injury or illness in 2011? A) 3.8 of 100 B) 4.2 of 100 C) 5.8 of 100 D) 6.2 of 100

A) 3.8 of 100 Ans: A Feedback: The U.S. Bureau of Labor Statistics indicates that 3.8 of 100 workers in all industries, including state and local governments, had a reportable injury or illness in 2011.

The nurse works with a variety of clients at a general hospital in a rural area. For which clients would it be most appropriate to administer palliative care? (Select all that apply.) A) 92-year-old man who has just suffered a stroke B) 83-year-old woman with end-stage dementia C) 12-year-old girl with terminal lymphoma D) 74-year-old man with osteoarthritis E) 54-year-old woman with high blood pressure

A) 92-year-old man who has just suffered a stroke B) 83-year-old woman with end-stage dementia C) 12-year-old girl with terminal lymphoma Ans: A, B, C Feedback: Palliative care is interdisciplinary team-based care that is focused on the relief of suffering for clients with serious illness. It attempts to achieve the best possible quality of life, not only for clients, but also for their families. Although clients may be any age, even children, palliative care is especially appropriate when provided to older people who have one of the following: (1) an acute, serious, life-threatening illness (e.g., stroke, trauma, major myocardial infarction, and cancer) in which cure or reversibility may or may not be a realistic goal but the burden of treatment is high; or (2) a progressive chronic illness (e.g., end-stage dementia, congestive heart failure, renal or liver failure, and frailty). Osteoarthritis and high blood pressure are not serious illnesses and would not require palliative care.

The occupational health nurse works in facility located in a region that is highly prone to tornadoes. Which intervention should the nurse make sure is included in the facility's emergency plan to address this potential threat? A) A shelter-in-place policy and procedure B) Personal protective equipment C) Evacuation drills D) Decontamination procedures

A) A shelter-in-place policy and procedure Ans: A Feedback: A shelter-in-place policy and procedure must be established for emergencies such as hurricanes, tornadoes, high winds, or chemical releases in buildings such as healthcare and correctional facilities. Personal protective equipment and decontamination procedures are needed for those who work with and around hazardous materials and chemicals but would not be needed for a tornado. During a tornado, workers should shelter in place, not evacuate the building.

13. The nurse cares for a client who has a laceration on her arm and reports moderate aching, throbbing pain from the injury. Which medication should the nurse expect to be ordered first for this client? A) Acetaminophen B) Ibuprofen C) Opioids D) Anticonvulsants

A) Acetaminophen Ans: A Feedback: Nociceptive pain usually resolves when the injury heals, and initial treatment involves nonopioid pain relievers. Acetaminophen is usually the first choice, followed by nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; then physicians choose opioids. Difficult to relieve with routine pain medications, neuropathic pain may be deep and severe. At times, anticonvulsants, antidepressants, and opioids are used for pain relief.

Principles of epidemiology can be used as a method to determine patterns of illness for the faith community, and risk factor assessment helps the nurse decide what programs to provide. Which demographic data about the faith community should the nurse gather for the purpose of assessment? (Select all that apply.) A) Age B) Sex C) Family structure D) Proximity of residence to church E) Proximity of residence to healthcare facilities

A) Age C) Family structure E) Proximity of residence to healthcare facilities Ans: A, C, E Feedback: The nurse should gather general demographic data about the faith community, including age, family structure, and proximity of residence to a healthcare facility and other health resources. These data can be summarized with descriptive statistics that can be used to generate reports and to assist planning. The sex of faith community members and the proximity of their residences to the church are not relevant for the purpose of community assessment.

The occupational health nurse is a member of the emergency planning committee in the workplace. The nurse is helping to formulate an emergency plan for the facility. Which key components should the nurse include in the emergency plan? (Select all that apply.) A) Alarms B) Phones C) Reporting D) Communication E) Evacuation

A) Alarms C) Reporting D) Communication E) Evacuation Ans: A, C, D, E Feedback: Key components of the emergency plan involve alarms, reporting, communication, evacuation, a system for counting the occupants, procedures for staff who do not immediately evacuate, and rescue and medical services. Phones would not be a component of the plan.

A parish nurse helps an older woman in the congregation who is taking multiple medications develop a system whereby the woman can more easily remember to take the right medications at the right time. Which is the primary ethical principle observed by the nurse in this situation? A) Autonomy B) Confidentiality C) Beneficence D) Nonmaleficence

A) Autonomy Ans: A Feedback: The parish nurse works to empower members of the congregation to take charge of their health, such as by helping an older woman develop a system to help her remember to take the right medications at the right time. This can enhance their autonomy. One area in which parish nurses can commit an ethical breach comes up often in the family context of a congregation; this area is the need to protect confidentiality. The faith community nurse is also to be guided by beneficence, the act of doing good. This is an even more stringent requirement than nonmaleficence, the need to do no harm.

The nurse cares for many clients who have serious illnesses. The best candidate for hospice care is the client with A) Brain cancer who is expected to live 3 months and who is not pursuing aggressive treatment B) Congestive heart failure who is expected to live 9 months and who is not pursuing aggressive treatment C) Lung cancer who is expected to live 1 month and who is pursuing radiation therapy D) Stroke who is expected to live only a few more hours unless emergency brain surgery can remove a clot

A) Brain cancer who is expected to live 3 months and who is not pursuing aggressive treatment Ans: A Feedback: In the early 1980s, Congress added a hospice benefit to the Medicare program that was designed to support dying clients with an expected prognosis of less than 6 months to live if the disease ran its usual course. When two physicians determine that a seriously ill client has 6 months or less to live, and the dying person and family agree to provide care and comfort as opposed to aggressive medical intervention, loved ones often seek hospice.

Which exemplify biological hazards? (Select all that apply.) A) Contaminated body fluids B) Poisonous plants C) Diesel exhaust D) Venomous snakes E) Aerosols

A) Contaminated body fluids B) Poisonous plants D) Venomous snakes Ans: A, B, D Feedback: Contaminated body fluids, poisonous plants, and venomous snakes are examples of biological hazards. Diesel exhaust and aerosols are examples of chemical exposure.

The occupational health nurse for a hydroelectric plant uses root cause analysis to investigate a recent accidental electrocution of a plant worker. The nurse currently is defining the characteristics of the case. In which step of the root cause analysis is the nurse? A) Define the problem B) Collect data C) Identify possible causal factors D) Identify the root cause

A) Define the problem Ans: A Feedback: Defining the problem includes defining the characteristics of the case and determining the circumstances under which it occurred. Collecting data includes determining whether similar illnesses or injuries occurred in the past, comparing similarities and differences, creating a time line related to the problem, and determining the impact of the problem. Identifying possible causal factors includes convening people involved in the situation to discuss the cause, determining the sequence of events that led to the illness or injury, identifying the conditions that allowed the problem to occur, identifying related problems, creating a chart of possible causal factors, and identifying causal factors and possible interrelationships. Identifying the root cause includes identifying the true causes of the illness or injury, determining why the causal factor or factors exist, and determining the real reason the problem occurred.

A living will is a document that: A) Describes the client's wishes regarding treatment intended to sustain life B) Designates someone to make medical decisions for the client if he or she is unable to do so C) Permits someone access to the client's finances D) Ensures appropriate end-of-life care

A) Describes the client's wishes regarding treatment intended to sustain life Ans: A Feedback: Living wills are documents in which clients describe their wishes regarding treatment intended to sustain life. A healthcare proxy or durable power of attorney for healthcare is a person designated to make decisions for the client if he or she is unable to do so. The healthcare proxy is responsible for medical decisions only if the client is unable to do this and does not have legitimate input into any other areas of the client's affairs. Decision making around the time of death raises many legal and ethical questions. Advance directives such as a living will can help with these question, though may not necessarily represent a guarantee that the client's wishes will be carried out.

The occupational health nurse is a member of the emergency planning committee in the workplace. The nurse is helping to formulate an emergency plan for the facility. Which goals should the nurse keep in mind while developing the plan? (Select all that apply.) A) Establish clear reporting instructions for employees. B) Provide instructions on safe lifting techniques. C) Identify hazardous substances that workers are exposed to in their daily work. D) Name key personnel who will assume necessary tasks. E) Establish emergency escape routes.

A) Establish clear reporting instructions for employees. D) Name key personnel who will assume necessary tasks. E) Establish emergency escape routes. Ans: A, D, E Feedback: The goals of an emergency plan are to anticipate emergencies and to establish clear reporting instructions for employees. The plan names key personnel who will assume necessary tasks. It establishes emergency escape routes and procedures to identify workers and visitors with and without disabilities. The plan ensures that predesignated areas have been arranged and employees have participated in actual drills. An emergency plan would not include providing instructions on safe lifting techniques or identifying hazardous substances, as these are normal work concerns, not emergencies.

Pain and symptom control are crucial to the delivery of quality end-of-life care. For which signs of pain should the nurse carefully assess? (Select all that apply.) A) Grimacing or strained facial expression B) Slow heartbeat C) Diaphoresis D) Moaning or groaning at rest or movement E) Taking sips of water from a cup

A) Grimacing or strained facial expression C) Diaphoresis D) Moaning or groaning at rest or movement Ans: A, C, D Feedback: The nurse should carefully observe the client for the following signs: moaning or groaning at rest or with movement; failure to eat, drink, or respond to the presence of others; grimacing or strained facial expression; guarding or not moving parts of the body; resisting care or noncooperation with therapeutic interventions; and rapid heartbeat, diaphoresis, or change in vital signs.

A client has not been able to receive adequate pain control with several different medications that have been administered and is experiencing severe pain. What route of administration might be tried at this time? A) Intraspinal B) Intravenous C) Rectal D) Transdermal

A) Intraspinal Ans: A Feedback: The administration of drugs into or around the spinal cord via the epidural or intrathecal route—known as the intraspinal route—is reserved for those clients who cannot achieve pain control in any other manner. Some medications are available in suppository form, and the rectal route may be useful when the client can no longer swallow or has problems with nausea and vomiting. Medications such as the fentanyl patch require placement on the skin of the upper body every 72 hours for relief of pain and operate through the transdermal route. The intravenous and subcutaneous routes are useful when the client is unable to swallow.

Which data are tracked under epidemiologic workplace surveillance? (Select all that apply.) A) Injuries B) Illness C) Hazards D) Exposures E) Productivity

A) Injuries B) Illness C) Hazards D) Exposures Ans: A, B, C, D Feedback: Workplace health surveillance includes physical examinations and the tracking of injuries, illness, hazards, and exposures both in individual people and for groups of workers. Productivity would not be tracked under epidemiologic workplace surveillance.

The Church Health Center, in developing its curriculum for the preparation of faith-based nurses, identifies seven specific functions that parish nurses perform in faith community work. Spiritual care would occur as part of which function? A) Integrator of faith and health B) Health educator C) Personal health counselor D) Accessing and developing support groups

A) Integrator of faith and health Ans: A Feedback: The role of the integrator of faith and health includes spiritual care, spiritual assessment, sharing scripture, and therapeutic listening. The role of the health educator includes individual health teaching, group health teaching, and providing health resources. The role of the personal health counselor includes therapeutic communication, assessing for emotional distress, and assessing for suicidality. The role of accessing and developing support groups includes referring congregation members to existing support groups and developing support groups for congregation members.

The nurse cares for a client whose husband of 50 years died a year ago. A behavior that indicates the client has reached the reorganization phase of grief is when she: A) Joins a book club to get out of the house and meet new people B) Expresses no emotions regarding the loss of her husband C) Begins crying on a daily basis D) Experiences panic attacks regularly

A) Joins a book club to get out of the house and meet new people Ans: A Feedback: In the reorganization or resolution phase of grief, coping strategies and positive outlooks emerge, such as joining a book club. A final resolution phase leads to acceptance of the loss. The widow or widower may return to prior levels of functioning. In the numb shock phase of grief, the widow or widower cannot believe the spouse's death occurred. This phase is marked by shock, emotional dullness, and restless behavior that may include stupor and withdrawal. One wants to protect oneself from the feeling of loss. In the emotional turmoil or depression phase of grief, alarm or panic-type reactions occur. Emotional expression may include crying, low mood, sleep disturbance, and anorexia. Anger, guilt, or longing for the deceased may take place. The widow or widower may also become preoccupied with the meaning of the loss.

A line operator in a manufacturing facility comes in to the on-site clinic reporting numbness in his hands after excessive exposure to the toxin benzene. Applying the epidemiologic triad to this scenario, which is the host? A) Line operator B) Manufacturing facility C) Benzene D) Hands

A) Line operator Ans: A Feedback: The epidemiologic triad is very helpful in occupational health nursing practice as a means to understand the complex relationships among the workers, hazards in the workplace, and hazards in the environment. In the epidemiologic triad, each worker is a host within the work population. The agents in the epidemiologic triad are workplace hazards classified as biological, chemical, physical, or psychosocial agents. The workplace exists within an external environment with specific geological and atmospheric characteristics, air and water quality, and presence or absence of environmental pollution.

The nurse cares for a client whose husband of 50 years died last week. The nurse arrives at her home to find her staring out of a window in a stupor, her face devoid of any emotion. When the nurse speaks with her, the client seems withdrawn and distant. Which phase of grief should the nurse most suspect this client to be in? A) Numb shock B) Emotional turmoil C) Reorganization D) Resolution

A) Numb shock Ans: A Feedback: In the numb shock phase of grief, the widow or widower cannot believe the spouse's death occurred. This phase is marked by shock, emotional dullness, and restless behavior that may include stupor and withdrawal. One wants to protect oneself from the feeling of loss. In the emotional turmoil or depression phase of grief, alarm or panic-type reactions occur. Emotional expression may include crying, low mood, sleep disturbance, and anorexia. Anger, guilt, or longing for the deceased may take place. The widow or widower may also become preoccupied with the meaning of the loss. In the reorganization or resolution phase of grief, coping strategies and positive outlooks emerge. A final resolution phase leads to acceptance of the loss. The widow or widower may return to prior levels of functioning.

An advisory board is essential for solving problems and avoiding pitfalls in faith communities. How might the advisory board offer help to a faith community nurse? (Select all that apply.) A) Offer leadership B) Establish policy C) Develop guidelines D) Establish the budget for the program E) Provide recommendations on clinical best practices

A) Offer leadership B) Establish policy C) Develop guidelines Ans: A, B, C Feedback: The advisory board offers leadership, establishes policy, and helps develop guidelines for faith community nursing programs. The advisory board can help develop support for a budget for the program, but cannot establish the budget for the program. The board cannot provide recommendations on clinical best practices, as its members are typically not qualified to do so.

