Ch 20 - Family Health, Chapter 15: Health in the Global Community, Chapter 14: Environmental Health, Chapter 13: Cultural Diversity and Community Health Nursing

In what way is the U.S. approach to primary health care inconsistent with the World Health Organization (WHO) approach? a. Our primary health care system does not provide universal coverage to all citizens. b. Most U.S. citizens can afford health care through employer insurance plans. c. Tertiary care is preferred over primary care. d. U.S. hospitals make maximum use of the newest and best technology.

ANS: A As a market-based society, the United States does not focus on primary health care and does not provide coverage to all U.S. citizens. Few managed care models propose universal access or the comprehensive primary health care that WHO, U.S. President Barack Obama, and the late Senator Edward Kennedy advocate. DIF: Cognitive Level: Understand (Comprehension) REF: p. 278

Most of a country's citizens have died from malnutrition or as the result of violence. Which of the following conclusions can be drawn? a. Their country has a problem with an adequate water supply for agriculture. b. They live in a country where weather interferes with food crops. c. They live in a developed country involved in a war. d. They live in a developing country.

ANS: D Infections, malnutrition, and violence are the primary causes of mortality in developing countries. Cardiovascular disease, cancer, respiratory disease, stroke, violence, and traumatic injury are the primary causes of mortality in a developed country. The problem of malnutrition is broader than examining the environment associated with growing the country's food supply. DIF: Cognitive Level: Understand (Comprehension) REF: p. 274

When a nurse visited a client's home, it was apparent that the client had not begun to implement the needed exercise program. Rather, the client had been doing drawings about his illness experience. Which of the following actions would be most appropriate for the nurse to take next? a. Express admiration for his artistic ability, and do not schedule future visits because the patient is noncompliant b. Point out the negative consequences that will ensue if the client does not begin exercising c. Review with the client why exercise is so crucial to his recovery d. Suggest drawing might be more forceful after exercising

ANS: D The dominant cultural value is action oriented, so the client would be expected to have begun to exercise. Dominant cultural values include an emphasis on productivity and being busy. However, some persons are not action oriented but being oriented, with a focus on expression of impulses and desires. DIF: Cognitive Level: Apply (Application) REF: p. 227

When making a home visit, a nurse is usually expected to focus attention on the ill family member. But whom would the nurse possibly focus on instead? a. The children who are being affected by the stress of the situation b. The ill family member's primary caregiver c. The spouse of the ill family member d. The neighbors of the family who may be able to help

B. The ill family member's primary caregiver Changes in family patterns, fears, emotional responses, and expectations of individual family members can be assessed in the family interview. Special needs of the primary caretaker (i.e., often the spouse, daughter, or daughter-in-law) must be assessed

Beyond gathering needed information for future interventions, which of the following purposes is served when the nurse interviews the family? a. Assessing the safety of the immediate environment before further planning can be done b. Establishing a process for the nurse and the family to make decisions c. Engaging in focused planned conversation, which has healing potential in itself d. Focusing on giving compliments to make the family feel good about themselves

C. Engaging in focused planned conversation, which has healing potential in itself The second key element in the interview is the therapeutic conversation. This type of conversation is focused and planned and engages the family. The nurse must listen and remember that even one sentence has the potential to heal or help a family member. Every encounter, whether brief or extended, has "healing potential."

The nurse has started to complete a family health tree. Which of the following questions would be most helpful as the nurse works with the family to promote their health? a. "Can you tell me the cause of death of your older relatives back several generations?" b. "Do you know of any chronic health problems any of your relatives or their spouses have had?" c. "What concerns do you have about your family's health?" d. "What do your family members do to keep in shape and handle stress?"

D. "What do your family members do to keep in shape and handle stress?" The family health tree is based on the genogram of the current generations—that is, parents, their children, and their own parents. Spouses and past generations aren't included. The family health tree provides a mechanism for recording the family's medical and health histories. The nurse should note causes of death of deceased family members, genetically linked diseases, and lifestyle-related risk factors (i.e., by asking what family members do to "handle stress" and "keep in shape"). The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination

Which of the following definitions of family would be the most useful for the nurse practicing in the community? a. A group of persons with shared convictions b. A social unit interacting with the larger society c. People descended from a common ancestor d. Persons related either by blood or by legal contract (marriage) e. Whoever the family says is in their family

E. Whoever the family says is in their family Although some believe even these definitions are too narrow, the widest definitions are "the members of the family are self-defined" and "the family is who they say they are."

Which of the following groups makes up about 30% of the world's population? a. Children b. Elderly c. Teenaged adolescents d. Caucasians

ANS: A According to the World Health Organization, in 2007, 30% of the world population consisted of children and 8% of the population were over age 60. The percentage of teenaged adolescents and Caucasians is not reported in the text. DIF: Cognitive Level: Remember (Knowledge) REF: p. 273

Which of the following actions has been most effective in reducing HIV infections in some countries? a. ABC campaign b. Free HIV immunizations c. Religious leaders stressing abstinence or faithfulness in monogamous marriages d. Public health workers distributing free condoms

ANS: A Substantial reductions in HIV seroprevalence occurred after several countries deployed "ABC" (Abstinence, Be faithful, Condom use) strategies. There is not an immunization available to prevent HIV. The ABC strategy involves use of all three strategies, not just abstinence or condom use. DIF: Cognitive Level: Understand (Comprehension) REF: p. 274

Which of the following statements best describes how the Centers for Disease Control and Prevention (CDC) differs from its many peer agencies? a. It focuses primarily on prevention. b. It is a uniquely American approach to problem resolution. c. It responds to health emergencies. d. It uses years of experience as the basis for its actions.

ANS: C The CDC applies research and findings to improve people's daily lives and responds to health emergencies—something that distinguishes the CDC from many of its peer agencies. Other peer agencies of the CDC also are involved in focusing on primary prevention, using an American approach to problem resolution, and using years of experience as the basis for action. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

Which of the following theoretical approaches would be most useful to the nurse who wants to improve patient-provider communication and address the gap between what providers discuss and what families want to know about? a. Ecological framework b. Network therapy theory c. The Kentucky Partnership model d. Transaction model

A. Ecological framework The ecological framework is a blend of systems and developmental theory with an individual's understanding of his or her environment. Kogan and others investigated parent-health care provider discussions of family and community health risks during well-child examinations, as well as the gaps in issues discussed by the practitioner and the information the parent desired. The results indicate the need for better communication and education between health care providers and clients.

Why are health care providers concerned over such social issues as mass transit, clean power, and the farming industry? a. Because air pollutants are contributors to asthma and other health problems. b. Clean power would reduce the pollution that results from burning of high-sulfur coal. c. Manure runoff from industrial farming is polluting water and killing fish throughout the United States. d. Mass transit would remove the problem of so many Americans being killed or injured by drunken or impaired drivers.

ANS: A All three (mass transit, clean power, and industry) emit air pollutants, which result in smog, the most common outdoor air pollutant in the United States. Atmospheric pollutants cause or contribute to asthma, allergic reactions, bronchitis, lung cancer, chronic respiratory disease, and death. They also harm animals and plants. The most inclusive answer refers to air pollutants, although certainly, the others are true in society today. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 256-257

Which of the following strategies should be used to lower the risk of malaria among the world's population? a. Distribute insecticide-treated nets and antimalarial medications b. Educate people to keep their windows closed at night c. Spray neighborhoods with insecticides to kill any mosquitoes present d. Spread DDT on bodies of water to prevent larva growth

ANS: A Effective low-cost strategies are available for malaria's prevention, treatment, and control, including insecticide-treated nets and new-generation medications such as artemisinin-based combination therapies. It would be very dangerous to spray neighborhoods with insecticides, which also contaminate food. DDT has been banned in the United States for many years because of its long-term harmful effects on the environment, including food animals. Keeping the windows closed at night is not going to prevent the threat that occurs during other times of the day. DIF: Cognitive Level: Understand (Comprehension) REF: p. 274

In a client's culture it is exceedingly rude to ask any questions about income or wealth. Which of the following actions should be taken by the nurse to draw conclusions about the client's socioeconomic status (SES)? a. Ask about the client's education or employment position b. Ask his or her religious leader to share such information with the nurse c. Let the financial office deal with the problem d. Refer the issue to the social worker who has better sources of information