Characteristics of a congregation include: (Select all that apply.) A) Organized group of people B) Individuals in the group have diverse religious beliefs, customs, or practices C) External governance structure D) Independent or affiliated with a local or national denomination E) Community within the larger community

A) Organized group of people D) Independent or affiliated with a local or national denomination E) Community within the larger community Ans: A, D, E Feedback: A congregation is an organized group of people who share religious beliefs, customs, or practices. The congregation has an internal governance structure and may be independent or affiliated with a local or national denomination. It is a community within the larger community.

Hospice care includes services that are reasonable and necessary for the comfort and management of a terminal illness. Which services might be included? (Select all that apply.) A) Physician services B) Nursing care C) Long-term inclient pain control D) Hospice aide services E) Social worker services

A) Physician services B) Nursing care D) Hospice aide services E) Social worker services Ans: A, B, D, E Feedback: Hospice care services may include physician services, nursing care, hospice aide services, social worker services, and short-term, not long-term, inclient care (for pain and symptom management).

The nurse provides palliative care to a client with end-stage renal disease and a chronic upper respiratory infection. Which interventions should be included in this type of care? (Select all that apply.) A) Providing the client with a foot massage B) Administering ordered analgesics C) Assisting with a kidney transplantation D) Clearing secretions from the client's airway for easier breathing E) Gently stretching the client's arms and legs to preserve range of motion

A) Providing the client with a foot massage B) Administering ordered analgesics D) Clearing secretions from the client's airway for easier breathing E) Gently stretching the client's arms and legs to preserve range of motion Ans: A, B, D, E Feedback: Palliative care is interdisciplinary team-based care that is focused on the relief of suffering for clients with serious illness. Nursing interventions that help enhance the quality of clients' lives, reduce pain and suffering, optimize functionality, and promote appropriate goal setting and decision making are integral to the provision of excellent palliative care. Assisting with a kidney transplantation would be classified therapeutic or treatment-oriented care, not palliative care. All other interventions listed refer to reducing pain and suffering and optimizing functionality of the client.

Which strategies have been shown successful for preventing adolescent pregnancy? (Select all that apply.) A) Responsible sexual behavior education B) Abstinence education C) Mandated religious education on sex practices D) Contraceptive counseling E) Confidential reproductive services

A) Responsible sexual behavior education B) Abstinence education D) Contraceptive counseling E) Confidential reproductive services Ans: A, B, D, E Feedback: Successful strategies for preventing adolescent pregnancy vary from responsible sexual behavior education, which includes abstinence education, to improved contraceptive counseling and confidential reproductive services, but not mandated religious education on sex practices

In an institution-based model of nursing, the nurse: (Select all that apply.) A) Serves a health system with assignment to particular congregational settings B) Serves as a liaison between a health system and a congregation C) Is part of the ministry staff of the congregation D) Serves a particular faith community by virtue of a contract or job description E) Provides care of the human spirit

A) Serves a health system with assignment to particular congregational settings B) Serves as a liaison between a health system and a congregation Ans: A, B Feedback: In the institution-based model, the nurse serves a health system with assignment to particular congregational settings, acting as a liaison between the health system and the congregation and helping plan and coordinate care, particularly at times of transition. In the parish nursing model, the nurse contributes to the health and wholeness of people in the context of a faith community, is part of the ministry staff of the congregation, and serves the illness needs of individual people, families, and the entire faith community. In the congregation-based model, the nurse serves a particular faith community by virtue of a contract or job description; this model supports the concept of a faith community nurse who can be paid or serve as a volunteer. Spiritual care is care of the human spirit that may include dealing with the meaning of health, illness or loss, and relationships with God and others, and that which has the goal of peace.

A newly hired health promotion specialist works at a meat-processing facility. The specialist is in charge of developing a program that encourages a balance among work, family, personal, health, and psychosocial concerns. Which components are appropriate to include in this program? (Select all that apply.) A) Signage that demonstrates safe lifting techniques B) Free screening for HIV C) Diagnosis of potentially malignant skin lesions D) Clinic on proper use of safety goggles and other equipment E) Monitoring of noise levels within the facility

A) Signage that demonstrates safe lifting techniques D) Clinic on proper use of safety goggles and other equipment E) Monitoring of noise levels within the facility Ans: A, D, E Feedback: Educating all employees and administrative staff regarding the exposures and hazards associated with the workplace is the foundation of health-promotion efforts, such as signage that demonstrates safe lifting techniques. A common health and safety promotion program in occupational settings involves preservation of sight and hearing, such as use of safety goggles and monitoring of noise levels. Screening for HIV and diagnosis of skin lesions would go beyond the scope of health promotion and would involve clinical diagnosis.

Which injury has the highest incidence rate among occupational injuries and illnesses that result in days away from work? A) Sprains B) Broken bones C) Cuts D) Carpal tunnel syndrome

A) Sprains Ans: A Feedback: The highest incidence rate resulting in days away from work occurred from sprains, strains, and tears. Cuts were in second place, fractures in fourth place, and carpal tunnel syndrome in seventh place.

While visiting the home of an 89-year-old woman out in the country, the nurse learns that her primary care provider's office is one hour's drive away. The client states, "I've just stopped going in for appointments in the past few years. It's just too far for me to drive by myself." This situation exemplifies which of the seven A's of challenges to elders in rural areas? A) Availability B) Accessibility C) Affordability D) Awareness

B) Accessibility Ans: B Feedback: Accessibility refers to amount of adequate, appropriate, and affordable transportation as well as the degree of cultural and geographic isolation. Availability refers to the number and diversity of formal services and providers, number of acceptable services, and amount of human service infrastructure. Affordability refers to the ability to pay for services. Awareness refers to the level of information dissemination and degree of literacy.

Supportive relationships with the spiritual head of the congregation are important for the success of a faith community nursing program. Unless the pastor has worked with a faith community nurse before, repeated explanations will most likely be necessary. The spiritual head of the congregation may need further education to clear up the common misconception that the nurse will: A) Provide confidential professional nursing care B) Be a private visiting nurse for the congregation C) Make referrals for appropriate healthcare in the faith community D) Work under the ANA's Faith Community Nursing Scope of Practice

B) Be a private visiting nurse for the congregation Ans: B Feedback: One common misconception is that the faith community nurse is a private visiting nurse for the congregation. The faith community nurse provides confidential professional nursing and refers to the American Nurses Association (ANA)'s Faith Community Nursing: Scope and Standards of Practice (2005) for guidance. If a member of the congregation is in need of visiting nurse services, then the faith community nurse provides an appropriate referral.

Which is an advantage, from the perspective of a faith community nurse, of working in an unpaid congregation-based model? A) Is recognized as a member of the ministry team B) Can limit how much time he or she offers to the congregation C) Receives much assistance from other nurses D) Can serve as an ambassador and referral agent to a health system

B) Can limit how much time he or she offers to the congregation Ans: B Feedback: One advantage is that the faith community nurse can limit how much time he or she offers and can maintain other employment. In a paid, institution-based model, a faith community nurse is employed by a health system, hospital, or community agency. The benefit to the agency is that the faith-based nurse can serve as an ambassador and referral agent for the institution. Both paid and unpaid congregation-based models share a disadvantage. The nurse usually operates independently, with little assistance from other nurses, and there is little support for developing new approaches to care. One disadvantage to having an unpaid faith community nurse is that this person may not be recognized as a member of the ministry team and will probably have fewer hours to offer in service.

The occupational health nurse for an electronics factory compiles an occupational health history for each worker. Which should be included? (Select all that apply.) A) Location of facility exits and entries B) Chronological record of all past work and potential exposures C) An occupational exposure inventory D) List of exposures in the home or community E) Availability of emergency equipment

B) Chronological record of all past work and potential exposures C) An occupational exposure inventory D) List of exposures in the home or community Ans: B, C, D Feedback: Components of the occupational health history include characteristics of the workers' present jobs, a chronological record of all past work and potential exposures, an occupational exposure inventory, and a list of other exposures in the home or community. The location of facility exits and entries and the availability of emergency equipment are aspects of a workplace walk-through.

The occupational and environmental health nurse faces many different practice issues every day and can function comfortably in roles as a clinician, coordinator, and case manager following company procedures, using assessment checklists and clinical protocols to provide treatment. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

B) Competent Ans: B Feedback: Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals. The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client. The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

The faith community nurse works in a hospital that serves several local congregations. Which tasks would the nurse likely perform in this role? (Select all that apply.) A) Administer flu shots B) Coordinate the discharge and transition of congregation members from the hospital to home C) Recommend services that the hospital provides D) Serve as a health advisor to members of the congregation E) Assess congregation members for possible upper respiratory illnesses

B) Coordinate the discharge and transition of congregation members from the hospital to home C) Recommend services that the hospital provides D) Serve as a health advisor to members of the congregation Ans: B, C, D Feedback: In a paid institution-based model, the faith community nurse can serve as an ambassador and referral agent for the institution. For example, a religiously affiliated hospital can support the services of faith community nurses in key feeder congregations so that clients discharged from the hospital have coordinated transition to the home congregation setting. The faith community nurse does not provide direct nursing care services (such as flu shots or assessment of upper respiratory illnesses), but supports the patient and family members in assuming self-care and in engaging the healthcare system appropriately. The faith community nurse serves as a health advisor, and he or she can recommend services that the hospital or health system provides.

A client is receiving adjuvant medications to increase the effectiveness to treat the pain associated with end-stage prostate cancer. Which exemplifies an adjuvant medication? A) Opioids B) Corticosteroids C) Antihistamines D) Antivirals

B) Corticosteroids Ans: B Feedback: Adjuvant medications are those used along with analgesics to increase the effectiveness of the drugs to treat pain and associated symptoms. Adjuvant medications include muscle relaxants, corticosteroids, anticonvulsants, antidepressants, and topical medications. Opioids are typically used for moderate-to-severe pain when nonopioid medications have not been effective. Antihistamines and antivirals are not pain medications.

The occupational health nurse at a company has seen three different employees in one week who have all reported similar upper respiratory symptoms. Which rate should the nurse consider calculating to understand the severity of this problem and to determine whether a cluster or cohort is forming? A) Productivity rate B) Incidence rate C) Prevalence rate D) Ratio of affected to unaffected

B) Incidence rate Ans: B Feedback: If there happens to be more than one worker from the same department with consistent symptoms and objective findings, the OHN may immediately begin to suspect that a cluster or cohort is forming and should determine the number of new cases of the condition, or the incidence rate. Clusters are aggregations of disease diagnoses collected from a specific population within a distinct period of time or space. The calculation of incidence rates is a helpful tool in understanding the severity of a workplace problem. Prevalence reflects the total burden of the injury or illness that exists in the population—in this case, the workplace. It includes both new cases and existing cases, as opposed to the incidence rate, which only includes new cases. Ratios can compare and involve groups of workers in settings. This approach adds clarity when comparing the number of affected workers in an organization that employs workers located in various geographic locations.

Which is a community nursing diagnosis? A) Impaired Home Maintenance B) Lack of Health-Seeking Behaviors C) Risk for Imbalanced Nutrition: More than Body Requirements D) Risk for Activity Intolerance

B) Lack of Health-Seeking Behaviors Ans: B Feedback: Diagnoses for faith community nurses should include nursing diagnoses as identified by organizations such as the North American Nursing Diagnosis Association. Examples of diagnoses related to community health are Lack of Health-Seeking Behaviors, Imbalanced Nutrition: More Than Body Requirements, and Deficient Diversional Activity. Impaired Home Maintenance, Risk for Imbalanced Nutrition: More Than Body Requirements, and Risk for Activity Intolerance are all examples of family nursing diagnoses.

The occupational health nurse with a construction company is responsible for filling out a record of accidents and illnesses that occur on the company's work sites. Which source should the nurse consult to acquire the proper record-keeping form and guidelines? A) FMLA B) OSHA C) HIPAA D) NORA

B) OSHA Ans: B Feedback: The Occupational Safety and Health Administration (OSHA) designs and distributes record-keeping forms called the OSHA log. The Occupational health nurse is usually responsible for filling out the OSHA log. This injury log is a record of accidents and illnesses that occur within a given year at every workplace facility employing 10 or more people. According to the Family and Medical Leave Act (FMLA), in the case of serious illness affecting themselves or family members, when all conditions are met under this act, employees can leave work for up to 12 weeks and return to work without penalty. The Health Insurance Portability and Accountability Act (HIPAA) mandates that all medical information be held in confidence. One way to ensure privacy is to keep all health-related information in a separate, secured file and storage area other than the business or human resource files. The National Occupational Research Agenda (NORA) is a partnership program to stimulate innovative research and improved practices for safer, healthier workplaces.

Which is one of the most important strategies recommended by the Centers for Disease Control and Prevention (CDC) for reducing the spread of HIV? A) Excluding students from school who have symptoms of sexually transmitted infections B) Routinely screening all adolescents and adults aged 13 to 64 C) Requiring parents to take their adolescent children who have sexually transmitted infections for treatment D) Keeping detailed records of all new cases of sexually transmitted infections in people aged 15 to 24 years

B) Routinely screening all adolescents and adults aged 13 to 64 Ans: B Feedback: Making HIV testing a routine part of healthcare for adolescents and adults 13 to 64 years of age is one of the most important strategies recommended by the CDC for reducing the spread of HIV. Accurate measures of sexually transmitted infections (STIs) in the 15- to 24-year-old population are difficult to obtain because many affected people have few, if any, identifiable symptoms. Symptomatic adolescents who are suspected of having an STI cannot be excluded from school. Federal law stipulates that adolescents can go directly to a health department-operated STI clinic for diagnosis and treatment of their disease without parental consent.

The Centers for Disease Control and Prevention (CDC) recommends which methods for improving the food environments of school-aged children and adolescents? (Select all that apply.) A) Preserving social norms of adolescents B) School-based prevention C) Policy and regulatory strategies D) Strategic use of media E) Coordination of statewide and local activities

B) School-based prevention C) Policy and regulatory strategies D) Strategic use of media E) Coordination of statewide and local activities Ans: B, C, D, E Feedback: The CDC has established a self-assessment and planning tool (School Health Index) and guidelines that can be used in school health programs in an effort to improve the food environments of school-aged children and adolescents. These current CDC guidelines focus on changing the social norms and environments of adolescents. In addition to school-based prevention, the guidelines recommend policy and regulatory strategies, community participation, establishment of public and private partnerships, strategic use of media, development of local programs, coordination of statewide and local activities, linkage of school-based activities to community activities, and use of data collection and evaluation techniques, such as the School Health Index, to monitor program impact.

Screening for cholesterol is an example of which prevention level? A) Primary B) Secondary C) Tertiary D) Quaternary .