ANS: A SES may be determined by examining income, occupation, and educational level. If that is not possible, age, gender, possessions, location of residence, religion, and race may also be considered. DIF: Cognitive Level: Apply (Application) REF: p. 228

Which of the following best describes the challenges when providing care to someone from a minority group? (Select all that apply.) a. Communication, both words and gestures, may be unfamiliar. b. Few members of the minority group are nurses themselves. c. Immigrants will soon adapt to the mainstream culture, but in the meantime many are clinging to "the old ways." d. So few patients are minority group members that it is difficult to remember how they prefer to receive care. e. The nurse may have to confront personal values and beliefs.

ANS: A, B, E Nurses must understand how patients define health and illness, how their cultural group cures and cares for members, and how the nurse's personal cultural background influences the way in which care is delivered. The context and process of helping people involves at least two people who often have different cultural orientations and lifestyles. Very few nurses are members of a minority group. Although immigrants may adopt some of the ideas of the mainstream culture, many will continue to use traditional practices and the nurse must be aware and respect these cultural beliefs. Many minority group members represent the patient population who receives care, so nurses must be aware and respect these cultural beliefs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 222 | p. 224 | p. 233

A nurse is caring for a client from a different culture. Which of the following actions would be the most helpful for the nurse to take? a. Ask to have a nurse from that culture assigned to the patient even if the nurse must be obtained from a different clinical area b. Be aware of cultural similarities and differences between the nurse and the client c. Explain that the patient must follow the rules of the hospital while a patient d. Verbalize the nurse's own discomfort, and ask for assistance with surmounting the cultural differences

ANS: B Recognizing both similarities and differences is being culturally aware. Although it would be helpful to have a nurse from the same culture give care, that is often not feasible. A nurse from another area cannot be expected to be clinically expert, to say nothing of the legal problems of having a nurse from a different agency give care. Asking the patient for help makes the problem belong to the patient, but it is the nurse's problem. Asking the patient to comply with the hospital regulations is being culturally insensitive. DIF: Cognitive Level: Apply (Application) REF: p. 244

Which of the following actions was taken by the federal government to help improve health disparities among minorities? a. Created scholarships and traineeships only for minority applicants b. Created the National Center on Minority Health and Health Disparities c. Established grants that funded only minority health projects d. Legislated funds to create new colleges for preparing health professionals in minority neighborhoods

ANS: B The National Center on Minority Health and Health Disparities was developed in 2000 to assist in the investigation of factors affecting minority health. Its mission is to promote minority health and to ultimately eliminate health disparities. The federal government did not create scholarships and traineeships specifically for minority applicants, establish grants for minority health projects, or legislate funds to create new colleges to address the improvement in health disparities. DIF: Cognitive Level: Understand (Comprehension) REF: p. 241

What would be an appropriate term for intoxicated drivers, secondhand smoke, urban crowding, noise, and mechanization? a. Risks of living style b. Risks in the built environment c. Personal health risks d. Modern day health risks

ANS: B The built environment is the connection between people, communities, and their surrounding environments that affect health habits and behaviors, interpersonal relationships, cultural values, and customs. Most people live within areas that require almost daily contact with potential health risks and threats, such as intoxicated or impaired drivers, secondhand smoke, urban crowding, noise exposure, unabated traffic, and the stress of increased mechanization. DIF: Cognitive Level: Understand (Comprehension) REF: p. 253

A nurse became frustrated because after each interview question there was a long pause before the client responded. Which of the following actions should be taken by the nurse? a. Accept the hesitation before receiving an answer b. Ask the client what silence after a question means c. Copy the client's behavior; insert a pause before asking the next question d. Recognize that the client was distracted, and reschedule the home visit

ANS: B Wide cultural variation exists when interpreting silence. Some individuals find silence uncomfortable, whereas others use silence to show understanding and respect. Because the nurse is uncomfortable, action should be taken. The only way to know the meaning of the silence is to ask. DIF: Cognitive Level: Apply (Application) REF: p. 233

Which of the following describe a problem with the U.S. water quality today? (Select all that apply.) a. Companies demand high reimbursement when asked to stop dumping heavy metals into local water sources. b. Many aquifers are contaminated with pesticides and fertilizers. c. More than 45 million Americans drink untreated water. d. Sediment from construction, agriculture, and deforestation is often present. e. Underground water, if contaminated, cannot be cleansed. f. Water-related diseases (cholera, typhoid, dysentery) frequently occur.

ANS: B, C, D, E More than 45 million Americans obtain water from private wells, which have no treatment or monitoring guidelines. Water quality problems include dosing reservoirs with chemicals to reduce algae, contaminating aquifers with pesticides and fertilizers, and leaching lead from water pipes. Underground water cannot be cleansed. Companies demand high reimbursement when asked to stop dumping heavy metals into local water sources and the frequent occurrence of water-related diseases (cholera, typhoid, dysentery) are not current problems with the water quality in the United States. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 258-259

Which of the following are the most important factors in reducing disparities in health outcomes between different cultural groups? (Select all that apply.) a. A strong family structure b. Access to a health care provider c. Access to transportation d. Health care insurance e. Having ongoing employment f. Owning one's own home

ANS: B, D Disparities in health care can be reduced or even eliminated when adults have health care insurance and a medical home defined as a setting that provides patients with timely, well-organized care and enhanced access to providers. According to the Commonwealth Fund (2007), when adults have insurance and a medical home, "their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially." Thus, having a strong family structure, access to transportation, ongoing employment, and owning one's own home are not nearly as important as having health insurance and a medical home. DIF: Cognitive Level: Understand (Comprehension) REF: p. 223

Which of the following have been identified as part of the core environmental health competencies? (Select all that apply.) a. Assurance b. Assessment c. Policy development d. Management e. Advocacy f. Communication

ANS: B, D, F The National Center for Environmental Health, the Centers for Disease Control and Prevention, and the American Public Health Association have established three core competencies for Environmental Health professionals: (1) assessment, (2) management, and (3) communication. Assurance, policy development, and advocacy are not part of the core environmental health competencies. DIF: Cognitive Level: Understand (Comprehension) REF: p. 264 | p. 265

Which of the following helps to balance the fact that poverty is typically a major factor in certain groups having poorer health? a. A strong community health center in the neighborhood b. Intact families where fathers are married to children's mothers c. Strong family and community support for healthy behaviors d. The large number of programs available to be of assistance in fighting poverty

ANS: C Latino children who live in poverty enjoy relatively good health compared with children in other low socioeconomic groups. It is believed that strong family-community support fosters optimum family health behaviors. Many of these behaviors are integrated into the culture as part of the family identity, traditions, and history. Without strong family and community support having other resources in the community is insignificant. Strong support structures can exist in communities where fathers are not married to children's mothers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 240

A nurse set up a clinic appointment for Friday of the following week. An Arab patient asked to come earlier in the week. As those days were heavily booked, the nurse left the appointment on Friday. The patient was a "no show." Which of the following best explains what happened? a. A lot of people do family errands such as shopping on Fridays, Saturdays, and Sundays. b. It was inconvenient for the client so he did not come. c. A Muslim's holy day is from sunset Thursday to sunset Friday. d. Patients do not like being told what to do.

ANS: C The nurse should know the days of religious worship. Protestants usually worship on Sundays; Muslims' day of worship is from sunset Thursday to sunset on Friday; and Jews and Seventh-Day Adventists' holy day is from sunset on Friday to sunset on Saturday. The other responses do not address the recognition by the nurse of the significance of the days of worship that were indicated as a priority for the client when an appointment was requested for earlier in the week. DIF: Cognitive Level: Apply (Application) REF: p. 230

What was the importance of the Lalonde Report, which proposed the "health field concept" in 1974? a. It first called attention to the growing problem of air pollution. b. It first emphasized the importance of basic hand washing. c. It first emphasized influence of lifestyle and environment. d. It was the first report that suggested a link between smoking and lung cancer.