B) Secondary Ans: B Feedback: Primary prevention activities include programs on exercising to maintain health, smoking cessation programs, and heart-healthy eating programs. Secondary prevention includes screening for hypertension and setting up screenings such as mammogram vans or other tests to diagnose problems early. Tertiary prevention involves minimizing the effect of health problems and maximizing function for people with such conditions such as diabetes, stroke, or injury. There is no quaternary level of prevention.

The faith community nurse recently visited with a member of the congregation, Sandy, who is recovering from a hysterectomy. Following a church service one Sunday, another member of the congregation, Patricia, approaches you and says, "How is Sandy recovering from her surgery?" Which is the most appropriate response? A) "She still has some bleeding, but overall she's doing well." B) "You mean her hysterectomy? She's doing really well." C) "I'm afraid I can't share any details, but I'm sure she'd love a call or text from you." D) "I'm sorry, Patricia, but that's none of your business."

C) "I'm afraid I can't share any details, but I'm sure she'd love a call or text from you." Ans: C Feedback: The parish nurse is bound by professional confidentiality not to reveal information about the health of patients, even if they are known to members of the congregation. Refusing to share information in a way that does not seem cold is a delicate art. One way to avoid this conflict is to explain to congregants early in the program, and often thereafter, that confidentiality for each member will be maintained. Often, the nurse can simply say, "I am sure that she would appreciate a call or a card"; this relieves pressure to share much information.

A client has been prescribed a nonopioid analgesic for mild-to-moderate pain. The client has normal liver function. What is the maximum recommended amount of acetaminophen for this client to take per day to avoid liver damage? A) 2 g B) 3 g C) 4 g D) 5 g

C) 4 g Ans: C Feedback: Clients with normal liver function should take no more than 4 g or less daily to avoid liver damage. It is essential to use with caution in those with liver disease or significant alcohol use.

Which are examples of primary prevention activities? (Select all that apply.) A) A program helping military veterans with amputations adapt to their new circumstances B) HIV screening open to the whole faith community C) A weight-lifting program for seniors to maintain strong bones D) A community vegetable garden to promote healthy eating E) Leg exercises to help people recovering from hip fractures to walk again

C) A weight-lifting program for seniors to maintain strong bones D) A community vegetable garden to promote healthy eating Ans: C, D Feedback: Primary prevention activities include programs on exercising to maintain health, smoking cessation programs, and heart-healthy eating programs. Secondary prevention includes screening for hypertension and setting up screenings such as mammogram vans or other tests to diagnose problems early. Tertiary prevention involves minimizing the effect of health problems and maximizing function for people with such conditions such as diabetes, stroke, or injury.

Pain at the end of life is complex and multifactorial, and prevalence varies according to diagnosis and other factors. A client has somatic pain. How is this type of pain typically described? A) Burning, electrical, or tingling B) Gnawing, cramping, or aching C) Aching, throbbing, or stabbing D) Electrical, cramping, throbbing

C) Aching, throbbing, or stabbing Ans: C Feedback: Somatic pain is characterized by aching, throbbing, or stabbing. Neuropathic pain is often described as burning, electrical, or tingling. Visceral pain is characterized by gnawing, cramping, or aching.

A dying client with inadequate fluid intake is experiencing constipation. What would be an appropriate nursing intervention for this client? A) Administer psyllium B) Tap water enema C) Administer lactulose D) Apricot juice

C) Administer lactulose Ans: C Feedback: Stimulants such as prune juice (not apricot juice), senna, or lactulose are preferable in dying clients. Avoid bulking agents (psyllium) in clients with inadequate fluid intake to avoid impaction. Monitor bowel function. Do not allow the client to go longer than 3 days without a bowel movement. A mineral oil, not tap water, enema may be necessary to prevent impaction.

Origin: Chapter 23- Faith-Oriented Communities and Health, 12 Which is an example of a tertiary prevention strategy that a nurse might implement or facilitate for members of a faith community? A) A program on radon detection in the home B) A class on cooking nutritious foods C) An occupational therapy program for patients recovering from strokes D) A water aerobics class for seniors

C) An occupational therapy program for patients recovering from strokes Ans: C Feedback: Primary prevention activities include programs on exercising to maintain health, smoking cessation programs, and heart-healthy eating programs. Tertiary prevention involves minimizing the effect of health problems and maximizing function for people with such conditions as diabetes, stroke, or injury.

In which phase of a school-based substance abuse program is information most likely to have meaning and applicability to students? A) Inoculation B) Primary C) Early relevance D) Tertiary

C) Early relevance Ans: C Feedback: The three phases during which introducing interventions is most likely to produce results are as follows: (1) the primary prevention or inoculation phase, which is designed to introduce knowledge; (2) the secondary prevention or early relevance phase, when information is likely to have meaning and applicability to students; and (3) the tertiary prevention or later relevance phase, when young people are actually being exposed to new situations involving experimentation.

The occupational health nurse for a multinational corporation compares aggregate data on the occurrence of lung cancer in workers in a factory in Brazil with workers in a factory in Hong Kong. Which type of epidemiologic study is this nurse most likely conducting? A) Prospective, cohort B) Case-control C) Ecological D) Cohort case-control

C) Ecological Feedback: Ecological studies are types of epidemiologic studies that compare the rates of exposures and diseases in different populations, such as in the two groups of factory workers in different countries. Prospective, cohort epidemiologic studies investigate workers who have been exposed to a variety of chemical, biological, or physical agents. The purpose of these follow-up studies is to determine whether the risk of adverse health outcomes after the event is increased. Epidemiologic studies may involve the evaluation of workers who have already experienced a common adverse health outcome. In this case, the outcome has already occurred, so the purpose of these case-control studies is to investigate, retrospectively, what agent or set of agents may explain their condition. There is no cohort case-control study.

Which exemplifies a physical hazard? A) Infectious agents B) Hazardous drug and toxin exposures C) Electric and magnetic fields D) Sexual harassment

C) Electric and magnetic fields Ans: C Feedback: Electric and magnetic fields are an example of a physical hazard. Infectious agents are an example of a biological hazard. Hazardous drug and toxin exposures are an example of a chemical exposure. Sexual harassment is an example of a psychosocial factor.

The Church Health Center, in developing its curriculum for the preparation of faith community nurses, identifies seven specific functions that parish nurses perform in faith community work. Which exemplifies the health advocate function of the faith community nurse? A) Individual health teaching B) Group health teaching C) Empowerment of members of the congregation D) Provider of health resources

C) Empowerment of members of the congregation Ans: C Feedback: A health advocate's role includes empowerment of members of the congregation and empowerment of the congregation to improve the health of the community. A heath educator's role includes individual health teaching, group health teaching, and providing health resources.

In a parish nursing model, the nurse: A) Serves a health system with assignment to particular congregational settings B) Serves as a liaison between a health system and a congregation C) Is part of the ministry staff of the congregation D) Serves a particular faith community by virtue of a contract or job description

C) Is part of the ministry staff of the congregation Ans: C Feedback: In the parish nursing model, the nurse contributes to the health and wholeness of people in the context of a faith community, is part of the ministry staff of the congregation, and serves the illness needs of individual people, families, and the entire faith community. In the institution-based model, the nurse serves a health system with assignment to particular congregational settings, acting as a liaison between the health system and the congregation and helping plan and coordinate care, particularly at times of transition. In the congregation-based model, the nurse serves a particular faith community by virtue of a contract or job description; this model supports the concept of a faith community nurse who can be paid or serve as a volunteer.

The chart of a client with brain cancer notes "CMO." Which intervention should the nurse most expect this client to receive? A) Chemotherapy for killing the cancer cells B) Radiotherapy for reducing the size of the tumor C) Morphine for pain management D) Antibiotic to fight off an infection

C) Morphine for pain management Ans: C Feedback: Comfort measures only (CMO) indicates a plan of care that specifies nursing interventions designed not to treat disease but to improve pain, function, or quality of life. Morphine for pain management best fits this description. Chemotherapy and radiotherapy are treatments for cancer and an antibiotic is a treatment for infection.

The occupational and environmental health nurse quickly obtains the information needed for accurate assessment and zoom in on the critical aspects of a problem in response to a client situation. The nurse uses highly developed clinical and managerial skills in the work environment. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

C) Proficient Ans: C Feedback: Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals. The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client. The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

The nurse is setting up a faith community nursing program at a local synagogue and would like a better understanding of how the overall congregation is structured and organized. Who would be best to ask about the structure of the congregation? (Select all that apply.) A) Lay members B) Physician in the congregation C) Rabbi D) Health system administrator

C) Rabbi Ans: C Feedback: The pastor, rabbi, or other congregational leader can be a great source of information about structure. If no suitable group exists, then the faith community nurse needs to assemble an advisory board. Lay members, including any physician in the congregation, may or may not be able to provide information about the structure of the congregation. A health system administrator would likely have no idea about the structure of the congregation.

The nurse cares for a client who is near death. For which change, indicating that death is imminent, should the nurse observe? A) Deep breaths with periods of apnea B) Mottling of upper extremities C) Skin cool and dusky D) Signs of respiratory alkalosis

C) Skin cool and dusky Ans: C Feedback: Physiological changes that occur when death is imminent include gradual hypoxia, respiratory acidosis (not alkalosis), and renal failure. Changes in respiratory patterns (shallow [not deep] breaths with periods of apnea) may indicate significant neurological declines, with Cheyne-Stokes respirations often heralding the impending death. Skin may appear dusky or gray and feel cold or clammy. Mottling of the lower (not upper) extremities may take place days or hours before the actual death.

Which is an example of a family assessment? A) Blood pressure screening B) Home assessment for safety C) Stress assessment for the family with a new baby D) Assessment for normal grieving for the recently widowed

C) Stress assessment for the family with a new baby Ans: C Feedback: Family assessments might include stress assessment for the family with a new baby. Individual assessments may include blood pressure, home assessment for safety, and assessing for normal grieving for the recently widowed.

Which level of assessment occurs when assessing whether healthcare is accessible to members of the congregation? A) Individual B) Family C) Congregation D) Community

D) Community Ans: D Feedback: Individual assessments may include blood pressure, home assessment for safety, and assessing for normal grieving for the recently widowed. Family assessments might include stress assessment for the family with a new baby. Community assessments can include assessing whether healthcare is accessible to members of the congregation. There is no such thing as a congregation assessment.

Which is the most appropriate intervention to use in a school-based substance abuse program? A) Integrating students' goals with those of a prevention program B) Assessing the needs and interests of the group carefully after selecting a program C) Designing a program that is knowledge based D) Designing an interactive, behavior-focused program

D) Designing an interactive, behavior-focused program Ans: D Feedback: Integrating the goals of the school (not those of the students) with those of the prevention program, assessing the needs and interests of the group carefully before (not after) the selection of any program, and designing programs that are behavior focused rather than knowledge based are important principles to use in education programs.

The occupational and environmental health nurse provides leadership in developing occupational safety and health policy within the organization and function in an upper management role. The nurse has served as a consultant to both business and government and has designed and conducted significant research. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

D) Expert Ans: D Feedback: Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals. The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client. The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

The leading cause of death in 2010 was: A) Cerebrovascular disease B) Chronic lower respiratory disease C) Diabetes mellitus D) Heart disease

D) Heart disease Ans: D Feedback: In 2010, the 10 leading causes of death accounting for 80% of all deaths in the United States include, in descending order, heart disease, malignant neoplasms, cerebrovascular disease, chronic lower respiratory disease, accidents, diabetes mellitus, influenza and pneumonia, Alzheimer disease, renal disease, and septicemia.

The nurse cares for a hospice client who reports pain from nerve damage related to diabetic neuropathy. She rates the pain at 9 out of 10. Which medication should she expect the physician to order for this client? A) Antidepressant B) Muscle relaxant C) Low doses of opioid D) High doses of opioid

D) High doses of opioid Ans: D Feedback: The client has neuropathic pain; mild pain (1-3 on the 0-10 scale) requires the use of adjuvant drugs (nonopioid medications such as antidepressants and muscle relaxants). Moderate pain (4-6 on the pain scale) necessitates the use of low doses of opioids; the use of nonopioids and adjuvants may continue. Severe pain (7-10) requires the use of higher opioid doses.

According to current research findings, which group has the most experience with congregational health ministers? A) Mainline Protestant and African-American Protestant B) Conservative Protestant and Roman Catholic C) African-American Protestant and Conservative Protestant D) Mainline Protestant and Roman Catholic

D) Mainline Protestant and Roman Catholic Ans: D Feedback: The groups with the most experience with congregational health ministers are mainline Protestant and Catholic, and congregations that are large, suburban, and financially well off.

A Muslim client is receiving end-of-life care. As death approaches, what special considerations should the nurse take in the care of this client? A) Speak with the family about arrangements for cremation B) Schedule a visit from the chaplain for special rites C) Arrange for grief counseling for the client D) Place the client in a special position

D) Place the client in a special position Ans: D Feedback: As death approaches, a Muslim client is positioned supine facing Mecca. If the family is unavailable to do this, the nurse may do it, wearing gloves. Discussion of death and grief counseling are discouraged and cremation is not acceptable in the Muslim faith. A client of the Roman Catholic faith may wish to receive the sacrament of the anointing of the sick to give spiritual strength and prepare for death.

In a congregation-based model of nursing, the nurse: A) Serves a health system with assignment to particular congregational settings B) Serves as a liaison between a health system and a congregation C) Contributes to the health and wholeness of people in the context of a faith community D) Serves a particular faith community by virtue of a contract or job description

D) Serves a particular faith community by virtue of a contract or job description Ans: D Feedback: In the congregation-based model, the nurse serves a particular faith community by virtue of a contract or job description; this model supports the concept of a faith community nurse who can be paid or serve as a volunteer. In the institution-based model, the nurse serves a health system with assignment to particular congregational settings, acting as a liaison between the health system and the congregation and helping plan and coordinate care, particularly at times of transition. In the parish nursing model, the nurse contributes to the health and wholeness of people in the context of a faith community, is part of the ministry staff of the congregation, and serves the illness needs of individual people, families, and the entire faith community.

A newly hired health and safety officer works for a large manufacturing facility. One of the officer's first jobs is to conduct a complete survey of the workplace to determine what hazards are present, the location of entries and exits, the availability of emergency equipment, and potential trouble spots. Which interventions should the officer implement to accomplish this goal? A) Ergonomics B) Occupational health history C) Root cause analysis D) Workplace walk-through

D) Workplace walk-through Ans: D Feedback: A workplace walk-through is a complete survey of the workplace, inside and outside, compiling information as to the presence of hazards, the location of entries and exits, the availability of emergency equipment, and potential trouble spots. Ergonomics is the study of the relationship between people and their working environment. Occupational health history is an assessment of the characteristics of the workers' present jobs, a chronological record of all past work and potential exposures, an occupational exposure inventory, and a list of other exposures in the home or community. Root cause analysis is a process for understanding and solving a problem, with the goal of determining what happened, why it happened, and what can be done to prevent its reoccurrence.

The occupational health nurse for a computer manufacturer is required to conduct a physical examination of each new hire. The rationale for this action is to: A) Screen for cardiac defects the worker may be unaware of. B) Ensure the worker's fitness for the job. C) Determine possible causes of the worker's chief complaint. D) Provide a baseline for future comparison. E) Determine the worker's eligibility for the company health insurance plan.

Ensure the worker's fitness for the job. Ans: B Feedback: A health record can be kept on the employees as part of their other employment records. This process often starts with an initial physical examination appropriate to the type of work that is going to be done. The physical examination helps ensure fitness for the job and provides a baseline for future comparison. The physical examination is not performed to screen for cardiac defects, determine possible causes of a chief complaint, or determine a worker's eligibility for the company health insurance plan.

Definitions of rural areas are based on which concepts? (Select all that apply.) A) Administrative B) Religious C) Land-use D) Political E) Economic

A) Administrative C) Land-use E) Economic Ans: A, C, E Feedback: Definitions of rural areas can be based on administrative, land use, or economic concepts, including variations of these three themes. Religious and political concepts are not among the themes on which the definitions of rural areas are based.

An underserved population is a subgroup of the population that has a higher risk of developing health problems due to marginalization in which areas? (Select all that apply.) A) Age B) Gender C) Sociocultural status D) Political affiliation E) Religion

A) Age B) Gender C) Sociocultural status Ans: A, B, C Feedback: An underserved population is a subgroup of the population that has a higher risk of developing health problems due to marginalization in sociocultural status, access to economic resources, age, or gender. Marginalization in religion and political affiliation are not typically associated with underserved populations.

The nurse reviews the official document called the Scope and Standards of Home Health Nursing Practice. Using knowledge about the document providing guidelines for nurses involved in home healthcare practice, which are included in the standards of care? (Select all that apply.) A) Assessment by collecting data about home care clients B) Implementation of nurse-centered actions in collaboration with physicians C) Diagnosis through the analysis of data D) Outcome identification that helps identify nurse-sensitive measures E) Planning nurse-sensitive interventions directed at the identified outcomes

A) Assessment by collecting data about home care clients C) Diagnosis through the analysis of data D) Outcome identification that helps identify nurse-sensitive measures E) Planning nurse-sensitive interventions directed at the identified outcomes Ans: A, C, D, E Feedback: The standards of care include the following key elements of the nursing process: (1) assessment by collecting data about home care clients; (2) diagnosis through the analysis of these data; (3) outcome identification that helps home care nurses identify nurse-sensitive measures; (4) planning in the form of nurse-sensitive interventions directed at the identified outcomes; and (5) implementation of nurse-centered actions in collaboration with clients and families, not with physicians.

The nurse discusses home care options with an 85-year-old client who recently fractured her humerus in a fall in her house. She is recovering well now but says the experience has made her see that it is time for her to change her living arrangements. The client can still bathe herself and cook meals on occasion but says she would like to live where nursing care is available onsite and where communal dining and recreation options are offered. Which of the following living arrangements could the nurse recommend? A) Assisted living facility B) Independent living in a senior living facility C) Nursing home D) Apartment located near a hospital

A) Assisted living facility Assisted living is a type of community-based care that combines quasi-independent living with the availability of nursing care onsite and through home care visits. It is generally a level of care for people who cannot live on their own, but are not yet ready for a nursing home. This type of living arrangement is different from living independently in one's own apartment, such as living in a senior living facility, in that many activities are provided communally (e.g., eating, recreation) and there is an organized effort to create a "caring community" where residents' needs are supervised and met.

On the basis of the eight recommended components of a comprehensive school health program, which should be included in a K-12 health education curriculum? (Select all that apply.) A) Consumer health education B) Environmental health education C) Sexuality education D) Nutrition counseling E) Physical development activities

A) Consumer health education B) Environmental health education C) Sexuality education D) Nutrition counseling Ans: A, B, C, D Feedback: K-12 health education curriculum should discuss personal health, family health, community health, consumer health, environmental health, sexuality education, mental and emotional health, injury prevention and safety, nutrition, prevention and control of disease, and substance use and abuse. K-12 physical education curriculum should promote optimum physical, mental, emotional, and social development, as well as activities and sports that all students enjoy and can pursue throughout their lives.

In researching the problem of homelessness in the city, the nurse discovers that the number of mentally ill homeless has steadily grown over the past couple of decades. The biggest reason for this trend is: A) Deinstitutionalization B) An increase in the prevalence of major mental illness C) Economic downturns D) Shortages of affordable housing

A) Deinstitutionalization Ans: A Feedback: The rising number of mentally ill clients who are homeless has steadily increased in the United States as state governments embarked on a systematic plan to "deinstitutionalize" the mentally ill. The goal of deinstitutionalization is to replace state hospitals with smaller group homes, half-way houses, or other supported living arrangements that integrate, rather than separate, the chronic mentally ill in the community. Tragically, the services available in the community seldom have kept pace with the demand for services. The gap in community-based services persists in all developed countries because of fiscal and political constraints. There is no evidence to support an increase in the prevalence of major mental illness. Economic downturns and shortages of affordable housing might contribute to homelessness overall, but are lesser causes than deinstitutionalization with regard to homelessness among the mentally ill.

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exmplifies a primary prevention strategy for mental health problems? A) Educate families and community groups about mental health issues, symptoms of stress, and barriers to seeking help B) Screen for mental health disorders C) Promote support groups for people with mental health disorders D) Initiate health-promotion activities as a part of rehabilitation services

A) Educate families and community groups about mental health issues, symptoms of stress, and barriers to seeking help Ans: A Feedback: Primary prevention strategies include educating families and community groups about mental health issues, symptoms of stress, and barriers to seeking help. Secondary strategies include screening for mental health disorders. Tertiary strategies include promoting support groups for people with mental health disorders and initiating health-promotion activities as a part of rehabilitation services.

The community health nurse addresses cyber bullying in the local middle schools. Currently, there are no policies in place for this issue. The most appropriate first step is to: A) Explore current programs to prevent bullying and youth violence B) Develop rules for acceptable and safe use of all electronic media for all students C) Ban use of the Internet at all schools D) Actively monitor students' social media postings

A) Explore current programs to prevent bullying and youth violence Ans: A Feedback: The most appropriate first step to take would be to explore current programs to prevent bullying and youth violence. Many of the programs developed to prevent face-to-face aggression address topics such as school climate and peer influences that are likely to be important for prevention of electronic aggression. By researching and perhaps adopting an existing program, the nurse will not have to develop a program from scratch. Developing rules for acceptable and safe use of all electronic media for all students is not likely to be effective because there would be no way to enforce them. This would be a more appropriate action for parents and caregivers. Banning all use of the Internet at all schools would be impractical, as the Internet is increasingly being incorporated into learning, and impossible to enforce. Actively monitoring students' social media postings would be impractical, as no one would have time for this, and cyber bullying can occur on many different sites and devices.

The nurse works with 68-year-old client who is having great difficulty managing his blood glucose level. The nurse finds that the client is not following the diet that he had agreed to follow and is eating portions that are far too large. He apologizes and explains that he is grieving the loss of his wife, who died 2 weeks ago. The nurse shares condolences with him on his loss and explain that it is perfectly understandable to have trouble following a new diet while grieving. In this scenario, the nurse is using which principal approach in motivational interviewing? A) Expressing empathy B) Supporting self-efficacy C) Rolling with resistance D) Finding a discrepancy

A) Expressing empathy Empathy is an approach to clients that involves trying to see clients' lives through their own lens and trying to think about their experiences as they would think about them. Self-efficacy is the belief on the part of the client that change is possible. In motivational interviewing, the home care nurse does not fight client resistance but "rolls with it." Home care nurses also work to develop opportunities for clients to discover discrepancies between their current behavior and what they want to accomplish through changed behaviors.

Which exemplifies a nuclear family? A) First-degree relatives who live together B) First- and second-degree relatives who live together C) First- and second-degree relatives who live in the same neighborhood D) Individuals who are not blood relatives but share a common locale of origin or culture

A) First-degree relatives who live together Ans: A Feedback: Nuclear families consist of first-degree relatives—that is, two generations—who live together. Commonly, the two generations include parents and children. Extended families include both first- and second-degree relatives and can include grandparents, aunts, uncles, and cousins. Traditional definitions of extended family indicate that the family share a dwelling, but members can live in the same neighborhood or in relatively close proximity to one another. The time that an extended family spends together depends not only on geographic closeness to one another but also on family customs. Extended family can also include persons who are not blood relatives, but who share a common locale of origin or culture.

Which are included in the five types of health risk factors that affect families? (Select all that apply.) A) Genetics B) Age C) Intelligence D) Personal health habits and lifestyle E) Environment

A) Genetics B) Age D) Personal health habits and lifestyle E) Environment Ans: A, B, D, E Feedback: The five types of risk relate to: (1) genetics; (2) age; (3) biological factors; (4) personal health habits/lifestyle; and (5) environment. Intelligence is not a health risk factor.

The nurse visits a community health clinic in a remote rural area, at which emergency care is not provided because the facility lacks the medical staff necessary to offer such services. Based on this information, which is the most accurate description of this situation? A) Health professional shortage area B) Medically underserved area C) Medically underserved population D) Undeserved population

A) Health professional shortage area Ans: A Feedback: A health professional shortage area (HPSA) is a geographic area, population group, or medical facility with shortages of healthcare professionals to a degree that a full complement of healthcare services is not possible. A medically underserved area (MUA) is an area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older. A medically underserved population (MUP) is a U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services. An underserved population is a subgroup of the population that has a higher risk of developing health problems because of marginalization in sociocultural status, access to economic resources, age, or gender.

Which criteria must an individual meet to receive Medicare for home health services? (Select all that apply.) A) Home bound B) Specific plan of care C) Skilled healthcare needs D) Intermittent care needs E) Continuous 24-hour necessity for care

A) Home bound B) Specific plan of care C) Skilled healthcare needs D) Intermittent care needs Ans: A, B, C, D Feedback: Medicare has the following criteria for eligibility: (1) home bound, (2) a plan of care, (3) skilled needs, (4) intermittent care needs, and (5) necessity.

The nurse assesses a 7-year-old girl who has had problems at school lately with her behavior and mood. On the basis of the description provided by the child's mother, the nurse suspects either attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder may be involved. Which behaviors—when occurring in all spheres of the child's life—would most strongly suggest ADHD rather than bipolar disorder in this client? A) Hyperactivity and impulsivity B) Mood and anxiety symptoms C) Irritability and impulsivity D) Anxiety and hyperactivity

A) Hyperactivity and impulsivity Ans: A Feedback: In children with ADHD, hyperactivity and impulsivity are evident in all spheres of the child's life. Unlike bipolar disorder, mood and anxiety symptoms are not predominant in ADHD; generally, teachers and parents do not characterize the child with ADHD as angry, irritable, and moody.

How can genomics help improve care of underserved populations? (Select all that apply.) A) Identify increased risk in certain populations for specific diseases. B) Boost the immune system of individuals in the community. C) Predict how a community might metabolize medications. D) Reduce the cost of medications. E) Predict a community's unique vulnerability to environmental changes that can control gene expression in some diseases.

A) Identify increased risk in certain populations for specific diseases. C) Predict how a community might metabolize medications. E) Predict a community's unique vulnerability to environmental changes that can control gene expression in some diseases. Ans: A, C, E Feedback: Understanding the genetic predictors of disease through genomics is a determinant of how certain individuals, families, and communities may be disproportionately affected by illness, and why public health must be part of a strategy that addresses discoveries in a practical way in this developing science. We also know that different groups of people by gender or other key demographic characteristics respond to preventive treatment differently because of their genetic make-up. For example, some genotypes may metabolize medications differently. Some populations may have specific vulnerability and key environmental influences related to their health. Gomes and Pelosi (2013) discuss how the potential vulnerability to environmental changes can control gene expression in diseases of great interest in public health such as cancer, autoimmune diseases, and perhaps even the aging process.

The nurse assesses a 12-year-old boy who has been diagnosed with bipolar disorder. Which behaviors should the nurse most expect to observe in this child? (Select all that apply.) A) Irritability B) Distractibility C) Screaming D) Rage episodes E) Sleep disturbances

A) Irritability C) Screaming D) Rage episodes E) Sleep disturbances Ans: A, C, D, E Feedback: In contrast to attention-deficit/hyperactivity disorder (ADHD), which is characterized by impulsivity and distractibility, almost 75% of the children diagnosed with bipolar disorder have a predominance of mood symptoms such as irritability, sleep disturbances, and anxiety. For a child with bipolar disorder, the slightest frustration can set off a flood of crying, screaming, or anxiety symptoms. Unlike toddlers who have temper tantrums that are time limited, children with bipolar disorder can have rage episodes that can last from 2 to 3 hours

A woman mentions that her 6-month-old son has demonstrated some odd behavior. She thinks it might be related to autism. She asks what age would be best to have screening done on the child. The nurse should respond: A) Now, as an infant B) When the child begins to walk C) When the child is preschool-aged D) When the child starts school

A) Now, as an infant Ans: A Feedback: In the past, diagnosis of autism was often delayed until preschool because clinicians would look for evidence of language impairments before making a definitive diagnosis.

Which exemplifies cultural diversity? A) People from South Korea, Brazil, and Nigeria all living in the same apartment complex B) A town in which everyone speaks Spanish, is originally from the same region in Mexico, and prepares similar types of food C) A university where all of the professors share the same political views D) A workplace in which accountants, lawyers, marketing executives, information technologists, and maintenance workers are all employed

A) People from South Korea, Brazil, and Nigeria all living in the same apartment complex Ans: A Feedback: A culture is a social group that shares ethnic origins, language, and characteristic features of everyday life, such as the town in which everyone speaks Spanish. Culture also refers to a group of people who share attitudes, values, goals, and practices, such as the university with professors who all share the same political views. Diversity is a range or variety of differences, such as the workplace that employs people of various occupations. More recently, the term cultural diversity has come into use to describe people of different racial or ethnic backgrounds in society, such as the apartment complex with residents from several different countries.

Reasons blended families are becoming more widespread include an increase in the number of: (Select all that apply.) A) People who remarry following a divorce B) People who remain single after being widowed C) Recognized gay and lesbian relationships D) Married couples having children E) Couples cohabiting with children from prior relationships

A) People who remarry following a divorce C) Recognized gay and lesbian relationships E) Couples cohabiting with children from prior Ans: A, C, E Feedback: Blended families form when two partners cohabit or marry and live with children from a previous relationship or relationships. This type of family has become widespread as more divorced or widowed people marry and more gay and lesbian relationships become recognized.

Which are among the key categories of indicators of health presented in Healthy People 2020? (Select all that apply.) A) Physical activity B) Exposure to allergens C) Responsible sexual behavior D) Tobacco use E) Occupation

A) Physical activity C) Responsible sexual behavior D) Tobacco use Ans: A, C, D Feedback: Healthy People 2020 include lists of determinants or indicators of health that can help families direct priorities to address their own health risks. These leading indicators of health relate to physical activity, obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to healthcare. Exposure to allergens and occupation are not key categories of leading indicators of health.

The nurse has recently been appointed to a community-based advisory board of an agency that is interested in providing fiscally sound, high-quality care for clients they decide will be their service population. Any profit margin that is acquired is reinvested in the operations of the home healthcare service. Which type of agency is this? A) Private/voluntary B) Hospital based C) Proprietary D) Official

A) Private/voluntary Ans: A Feedback: Voluntary agencies are generally established as not-for-profit entities, although they operate with the same fiscal objectives as "for-profit agencies." A hospital-based agency is a home health agency that is not freestanding in the community but is one of many specialty services offered at a hospital setting. A proprietary agency is a home health agency that is motivated by a for-profit philosophy. Official agencies are supported by public monies that often come from taxes. The public monies can come from local, state, or federal governments.

The case manager works with a client who has type 2 diabetes and heart disease. In this role, which actions should the nurse take in managing the client's diseases? (Select all that apply.) A) Provide weekly coaching sessions by telephone for blood glucose management. B) Supervise cardiac stress tests in the exercise room of the local hospital. C) Administer emergency insulin when the client arrives at the hospital in a diabetic coma. D) Demonstrate use of a glucose meter to the client. E) Review heart-healthy and diabetic-friendly food options with the client and his family.

A) Provide weekly coaching sessions by telephone for blood glucose management. D) Demonstrate use of a glucose meter to the client. E) Review heart-healthy and diabetic-friendly food options with the client and his family. Disease management often focuses on chronic illness such as heart disease, heart failure, diabetes, pulmonary disease, urinary incontinence, and asthma. In disease management programs, in addition to medications, there is strong emphasis on the use of telephone coaching, Internet resources, and intensive client and family teaching to advance self-care and adherence to wellness care. Recently, to help clients and families manage their health problems in an effective and efficient manner, there has been an effort to bundle disease states together in light of many comorbidity patterns. Supervising a cardiac stress test and administering emergency glucose are clinical interventions that go beyond basic disease management.

The nurse investigates a family's health routines and rituals as part of the overall family assessment. Which exemplify family health routines? (Select all that apply.) A) Siblings all brushing their teeth together before bed every night B) Parents taking their 9-month-old child to the health clinic when he has a fever C) Entering a 5K run/walk charity event each year as a family D) Taking a walk together around the neighborhood after dinner each evening E) The mother having a mammogram performed every year

A) Siblings all brushing their teeth together before bed every night D) Taking a walk together around the neighborhood after dinner each evening Ans: A, D Feedback: Routines are observable, repetitive patterns that involve two or more family members. These patterns are repetitive and predictable. Rituals, on the other hand, are more formal, repetitive patterns that strengthen family self-image or identity. Six categories of family health routines are as follows: self-care; safety and precaution; mental health behaviors; family care; illness care; and member care giving. Siblings brushing their teeth together before going to bed every night and the family taking a walk together each evening are examples of family health routines. Taking a child in for a sick visit is not a routine because it is not repetitive or predictable. Entering a 5K as a family each year is more of a ritual than a routine. The mother having a mammogram every year is not a family routine because she does it by herself.

The nurse is selecting a health appraisal related to alcoholism to assess health risk in a client. Which are examples of information that should be included in the appraisal? (Select all that apply.) A) Signs and symptoms of alcoholism B) Recommended daily limit of alcoholic drinks consumed per day C) Examples, such as frequently drinking an alcoholic beverage in the morning D) Incidence rates of alcoholism in the United States E) Information on local substance abuse programs

A) Signs and symptoms of alcoholism B) Recommended daily limit of alcoholic drinks consumed per day C) Examples, such as frequently drinking an alcoholic beverage in the morning E) Information on local substance abuse programs Feedback: Appraisals often include information that identifies a common problem, specific criteria that confirm that the problem exists, tangible examples of the problem, and treatment recommendations. Incidence rates are often included in databases but would not be presented in a health appraisal.

Which services are reimbursable by Medicaid? (Select all that apply.) A) Speech/language therapy and evaluations B) Occupational therapy and evaluations C) Physical therapy and evaluations D) Nutrition screening and evaluations E) Allergy testing and evaluations

A) Speech/language therapy and evaluations B) Occupational therapy and evaluations C) Physical therapy and evaluations E) Allergy testing and evaluations Ans: A, B, C, E Feedback: Services reimbursable by Medicaid include speech/language therapy and evaluations, occupational therapy and evaluations, and physical therapy and evaluations. Medicaid does not cover nutrition or allergy screening and evaluations.

The school nurse at a public high school recently noticed an increase in students smoking before and after school. Using the community school model to reduce tobacco use among your students, which interventions are appropriate? (Select all that apply.) A) Starting an after-school tobacco cessation program with the assistance of local representatives of the American Cancer Society B) Having a local clinical oncologist speak at a PTA meeting about the hazards of tobacco use among children C) Confronting groups of students while they are smoking with information regarding the school's smoking policy and the dangers of smoking D) Promoting the community's "great smoke-out" smoking cessation event each year E) Encouraging the school's administration to designate a single smoking area outside to limit nonsmokers' exposure to the smoke

A) Starting an after-school tobacco cessation program with the assistance of local representatives of the American Cancer Society B) Having a local clinical oncologist speak at a PTA meeting about the hazards of tobacco use among children D) Promoting the community's "great smoke-out" smoking cessation event each year Ans: A, B, D Feedback: One solution for the provision of comprehensive school health services is called the community school model. This model is a collaborative design that uses the resources of a community to provide structured preventive services such as after-school programs, parent outreach, and crisis intervention. These preventive services are designed to promote changes throughout the school environment. Confronting a group of smokers by yourself is not an example of collaboration or of drawing on community resources to promote changes throughout the school environment. Encouraging the designation of a smoking area, although it might benefit nonsmokers, will not decrease smoking among students and might even encourage it. All of the other examples demonstrate collaborative, community-based approaches to smoking cessation.

The nurse examines a client who is taking haloperidol for schizophrenia and notices that she habitually twists her tongue and arms. This side effect of her medication is known as: A) Tardive dyskinesia B) Akathisia C) Dystonia D) Neuroleptic malignant syndrome

A) Tardive dyskinesia Ans: A Feedback: Of particular concern with the first-generation antipsychotics is the risk of developing tardive dyskinesia. This condition, which is irreversible, is characterized by twisting movements of the tongue, limbs, and torso. Some of the other debilitating side effects of the first-generation antipsychotics include akathisia (extreme restlessness in the limbs), dystonia (severe stiffness in muscles, most prominently the neck), blurred vision, urinary retention, and neuroleptic malignant syndrome.

Using knowledge of the parish or faith community nurse, which interventions are likely to perform on the basis of the key roles of this type of nurse? (Select all that apply.) A) Teaching a class to faith community members on managing high blood pressure B) Providing counsel on preventing upper respiratory illness to member C) Referring a faith community member to a nutritionist for dietary counsel D) Assisting an obstetrician in the birth of a faith community member's child E) Administering vaccinations at a local health clinic

A) Teaching a class to faith community members on managing high blood pressure B) Providing counsel on preventing upper respiratory illness to member C) Referring a faith community member to a nutritionist for dietary counsel Ans: A, B, C Feedback: The seminal work of Westberg identified seven key roles of the parish or faith community nurse: (1) health educator, (2) personal health counselor, (3) referral agent, (4) coordinator of volunteers, (5) developer of supportive groups, (6) integrator of faith and health, and (7) health advocate. A faith community nurse would not likely assist an obstetrician with a birth or administer vaccinations at a local health clinic.

The Youth Risk Behavior Surveillance Survey (YRBSS) outlines common risk behaviors influencing the health of the nation's youth. Which risk factors are included on this survey? (Select all that apply.) A) Unintentional injury B) Sports-related trauma C) Sleep deprivation D) Sexual behaviors E) Alcohol use

A) Unintentional injury D) Sexual behaviors E) Alcohol use Ans: A, D, E Feedback: Youth Risk Behavior Surveillance Survey risk behavior categories include the following: unintentional injury, violence, tobacco use, alcohol use, drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity. Sports-related trauma and sleep deprivation are not risk behavior categories.

Which common problems should a school nurse be prepared to identify in students? (Select all that apply.) A) Vision impairment B) Malignant melanoma C) Attention deficit hyperactivity disorder (ADHD) D) Scoliosis E) Need for orthodontia

A) Vision impairment C) Attention deficit hyperactivity disorder (ADHD) D) Scoliosis Ans: A, C, D Feedback: The school nurse must have skills in health assessment, including the ability to identify common problems that impact a child's learning, such as vision impairment, ADHD, and scoliosis. A school nurse would not be qualified to identify malignant melanomas or the need for orthodontia in children.

The community health nurse is reviewing guidelines for the 15-minute assessment to keep the interview focused and family centered. Which questions and considerations for the family assessment can be asked for the question "Who is part of the family?" (Select all that apply.) A) What is the nature of individuals' connections to one another? B) Does the individual live alone or have no living family members? C) What influences from the family of origin are present in daily life? D) Do members speak independently or is an interpreter present? E) What observations can be made about the interpersonal dynamics between members?

A) What is the nature of individuals' connections to one another? B) Does the individual live alone or have no living family members? C) What influences from the family of origin are present in daily life? Ans: A, B, C Feedback: Questions to consider for "Who is part of the family?" include the following: What is the nature of individuals' connections to one another? Does the individual live alone or have no living family members? What influences from the family of origin are present in daily life? Questions to consider for "Who is the informant?" are as follows: Do members speak independently or is an interpreter present? and What observations can be made about the interpersonal dynamics between members?

The nurse assesses a family in which the wife and mother has recently been diagnosed with breast cancer. Which factors will likely affect the family's response to the health risk that this diagnosis presents? (Select all that apply.) A) What the husband and wife learned about dealing with serious illness in their families of origin B) Whether the family is covered by health insurance C) How the children tend to cope with stressful situations D) The response of fellow members of the family's mosque E) The incidence rate of breast cancer in the family's community

A) What the husband and wife learned about dealing with serious illness in their families of origin B) Whether the family is covered by health insurance C) How the children tend to cope with stressful situations D) The response of fellow members of the family's Ans: A, B, C, D Feedback: Families approach the idea of health risk in many different ways depending on (1) what they have learned from their past experiences in their family of origin; (2) economic circumstances, especially healthcare insurance coverage; (3) stress and coping styles; and (4) internal and external culture. The incidence rate of breast cancer in the family's community is not as likely to affect their response.

8. An elementary school student comes to school nurse's office reporting a headache. The nursing assessment begins by gathering which subjective data? (Select all that apply.) A) Where it hurts on the child's head B) Whether the pain is constant, throbbing, or intermittent C) What the child's temperature is on arrival D) How bad the pain is on a scale of 1 to 10 E) The presence of a bruise on the child's forehead

A) Where it hurts on the child's head B) Whether the pain is constant, throbbing, or intermittent D) How bad the pain is on a scale of 1 to 10 Ans: A, B, D Feedback: The nurse should begin by collecting subjective data gathered from the child, teacher, or parent, or any other witness to the complaint. Subjective data are those that are reported by the client or others but that are not directly observable by the nurse. Data should include location, frequency, duration and severity, quality, quantity, setting, associated symptoms, and factors that make the symptom better or worse. Objective data are those that are directly observable by the nurse, such as the child's temperature on arrival and the presence of a bruise on the child's forehead

At what age are prodromal assessment symptoms of bipolar disorder typically evident? A) Younger than 3 years of age B) Younger than 6 years of age C) Younger than 9 years of age D) Younger than 12 years of age

A) Younger than 3 years of age Ans: A Feedback: In most cases, the prodromal symptoms of bipolar disorder are evident when the child is younger than 3 years of age.

The home care agency has just received a client referral from a physician and assigned the case. Within how many hours from receiving the referral should the nurse plan to make the initial visit to this client, on the basis of typical agency policy? A) 12 hours B) 24 hours C) 36 hours D) 48 hours

B) 24 hours Ans: B Feedback: Generally, home care agencies make sure that an initial visit is made within 24 hours after receiving a referral.

What percentage of rural children live in poverty? A) 14% B) 24% C) 34% D) 44%

B) 24% Ans: B Feedback: Nearly 24% of rural children live in poverty.

The identification of parental age as a potential risk factor in autism raises the issue that lifetime exposure to environmental toxins might damage the sperm and the ovum. Research findings suggest that the risk of autism in relation to age of the parent at the time of the child's birth is increased by: A) 30% if the father is older than 40 years B) 30% if the mother is older than 35 years C) 40% if the father is older than 35 years D) 40% if the mother is older than 40 years

B) 30% if the mother is older than 35 years Ans: B Feedback: Researchers found that the risk of autism increased by 30% if the mother was older than 35 years and 40% if the father was older than 40 years at the time of the child's birth.

The case manager works with a 10-year-old girl who has asthma. Because the client's family has trouble affording inhalers, the case manager researches client assistance programs through which they could receive free medications. This aspect of case management is known as: A) Care management B) Advocacy C) Disease management D) Interdisciplinary collaboration

B) Advocacy Feedback: Advocacy is always moving the needs of clients, families, and communities to a point of awareness that will advance change and increase quality of a life and experience. Care management is the coordination of a plan or process to bring health services together as a common whole in a cost-effective way. Disease management is a system of coordinated healthcare interventions and communications for groups of people with conditions in which client self-care efforts are significant. Disease management emphasizes prevention at the secondary and tertiary level using evidence-based practice guidelines. Interdisciplinary collaboration is sharing of evidence-based practice and skills by several disciplines as an integration strategy with clients and families in homes and other healthcare settings.

Which is an accurate health factor or effect of living in rural geopolitical areas? A) Only about 5% of physicians practice in rural America despite that nearly one fourth of the population lives in these areas. B) Although only one third of all motor vehicle accidents occur in rural areas, two thirds of the deaths attributed to these accidents occur on rural roads. C) Rural residents are nearly three times as likely to die from unintentional injuries other than motor vehicle accidents than are urban residents. D) Abuse of alcohol and use of smokeless tobacco is a significant problem among rural older adults.

B) Although only one third of all motor vehicle accidents occur in rural areas, two thirds of the deaths attributed to these accidents occur on rural roads. Ans: B Feedback: Although only one third of all motor vehicle accidents occur in rural areas, two thirds of the deaths attributed to these accidents occur on rural roads. Only about 10% (not 5%) of physicians practice in rural America despite that nearly one fourth of the population lives in these areas. Rural residents are nearly twice (not three times) as likely to die from unintentional injuries other than motor vehicle accidents than are urban residents. Abuse of alcohol and use of smokeless tobacco are a significant problem among rural youth (not older adults).

Which most accurately defines a medically underserved area? A) A geographic area, population group, or medical facility with shortages of healthcare professionals to the degree that a full complement of healthcare services is not possible B) An area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older C) A U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services D) A subgroup of the population that has a higher risk of developing health problems because of marginalization

B) An area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older Ans: B Feedback: A medically underserved area (MUA) is an area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population aged 65 or older. A health professional shortage area (HPSA) is a geographic area, population group, or medical facility with shortages of healthcare professionals to a degree that a full complement of healthcare services is not possible. A medically underserved population (MUP) is a U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services. An underserved population is a subgroup of the population that has a higher risk of developing health problems because of marginalization in sociocultural status, access to economic resources, age, or gender.

In comparison with other generations, members of generation X: A) Respect authority, but want recognition for their individual contributions B) Are likely to multitask and have more than one career in their lifetimes C) Prefer authoritarian leadership and direct personal interaction with superiors and others D) Are goal oriented and focused people who desire guidance

B) Are likely to multitask and have more than one career in their lifetimes Ans: B Feedback: People of the war generation were used to authoritarian leadership and direct personal interaction with superiors and others. "Baby boomers" respected authority, but wanted recognition for their individual contributions. People who were born between 1965 and 1983 are known as generation X (Gen X) and are likely to want more flexibility in their lifestyles. Whereas their parents were goal-oriented and focused, people in Gen X are more likely to multitask and have more than one career in their lifetimes. People born between 1984 and 2002 are known as generation Y and also want flexibility in life like their Gen X counterparts, but with guidance.

Which individual health assessment would a school nurse most likely perform? A) Immunization check B) Assessment of a playground injury C) Vision screening D) Height and weight measurements

B) Assessment of a playground injury Ans: B Feedback: Visits for acute illness, playground injury, initial immunization screenings, and counseling require that the nurse assess the child individually. Population-based screening programs may include periodic vision and hearing tests, height and weight measurements, or immunization checks.

Being a school nurse requires which combination of practice type and decision making? A) Collaborative practice and interdependent decision making B) Autonomous practice and independent decision making C) Collaborative practice and dependent decision making D) Autonomous practice and interdependent decision making

B) Autonomous practice and independent decision making Ans: B Feedback: School nursing requires autonomous practice and independent decision making, not collaborative practice or dependent or interdependent decision making.

The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Encouraging families to spend quality time together by hosting a movie or game night at a local church is an example of a strategy at which level? A) Family B) Community C) Organizational D) Government

B) Community Ans: B Feedback: Encouraging families to spend quality time together by hosting a movie or game night at a local church is an example of a strategy at the community level and not at the family, organizational, or government levels.

Which actions exemplify the school nurse's role as a child advocate? (Select all that apply.) A) Injecting a child with her EpiPen during an anaphylactic reaction to peanuts B) Convincing the cafeteria manager to include low-sugar options in the lunch menu for students with diabetes C) Taking the temperature of a child who is exhibiting signs of an upper respiratory infection D) Teaching a child who has recently been diagnosed with asthma how to use an inhaler E) Instructing a group of faculty members on the proper way to respond to a child having an epileptic seizure in class

B) Convincing the cafeteria manager to include low-sugar options in the lunch menu for students with diabetes D) Teaching a child who has recently been diagnosed with asthma how to use an inhaler E) Instructing a group of faculty members on the proper way to respond to a child having an epileptic seizure in class Ans: B, D, E Feedback: Advocacy involves both teaching children and empowering others who care for the children to ensure quality care. The child with a chronic health condition presents a unique challenge for nurses as advocates. As many as 10% to 15% of children in schools are affected with chronic conditions, such as asthma, diabetes, and seizure disorders, that require daily treatment. The nurse as advocate has two important roles: spreading knowledge and networking. Spreading knowledge does not ensure health, but a person's sense of being able to control his or her own healthcare does promote healthy behaviors. Networking is also important. Working together, the school nurse, parents, teachers, and healthcare providers can ensure that the child with special healthcare needs has access to all educational resources and opportunities. Injecting a child with an EpiPen during an anaphylactic reaction and taking a child's temperature are basic nursing interventions and do not exemplify advocacy, as the nurse is not teaching, networking, or empowering others. All of the other answers are characterized by these behaviors.

A client has just been pronounced dead. The first action the nurse should take is to: A) Remove all tubes B) Don gloves C) Grasp the eyelashes and gently pull the lids down D) Insert the dentures into the mouth

B) Don gloves Ans: B Feedback: After the pronouncement of death, the nurse should glove, remove all tubes, replace soiled dressings, pad the anal area in case of drainage, and gently wash the body to remove any discharges. The body should lie on its back, with head and shoulders elevated on a pillow. The nurse should grasp the eyelashes and gently pull the lids down. Insertion of dentures is necessary.

During a home visit of a client with high blood pressure with whom the nurse has developed a strong therapeutic relationship, the nurse learn that the client keeps a large salt shaker near the stove and heavily salts whatever he is cooking. He also keeps a salt shaker on the dinner table and adds more salt when eating. The nurse suggests removing the salt shaker near the stove and only lightly salting food when eating as a way to help reduce the client's sodium intake. This intervention would most likely achieve the goals for assessment associated with which nursing theory? A) Science of Unitary Beings B) Health as Expanding Consciousness C) Roy Adaptation Model D) Self-care Agency

B) Health as Expanding Consciousness Ans: B Feedback: The nursing goals for assessment for the theory of Health as Expanding Consciousness are to develop a therapeutic relationship with the family that helps them identify areas for change and to build a story with the family as a means to change a pattern. The nursing goals for assessment for the theory of Science of Unitary Beings are to identify family patterns, which enable nurses to gain understanding and appreciation for the family, and to partner with families to make changes and define outcomes. The nursing goals for assessment for the theory of Roy Adaptation Model are to identify basic health needs and the key roles and relationships within the family and to determine how different stimuli affect the family's ability to adapt to change. The nursing goals for assessment for the theory of Self-care Agency are to identify roles and relationships within the family and to determine the family's ability to respond to critical situations and support each other.

Which of the eight recommended components of a comprehensive school health program should include the physical, emotional, and social conditions that affect the well-being of students and staff? A) Family/community involvement B) Healthy and safe school environment C) Counseling and psychology services D) Health promotion for staff

B) Healthy and safe school environment Ans: B Feedback: A healthy and safe school environment should include the physical, emotional, and social conditions that affect the well-being of students and staff. Family/community involvement should include school health advisory councils, coalitions, and broadly based constituencies for school health. Counseling and psychology services should include individual and group assessments, interventions, and referrals. Health promotion for staff should encourage staff to pursue a lifestyle that contributes to their improved health status and morale and to develop a greater personal commitment to the school's overall coordinated health program.

What services is telehealth used to deliver? (Select all that apply.) A) Chronic care and specialty consultations B) Home telenursing C) Electronic referrals to specialists in expert health facilities D) Transmission of healthcare information to people in the same geographical area

B) Home telenursing C) Electronic referrals to specialists in expert health facilities Ans: B, C Feedback: Telehealth is a form of electronic communication used to deliver (1) acute (not chronic) care and specialty consultations, (2) home telenursing, and (3) electronic referrals to specialists in expert health facilities. According to Thede, it involves "using electronic communications for transmitting healthcare information such as health promotion, disease prevention, professional or lay education, diagnosis, or actual treatment to people located at a different geographical area."

Which type of agency can be either profit or nonprofit? A) Private/voluntary B) Hospital based C) Proprietary D) Official

B) Hospital based A hospital-based agency is a home health agency that is not freestanding in the community but is one of many specialty services offered at a hospital setting. It can be for profit or nonprofit depending on the philosophy of the hospital. Voluntary agencies are generally established as not-for-profit entities, although they operate with the same fiscal objectives as "for-profit agencies." A proprietary agency is a home health agency that is motivated by a for-profit philosophy. Official agencies are supported by public monies that often come from taxes. The public monies can come from local, state, or federal governments.

The community health nurse can receive a referral to a home health agency at any time. Which phases are included in a home visit? (Select all that apply.) A) Plan personal safety of visit B) Initiating a visit C) Preparation D) Actual visit E) Termination of the visit

B) Initiating a visit C) Preparation D) Actual visit E) Termination of the visit Ans: B, C, D, E Feedback: There are five phases to a home visit: (1) initiating the visit, (2) preparation, (3) the actual visit, (4) termination of the visit, and (5) postvisit planning.

In the United States, detention centers, jails, and prisons are places that provide safety to the public by incarcerating people who have committed crimes and who are deemed a threat to society. Which demographics are true of the majority of inmates? (Select all that apply.) A) Incarcerated for violent crimes B) Latino or African-American C) Average age of 37 years D) Serving sentences of more than 10 years E) Male gender

B) Latino or African-American C) Average age of 37 years E) Male gender Ans: B, C, E Feedback: Most inmates are males who are African-American or Latino. The average age of inmates is 37. Seventy-five percent of all prisoners are nonviolent and have been incarcerated for drug possession and trafficking, bribery, and extortion, and 40% are serving sentences of more than 10 years.

Which most accurately characterize Medicare clients with acute myocardial infarctions (AMIs) who are treated in rural hospitals? (Select all that apply.) A) Less likely to experience an opportunistic infection than those in urban hospitals B) Less likely to receive recommended treatments than those in urban hospitals C) More likely to have a second AMI within a month of the first than those in urban hospitals D) Have significantly higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals E) Experience faster recovery times than those in urban hospitals

B) Less likely to receive recommended treatments than those in urban hospitals D) Have significantly higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals Ans: B, D Feedback: Medicare clients with AMI who were treated in rural hospitals were less likely than those treated in urban hospitals to receive recommended treatments and had significantly higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals. The other answers are not true.

The nurse is conducting a 15-minute interview with a family. On the basis of the five leading principles for interviewing, appropriate actions for the nurse to take include: (Select all that apply.) A) Having family members share their family history with you, going back several generations B) Listening actively as the family members speak C) Constructing an ecomap of the family D) Asking family members to prioritize their needs and to express their expectations regarding nursing care E) Pointing out the strong relationships they enjoy in their family and explaining how they will help them cope with the health issue of concern

B) Listening actively as the family members speak C) Constructing an ecomap of the family D) Asking family members to prioritize their needs and to express their expectations regarding nursing care E) Pointing out the strong relationships they enjoy in their family and explaining how they will help them cope with the health issue of concern Ans: B, C, D, E Feedback: Five leading principles that maximize information gleaned in a 15-minute family interview include the following: use of manners (introducing yourself), use of therapeutic conversation (using active listening), use of ecomaps and genograms, use of therapeutic questions (asking members to discuss their needs and expectations), and acknowledgment of family strengths. Having family members share their family history in detail would not be appropriate, as you do not have the time for that.

The nurse assesses a client who recently attempted suicide by prescription drug overdose. Based on knowledge of a recent study of the findings of the Third National Health and Nutrition Survey, what is the most important risk factor to assess for in this client? A) Substance abuse B) Major depressive disorder C) Social isolation D) Chronic pain

B) Major depressive disorder Ans: B Feedback: A recent study of the findings of the Third National Health and Nutrition Survey found that, after adjustment for other risk factors, a history of major depressive disorder was the strongest risk factor associated with attempted suicide for both men and women. Other risk factors include a history of substance abuse, suicide or self-mutilating behaviors, chronic pain, social isolation, stress, unemployment, and poverty.

The nurse performs an assessment of a client with schizophrenia. Which comorbid health conditions should the nurse most expect to find in this client? (Select all that apply.) A) Osteoarthritis B) Obesity C) Hypertension D) Breast cancer E) Cardiac complications

B) Obesity C) Hypertension E) Cardiac complications Ans: B, C, E Feedback: Clients with schizophrenia often have a myriad of comorbid chronic health conditions. Obesity, hypertension, and severe cardiac and metabolic complications all are much more prevalent in people with schizophrenia due to higher rates of smoking, poor nutrition, and lack of exercise. Osteoarthritis and breast cancer are not comorbidities associated with schizophrenia.

The nurse works with a client who has just been diagnosed with schizophrenia. While discussing the various medication options for this disorder, the nurse explains that some have been associated with the development of type 2 diabetes. The client explains that she is already at risk for developing diabetes and would like to avoid any medications that might promote the disease. On the basis of this information, which medication should this client most avoid? A) Haloperidol B) Olanzapine C) Fluphenazine D) Ziprasidone

B) Olanzapine Ans: B Feedback: Evidence is mounting that the second-generation antipsychotics, in particular clozapine and olanzapine, may increase the risk of developing new-onset type 2 diabetes. Haloperidol and fluphenazine are first-generation antipsychotics. Ziprasidone is a second-generation antipsychotic but less associated with development of type 2 diabetes than is olanzapine.

Which best describes the function of the grand nursing theory in nursing practice? A) Presents a systematic view of related statements to describe, explain, predict, or prescribe a phenomenon of interest B) Relates human experience to nursing practice and nursing care C) Assesses health patterns in 11 areas of family health D) Engages the family as a way to identify its strengths with attention to family dynamics and concerns related to health and illness

B) Relates human experience to nursing practice and nursing care Feedback: In nursing practice, grand nursing theory relates human experience to nursing practice and nursing care. Theory presents a systematic view of related statements to describe, explain, predict, or prescribe a phenomenon of interest. Functional Health Patterns is an approach to family assessment that has as its goal to assess health patterns in 11 areas of family health. Family Systems is an approach to family assessment that has as its goal to engage the family as a way to identify its strengths with attention to family dynamics and concerns related to health and illness.

The school nurse works with a 12-year-old girl who is obese and has type 2 diabetes. As client advocate, which would be most appropriate nursing action? A) Scold the client when she buys a soda from a vending machine at school. B) Schedule a conference with the client's parents to discuss how to collaboratively manage her blood glucose level and encourage her to select appropriate foods in the cafeteria for lunch. C) Perform a finger stick and check the client's blood glucose level when she reports feeling weak and dizzy one day. D) Weigh the client each week in the office to help track her weight and hold her accountable to her weight loss goals.

B) Schedule a conference with the client's parents to discuss how to collaboratively manage her blood glucose level and encourage her to select appropriate foods in the cafeteria for lunch. Ans: B Feedback: Because advocacy involves teaching, empowering, and networking, scheduling a conference with the client's parents to discuss blood glucose management and nutrition would be the most appropriate action to take as her advocate. Performing a finger stick and checking her blood glucose level and weighing her weekly are not good examples of advocacy because they do not involve teaching, empowering, or networking. Scolding the client for buying a soda would not empower her but would likely shame her and would not be an effective intervention.

Which health education interventions are appropriate for the school nurse to perform? (Select all that apply.) A) Teaching faculty members how to assess their students for upper respiratory illnesses B) Teaching a student how and when to use her EpiPen C) Teaching a 6th-grade class about the consequences of cyber bullying D) Counseling a student about tobacco use E) Teaching a group of students with eating disorders about a healthy view of food

B) Teaching a student how and when to use her EpiPen C) Teaching a 6th-grade class about the consequences of cyber bullying D) Counseling a student about tobacco use E) Teaching a group of students with eating disorders about a healthy view of food Ans: B, C, D, E Feedback: The school nurse must seek to accomplish health teaching in encounters with students and families, in the classroom, in individual counseling sessions (e.g., teaching a child how and when to use his or her EpiPen), and in group meetings. It is recommended that the focus of health education be health promotion based on concerns addressed in the National Health Objectives of Healthy People 2020. These issues include use of drugs and alcohol, sexual behavior, tobacco use, nutrition, physical activity, and violence prevention. It would not be appropriate for the nurse to teach faculty members how to assess their students for upper respiratory illnesses, as this is the nurse's responsibility.

The nurse teaches about medication to a client who has just been diagnosed with schizophrenia. The psychiatrist has prescribed clozapine to the client. The primary adverse effect that the nurse should mention is: A) Hypoglycemia B) The metabolic syndrome C) Weight loss D) Dystonia

B) The metabolic syndrome Ans: B Feedback: Metabolic syndrome is an adverse effect of second-generation antipsychotics that develops as a result of pronounced weight gain, dyslipidemia, and hyperglycemia. Dystonia is common side effect of first-generation antipsychotic medications.

There are several approaches to family assessment that use particular concepts that nurses typically encounter in practice. These models provide an organized framework with which to conduct a family assessment. Which is the aim of the family assessment in the Life Span Development approach? A) To identify family routines and rituals that could influence family health B) To identify family health practices within a social and historical context C) To assess health patterns in 11 areas of family health D) To engage the family as a way to identify its strengths, with attention to family dynamics and concerns related to health and illness

B) To identify family health practices within a social and historical context Ans: B Feedback: The aim of family assessment in the Life Span Development approach is to identify family health practices within a social and historical context. The aim of family assessment in the Rituals and Routines approach is to identify family routines and rituals that could influence family health. The aim of family assessment in the Functional Health Patterns approach is to assess health patterns in 11 areas of family health. The aim of family assessment in the Family Systems approach is to engage the family as a way to identify its strengths, with attention to family dynamics and concerns related to health and illness.

In a 15-minute family interview, after asking a question, the nurse pauses and remains silent while the grandmother, whose English is limited, replies to the question. The nurse makes eye contact with her and nods while she talks. When she is finished, the nurse asks a few follow-up questions. Which principle to maximize information during an interview is demonstrated in this behavior? A) Manners B) Use of therapeutic conversation C) Use of therapeutic questions D) Acknowledgment of family strengths

B) Use of therapeutic conversation Ans: B Feedback: When time is limited, purposeful and focused conversation, known as therapeutic conversation, can help build a relationship. Nurses validate family concerns with their active listening. Use of manners and common courtesies such as the nurse introducing himself or herself to the family indicates a desire to connect with the family and to instill trust in family members. Asking family members therapeutic questions helps them not only to identify their expectations about nursing care but also to assign priorities to their needs. Acknowledgment of family strengths leads the family to view their situation differently and makes them more likely to move toward more effective problem solving.

The client wants to know how long Medicare will pay for skilled needs. How long can the nurse continue to provide this care before she must seek a renewal if skilled needs continue to exist? A) 30 days B) 45 days C) 60 days D) 90 days

C) 60 days Ans: C Feedback: Medicare requires the specified time period to be 60 days with appropriate renewals if skilled needs continue to exist.

The community health nurse is assessing stressful life events in a family. Which exemplifies a life event related to illness and family care strains? A) A history of police reports of a 23-year-old man's hitting his girlfriend B) A couple in their 40s divorcing C) A 63-year-old woman's sense of responsibility as the oldest among her siblings for taking care of her chronically ill parents D) A 35-year-old woman not speaking to her sister for 5 years after not being invited to her wedding

C) A 63-year-old woman's sense of responsibility as the oldest among her siblings for taking care of her chronically ill parents Feedback: An example of illness and family care strains is the responsibility an oldest sibling feels to care for chronically ill parents. An example of family legal violations is domestic violence or child abuse. An example of marital strain is divorce or decreased sexual intimacy. An example of intrafamily strains is a family feud in which two sisters refuse to speak to each other.

Which qualifies as an urbanized area according to the U.S. Census Bureau? (Select all that apply.) A) A central city with population of 30,000 and surrounding densely settled territory with a population of 25,000 with a combined population density of 500 people per square mile B) A central city with population of 50,000 and surrounding densely settled territory with a population of 10,000 with a combined population density of 750 people per square mile C) A central city with population of 25,000 and surrounding densely settled territory with a population of 25,000 with a combined population density of 1,100 people per square mile D) A central city with population of 20,000 and surrounding densely settled territory with a population of 30,000 with a combined population density of 1,250 people per square mile E) A central city with population of 100,000 and surrounding densely settled territory with a population of 50,000 with a combined population density of 1,500 people per square mile

C) A central city with population of 25,000 and surrounding densely settled territory with a population of 25,000 with a combined population density of 1,100 people per square mile D) A central city with population of 20,000 and surrounding densely settled territory with a population of 30,000 with a combined population density of 1,250 people per square mile E) A central city with population of 100,000 and surrounding densely settled territory with a population of 50,000 with a combined population density of 1,500 people per square mile Ans: C, D, E Feedback: The U.S. Census Bureau defines an urbanized area (UA) by population density. According to this definition, each UA includes a central city and the surrounding densely settled territory that together have a population of 50,000 or more and a population density generally exceeding 1,000 people per square mile.

An older woman in a rural health clinic tells the nurse that this is the first time she's been in a medical facility for more than 10 years. She shows signs of advanced diabetes, including significant necrosis in her feet. When asked why she didn't come in sooner, she says, "I don't drive, myself, and I hate asking my son to bring me—I feel like such a burden." This situation exemplifies which of the seven A's of challenges to elders in rural areas? A) Awareness B) Adequacy C) Acceptability D) Assessment

C) Acceptability Ans: C Feedback: Acceptability refers to the degree of reluctance to ask for help. Awareness refers to the level of information dissemination and degree of literacy. Adequacy refers to the level of service standards and evaluation and degree of evidence-based practice. Assessment refers to the amount of basic information available on what is needed using research rigor and analyses.

Which occurred as a result of the passage of the Education for All Handicapped Children Act in 1975? A) Children with disabilities were provided tax-funded tutors for home education. B) Children with mental disabilities were entitled to a tax-funded education at a special education private school. C) Children with chronic or complex medical issues were entitled to a public education. D) Children with physical disabilities were provided grants to attend the college of their choice.

C) Children with chronic or complex medical issues were entitled to a public education. Ans: C Feedback: The biggest change in school nursing practice came in 1975 with the passage of the Education for All Handicapped Children Act of 1975 (Public Law 94-142). Children who had previously not been able to attend school because of chronic or complex medical issues were now entitled to a public education, and they began attending public schools.

The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which exemplifies a strategy at the family level? A) Mentor a child in a READ program. B) Volunteer with children who are homeless or in foster care. C) Create daily homework routines and limit television viewing. D) Vote in every election and advocate for children.

C) Create daily homework routines and limit television viewing. Ans: C Feedback: Individual strategies include mentoring a child in a READ program, volunteering with children who are homeless or in foster care, and voting in every election and advocating for children. A family strategy is to create daily homework routines and limit television viewing.

The nurse assesses a client who recently immigrated to the United States from Haiti. The client reports upset stomach and diarrhea. He explains that a witch doctor put a curse on him and that he sometimes sees evil spirits around him. The most accurate way to describe this type of illness would be as a: A) Mental illness B) Gastrointestinal disorder C) Culture-bound syndrome D) Hypochondria

C) Culture-bound syndrome Ans: C Feedback: Mental health and, conversely, mental illness are concepts bound by culture. Understanding of what connotes mental health is shaped by social norms that evolve from generation to generation. In Western cultures, medical science interprets any deviation from normative function of the five senses as indicative of a psychotic disorder. Hearing a voice, claiming to see an object, or having certain tactile sensations is viewed as a pathological state to be treated by psychiatric professionals. In some parts of the world, spiritual possession and belief in healers with special powers are culture-bound syndromes. Although gastrointestinal symptoms are involved in this client's condition, he suffers from more than just a gastrointestinal disorder. Hypochondria, or a condition in which one imagines that he or she has an illness but really does not, would not be applicable because the client has real symptoms and comes from a culture in which his illness is acknowledged as such.

A student is considering becoming a home health nurse. In researching this type of nursing, the student finds that several key factors have played a part in the development of home healthcare as it is today? These include: (Select all that apply.) A) Increase in the number of hospitals nationwide B) Reduction in the incidence of chronic diseases C) Development of health insurance D) Rising costs in healthcare E) Increase in medical and nursing specialization

C) Development of health insurance D) Rising costs in healthcare E) Increase in medical and nursing specialization The development of health insurance, rising costs in healthcare in general, and medical and nursing specialization all have played a part in the development of home healthcare as it is today. Hospitals have not increased in number nationwide in recent years and the incidence of chronic diseases has increased, not decreased.

12. The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which strategies are at the government level? (Select all that apply.) A) Provide free tax filing assistance to low-income working families. B) Educate families about how they can apply for food stamps, Head Start, federal nutrition programs, and other similar benefits. C) Ensure children in foster care and detention receive quality treatment to address their mental, behavioral, and emotional needs. D) Promote high-quality children's television programming and access to other quality electronic media. E) Start a halfway house and counseling program for youth who have run away.

C) Ensure children in foster care and detention receive quality treatment to address their mental, behavioral, and emotional needs. D) Promote high-quality children's television programming and access to other quality electronic media. Ans: C, D Feedback: Government strategies include ensuring that children in foster care and detention receive quality treatment to address their mental, behavioral, and emotional needs and promoting high-quality children's television programming and access to other quality electronic media. Organization strategies include providing free tax filing assistance to low-income working families and educating families about how they can apply for food stamps, Head Start, federal nutrition programs, and other similar benefits. Community strategies include starting a halfway house and counseling program for youth who have run away.

The history of school nursing can be traced back to 1902, when Lillian Wald was working in a New York City public school. She viewed school nursing services as a way to decrease which problem? A) Nutrition deficiencies B) Dental cavities C) Excessive absenteeism D) Seasonal allergies

C) Excessive absenteeism Ans: C Feedback: She believed that school nursing services were a way to decrease excessive absenteeism, not to decrease nutrition deficiencies, dental cavities, or seasonal allergies.

The nurse provides care covered by Medicare for a client over 2 hours during the day, 3 days during the week, for 60 days. Which type of care is the nurse providing? A) Interdisciplinary B) Skilled C) Intermittent D) Part-time

C) Intermittent Feedback: Intermittent care refers to a situation in which skilled care is usually provided over several hours during the day, several days during the week, for a specified time period. Interdisciplinary care is that provided by several disciplines as an integration strategy with clients and families in homes and other healthcare settings. Skilled care involves the professional abilities of a registered nurse or her/his supervised designee. Necessity means that the service given by a home care agency is reasonable based on the status of the client.

The nurse works at a clinic in Arizona that provides bilingual (English and Spanish) care to low-income immigrant workers from Mexico. Which designation most accurately describes the area or the population this nurse serves? A) Health professional shortage area B) Medically underserved area C) Medically underserved population D) Inmates

C) Medically underserved population Ans: C Feedback: A medically underserved population (MUP) is a U.S. federal designation for those populations that face economic, cultural, or linguistic barriers to accessing primary medical care services. A medically underserved area (MUA) is an area with a lack of medical care services as determined by the number of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level, and percentage of the population 65 years or older. A health professional shortage area (HPSA) is a geographic area, population group, or medical facility with shortages of healthcare professionals to a degree that a full complement of healthcare services is not possible. An inmate is a person who is held in a jail or prison to protect the public.

The Children's Defense Fund supports initiatives at the individual, family, community, organizational, and government levels. Which level is represented by hosting a health fair to ensure all children who are eligible for Medicaid or state children's health insurance program are enrolled? A) Family B) Community C) Organization D) Government

C) Organization Ans: C Feedback: Organizations, not families, communities, or government, are likely host a health fair to ensure all children who are eligible for Medicaid or your state children's health insurance program are enrolled.

The nurse recently took a position in a national chain of home healthcare agencies directed at caring for clients who are on home hemodialysis. The services provided are often paid for privately by families, and any profit margin is used to benefit the owner of the agency. Which type of agency is this? A) Private/voluntary B) Hospital based C) Proprietary D) Official

C) Proprietary A proprietary agency is a private agency that plans to and wants to make a profit. It can be part of a local, national, or international chain of home healthcare agencies directed toward any group of clients with particular healthcare problems or challenges. A voluntary agency is generally established as a not-for-profit entity, although it operates with the same fiscal objectives as "for-profit agencies." A hospital-based agency is a home health agency that is not freestanding in the community but is one of many specialty services offered at a hospital setting. Official agencies are supported by public monies that often come from taxes. The public monies can come from local, state, or federal governments.

4. The community health nurse has limited time for family assessments because of demanding caseloads or staffing shortages. Using your knowledge that focused family interviews of 15 minutes or less can yield a wealth of information, which is an example of an activity that will acknowledge the family's strengths? A) Ask family members if they see an area that could be changed B) Allow everyone present to voice observations, insights, or concerns before offering how they could change the situation C) Share any genograms and ecomaps that illustrate relationships with family members D) Collaborate with the family to set priorities, plan care, and evaluate goals

C) Share any genograms and ecomaps that illustrate relationships with family members Ans: C Feedback: Acknowledge the family's strengths by sharing any genograms and ecomaps that illustrate relationships with family members. Avoid offering advice prematurely by allowing everyone present to voice observations, insights, or concerns before offering how they could change the situation and asking family members if they see an area that could be changed. Plan goals and outcomes with the family by collaborating with the family to set priorities, plan care, and evaluate goals.

Who primarily regulates the provisions of home healthcare? (Select all that apply.) A) Insurance companies B) Local government C) State government D) Federal government

C) State government D) Federal government Ans: C, D Feedback: Home healthcare is regulated by the state and federal government. Insurance companies generally align themselves with the regulations stipulated by these governments.

The nurse is speaking with a 14-year-old client who has attempted suicide by cutting his wrists in the past. How would the nurse implement a means-restriction approach to suicide prevention in this case? A) Teach the client to block out all thoughts of self-harm as soon as they arise B) Encourage the client to seek out counseling C) Suggest to the client's parents that they lock up all sharp knives in the house D) Recommend to the client's parents that the client be under constant surveillance

C) Suggest to the client's parents that they lock up all sharp knives in the house Ans: C Feedback: Community health nurses can promote "means restriction," especially in families where there is a member at risk for suicide. Families who own firearms should be encouraged to secure firearms using trigger locks and locking bullets in a separate location from the firearm. If a client informs the nurse that he or she is having thoughts of taking an overdose, then prescription or over-the-counter medications that may be fatal in overdose should be removed or secured in a safe location. Although families might presume that removing the instrumental means of harm is an ineffective gesture, the community health nurse must reassure the family that their actions are sending a strong, unambiguous message to the potential victim that people care about them and will take any necessary steps to ensure their safety. Means restriction does not involve blocking out thoughts of self-harm, counseling, or constant surveillance.

The nurse takes care of a dependent family member whose husband is in the military. Which government funding is most likely going to be used for home healthcare services for this client? A) Medicare B) Medicaid C) TRICARE D) Veterans Administration

C) TRICARE Feedback: Government funding for home healthcare includes Medicare (federal), Medicaid (state), TRICARE (federal funds for military personnel and their dependents), and the Veterans Administration (federal funds for those who are currently serving or have served in the armed services of the United States).

Which correctly ranks the top four rural health priorities according to the Healthy People goals? A) (1) Access to quality healthcare, (2) mental health and mental disorders, (3) diabetes, (4) heart disease B) (1) Mental health and mental disorders, (2) access to quality healthcare, (3) heart disease, (4) diabetes C) (1) Diabetes, (2) heart disease, (3) mental health and mental disorders, (4) access to quality healthcare D) (1) Access to quality healthcare, (2) heart disease, (3) diabetes, (4) mental health and mental disorders

D) (1) Access to quality healthcare, (2) heart disease, (3) diabetes, (4) mental health and mental disorders Ans: D Feedback: The correct ranking of rural health priorities is (1) access to quality healthcare, (2) heart disease, (3) diabetes, and (4) mental health and mental disorders.

On the basis of the understanding of demographic risk factors related to mental illness, which individual would be most likely to have an untreated psychiatric disorder? A) 50-year-old Caucasian man B) 35-year-old Korean woman C) 12-year-old Hispanic girl D) 18-year-old African-American man

D) 18-year-old African-American man Ans: D Feedback: Young African-Americans and the elderly have the highest rates of unmet psychiatric needs.

20. The home health nurse has to ensure that a safety plan is in place to address falls. Using knowledge that 55% of fall-related injuries occur with falls inside the home, a total of more than 60% of these falls occur in which two rooms? A) Living room and hallway B) Kitchen and bathroom C) Hallway and bedroom D) Living room and bedroom

D) Living room and bedroom Feedback: The most common rooms where people fall include the living room (31%), bedroom (30%), kitchen (19%), bathroom (13%), and hallway (10%).

A client is fearful of being infected with the Ebola virus. To which reliable source of family risk reduction information should this client turn? A) A report from the client's neighbor whose daughter was recently infected with the Ebola virus B) Information the client's wife reported from a newspaper article about the Ebola virus that she read C) Data from an Internet site that the client's daughter conveyed D) A conversation the client has with his healthcare provider

D) A conversation the client has with his healthcare provider Ans: D Feedback: Information the client gains from a conversation with his healthcare provider would be the most reliable, as the other sources are informal and secondhand. In informal settings, family members may receive inaccurate information about risk reduction, primarily because people interpret risk reports at their level of understanding (i.e., their own level of education or the level of information given). In fact, family members often hear ambiguous reports or interpretations about how someone became disabled or ill or died.

Which mental illness is most likely to go untreated? A) Anxiety B) Bipolar disorder C) Depression D) Alcoholism

D) Alcoholism Ans: D Feedback: Those suffering from alcoholism and addictive disorders are most likely to go untreated (78%), followed by anxiety disorders (57%), depression (56%), and bipolar disorder (50%).

When speaking with an older man in a rural community about his lifelong smoking habit, the nurse is alarmed to learn that he has never heard that cigarette smoking is the major cause of lung cancer. This situation exemplifies which of the seven A's of challenges to elders in rural areas? A) Availability B) Accessibility C) Affordability D) Awareness

D) Awareness Ans: D Feedback: Awareness refers to the level of information dissemination and degree of literacy. Availability refers to the number and diversity of formal services and providers, number of acceptable services, and amount of human service infrastructure. Accessibility refers to the amount of adequate, appropriate, and affordable transportation as well as the degree of cultural and geographic isolation. Affordability refers to the ability to pay for services.

A community care nurse at a healthcare agency assists in coordinating a plan for providing health services in the most cost-effective way possible to a large number of members living in the region. This work is known as: A) Case management B) Home healthcare C) Interdisciplinary collaboration D) Care management

D) Care management Care management is the coordination of a plan or process to bring health services together as a common whole in a cost-effective way. Case management is the development and coordination of care for a selected client and family. Home healthcare is a provision of healthcare that occurs in the setting clients consider their home. Interdisciplinary collaboration is the sharing of evidenced-based practice and skills as an integration strategy with clients and families in homes and other healthcare settings.

A nurse is assessing a client who was recently released from prison. Based on knowledge of the incidence rates of various types of crimes that lead to incarceration, the nurse suspects that the client may have committed which crime? A) Murder B) Rape C) Assault D) Drug possession and trafficking

D) Drug possession and trafficking Ans: D Feedback: Seventy-five percent of all prisoners are nonviolent and have become incarcerated for drug possession and trafficking, bribery, and extortion.

There is substantial variation in the incidence of mood disorders and suicide across cultures worldwide. The two most consistent factors associated with the incidence of depression and anxiety are: A) Number of parents in the home and education level B) Degree of social support and employment status C) Number of parents in the home and degree of social support D) Education level and employment status

D) Education level and employment status Ans: D Feedback: Across all cultures, the two most consistent social factors associated with the incidence of depression and anxiety are education level and employment status. The social factors with the lowest impact are degree of social support and number of parents in the home.

The case manager for a 12-year-old boy who is obese and prediabetic. To help the client develop a diet that will promote weight loss and control of his glucose level, the case manager decides to consult with a dietician, who provides several current journal articles that present findings on various diets. This aspect of case management is known as: A) Care management B) Advocacy C) Disease management D) Interdisciplinary collaboration

D) Interdisciplinary collaboration Ans: D Feedback: Interdisciplinary collaboration is sharing of evidence-based practice and skills by several disciplines as an integration strategy with clients and families in homes and other healthcare settings. Advocacy is always moving the needs of clients, families, and communities to a point of awareness that will advance change and increase quality of a life and experience. Care management is the coordination of a plan or process to bring health services together as a common whole in a cost-effective way. Disease management is a system of coordinated healthcare interventions and communications for groups of people with conditions in which client self-care efforts are significant. Disease management emphasizes prevention at the secondary and tertiary level using evidence-based practice guidelines.

The nurse assesses a 77-year-old woman who has been caring for her husband who has Alzheimer disease in their home for the past 8 years. The client complains of exhaustion and depression. Which stressors should the nurse most suspect as the cause of this client's symptoms? A) Marital strain B) Caregiver burden C) Spillover D) Interfamily strain

D) Interfamily strain Ans: D Feedback: Whether caring for an elder who is homebound or a child with a disability, caregiver burden has been well documented in the literature as a significant stressor on the family member who assumes primary responsibility for care. In most cultures, women (mothers, wives, sisters, daughters, or female in-laws) have assumed this role, usually by default. Caregiver burden is a significant issue for families because it can cause the development of physical or emotional illness in the caregiver over time. Marital strain is a term that describes how couples manage tensions and promote intimacy as opposed to create negativity (strain) in conflict resolution (Gottman, 1994). Defensiveness, criticism, contempt, and withdrawal erode trust in many relationships. Spillover describes the relationship between work and family—that is, requirements in different roles are similar, or fulfillment is sought in one role because of lack of gratification in others. Caregiver burden is considered intrafamily strain, which is the effect of stressors on families that make members less sensitive and loving to each other (not "interfamily strain").

The school nurse is concerned about the lack of nutritional choices available in the food vending machines at the school. Which is the best tool to address this situation? A) Food-Safe Schools Action Guide B) Health Education Curriculum Analysis Tool C) Improving the Health of Adolescents and Young Adults: A Guide for States and Communities D) Making It Happen!

D) Making It Happen! Ans: D Feedback: Making It Happen! is a health tool that provides examples and success stories of 32 schools and school districts that have implemented innovative approaches to improve the nutritional quality of foods and beverages sold outside the school meals program. Food-Safe Schools Action Guide (FSSAG) helps schools work with Cooperative Extension, health departments, and families in efforts to make schools food-safe. Health Education Curriculum Analysis Tool helps schools, school districts, and other school personnel responsible for curricular redesign to analyze health education curricula on the basis of alignment with national health education standards and characteristics of effective health education curricula. Improving the Health of Adolescents and Young Adults: A Guide for States and Communities helps guide people and organizations through public health processes that address the 21 Critical Health Objectives identified in Healthy People 2010 for adolescents and young adults.

In the Healthy People 2020 federal initiatives in the United States, which group is identified as needing special attention and creative solutions to live a healthy life in the face of sobering health disparities and social injustices? A) Older adults B) People with acute infectious diseases C) People recovering from traumatic accidents D) Mentally ill people

D) Mentally ill people Ans: D Feedback: In the Healthy People 2020 federal initiatives in the United States, the following groups are identified as needing special attention and creative solutions to live a healthy life in the face of sobering health disparities and social injustices: (1) high-risk mothers, (2) chronically ill and disabled people, (3) people living with HIV/AIDS, (4) mentally ill people, (5) substance abusers, (6) homeless people, and (7) immigrants and refugees.

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exemplifies a tertiary prevention strategy for mental health problems? A) Screen for mental health disorders B) Refer high-risk people for diagnostic services C) Provide mental health services following stressful community events D) Promote support groups for people with mental health disorders

D) Promote support groups for people with mental health disorders Ans: D Feedback: Tertiary prevention strategies include promoting support groups for people with mental health disorders and initiating health-promotion activities as a part of rehabilitation services. Secondary strategies include screening for mental health disorders, referring high-risk people for diagnostic services, and providing mental health services following stressful community events.

The community health nurse is using a genogram to aid in the family assessment. What aspect of family connections and relationships is included in the genogram? A) Influence of other systems on families B) Influence of groups on families C) Family relationships and their vital connections D) Relationships across two or more generations

D) Relationships across two or more generations Ans: D Feedback: Genograms are diagrams that show relationships across two or more generations. Ecomaps outline the influence that other systems or groups have on families. They illustrate family relationships and show vital connections, which can include religious, work, cultural, or social groups.

21. The nurse works with a client who was just diagnosed with major depression. Which would the nurse most suspect will be prescribed as the first line of treatment for this client? A) Tricyclic antidepressant (TCA) B) Electroconvulsive therapy (ECT) C) Stimulant D) Selective serotonin reuptake inhibitor (SSRI)

D) Selective serotonin reuptake inhibitor (SSRI) Ans: D Feedback: In general, the SSRIs are the first line of treatment for major depression because they are well tolerated and easy to administer in once-a-day dosing. An older class of antidepressants, TCAs, is a second-line treatment because these antidepressants have strong anticholinergic side effects and dosing has to be gradually titrated before a client reaches a therapeutic level. Both the SSRIs and the TCAs can take 4 to 6 weeks before reaching therapeutic blood levels—a serious concern when working with acutely suicidal clients. For that reason, electroconvulsive therapy (ECT) may be used for clients who are acutely suicidal or exhibiting profound neurovegetative signs of depression. Stimulants are prescribed for those with attention-deficit/hyperactivity disorder.

The case manager for two families with children who have type 2 diabetes is struck by the differences between the families. In one family, the parents are intentional about providing fruits and vegetables for their child to eat, regularly remind him to check his blood glucose level, and make sure that he engages in some sort of outdoor activity every afternoon. In the other family, the kitchen is stocked primarily with potato chips and processed snack foods, the child does not monitor her glucose level consistently, and she spends her afternoons texting or watching videos on the sofa. By this comparison, the case manager realizes how critical the family is in forming the attitude the child has toward caring for his or her own health. Which grand nursing theory does this experience best illustrate? A) Science of Unitary Beings B) Health as Expanding Consciousness C) Roy Adaptation Model D) Self-care Agency

D) Self-care Agency Ans: D Feedback: In the Self-care Agency theory, family is the foundation for self-care and a setting for care. In the Science of Unitary Beings theory, family represents a group energy field and is part of an individual's environment, along with individual patterns. In the Health as Expanding Consciousness theory, families are environments that are active, constantly interacting, and evolving. In the Roy Adaptation Model, roles and relationships within the family are part of family functioning and adaptation.

Epidemiologic studies are essential to target programs to populations in greatest need. To help measure progress toward improving mental health, which is a primary focus of epidemiologic studies? A) Physical costs B) Emotional costs C) Mental costs D) Social costs

D) Social costs Ans: D Feedback: Epidemiologic studies describe the social costs of mental illness and are essential to target programs to populations in greatest need.

The school nurse follows up with a third grader who was recently diagnosed with attention-deficit/hyperactivity disorder (ADHD) to make sure that he takes his prescribed medication. What type of medication would the nurse most suspect this client is taking? A) First-generation antipsychotic B) Second-generation antipsychotic C) Mood stabilizer D) Stimulant

D) Stimulant Ans: D Feedback: The pharmacologic treatment for ADHD is stimulants and for bipolar disorder second-generation—not first-generation—antipsychotics and mood stabilizers.