ANS: C This report emphasized lifestyle and environment as determinants of health outside the traditional medical sphere. It became the basis for rethinking new paradigms for health care delivery. The report signaled the early beginnings of a health care paradigm shift from the traditional medical model to a more holistic system-environment perspective. The report did not call attention to the problem of air pollution, emphasize the importance of basic hand washing, or suggest a link between smoking and lung cancer. DIF: Cognitive Level: Understand (Comprehension) REF: p. 278

Which of the following statements best describes what tobacco companies have done to counter their losses resulting from U.S. efforts to decrease smoking tobacco? a. Begun advertising in more subtle ways such as sponsoring sports programs or building and naming large sport arenas b. Bought off more restrictions on tobacco through the tobacco settlement funds, which gave a large amount of money to each state c. Increased international exports and targeted children d. Rapidly decreased their tobacco components and focused on other products

ANS: C Tobacco control and secondhand smoke policies have been implemented at various political levels in the United States and abroad. To continue their profits, the tobacco industry has targeted youth and dramatically increased international exports. The tobacco industry has not begun to focus on other products, changed to more subtle advertising, or bought off more restrictions on tobacco as ways to counter their losses. DIF: Cognitive Level: Understand (Comprehension) REF: p. 274

The clinic was seeing a great number of Hmong immigrants from the mountainous regions of the Far East. If the nurse could not obtain a translator, which of the following would be the next best action? a. Require each patient to bring a family member fluent in English b. Start teaching Hmong patients English on each clinic visit c. Suggest Hmong patients might be more comfortable seeking care elsewhere d. Try to make flash cards with common phrases used during clinic visits

ANS: D If a translator is not available, the nurse can try many approaches such as pantomime, but it would also be helpful to have common phrases used with many patients on flash cards so basic information can be obtained. Other Hmong patients or family members should not be used as interpreters. It is unrealistic to teach English to patients at clinic visits. This population needs care, so suggesting that they receive care elsewhere is not a therapeutic response by the nurse. DIF: Cognitive Level: Apply (Application) REF: p. 234

Which of the following aspects of health care could be learned by a developing country from a developed country? a. Acceptance of illness or disease as a learning experience b. Effective ways to treat chronic disease c. Use of healthy behaviors to prevent illness d. Delivery of primary health care

ANS: D Likewise, developed countries have much to learn about low-technology initiatives such as oral rehydration therapy for the treatment of diarrhea and the delivery of primary health care as defined by the World Health Organization. The other behaviors such as acceptance of disease, effective ways of treating chronic disease, and use of healthy behaviors to prevent illness would most likely be passed on from developed countries to developing countries. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 277-278

An unidentified patient was injured in a hit-and-run accident and was conscious. When asked how he felt, the patient looked very confused and responded in a language the nurse did not recognize. Which of the following actions should the nurse take next? a. Look closely at the person, try to determine the patient's ethnic background, and then seek someone fluent in his language b. Report the language barrier to administration, and let them handle the problem c. Tell the unit supervisor so various translators can be brought to the floor until the language is recognized and communication can be established d. Use gestures and pantomime until the nurse is able to determine what language the patient is speaking

ANS: D The nurse can report the problem and request a translator, but in the meantime the nurse should pantomime words and simple actions while verbalizing them until communication can be established using a translator from his culture. Just looking at a patient will not allow you to assume his or her ethnic background. DIF: Cognitive Level: Apply (Application) REF: p. 234

Which of the following are examples of the internal structure of the family? a. Ethnicity and race b. Extended family members c. Gender and rank order of birth d. Social class and religion

C. Gender and rank order of birth Internal structure of the family refers to such items as family composition, gender, rank order (by age and sex), subsystems through which the family functions, and boundaries or who is in and who is not in the family system. Extended family members are part of the external structure.

Which of the following is a major barrier to a nurse caring for the family as a whole? a. Families often don't want to know what is wrong with their loved one. b. Nurses don't know how to care for families. c. Reimbursement is paid only for services given to an individual. d. The family often isn't available when the nurse is giving care.

C. Reimbursement is paid only for services given to an individual. As a result of the current era of cost containment, constraints on the community health nurse will increase. Reimbursement is almost entirely calculated for services rendered to the individual and thus is a major constraint toward moving toward planning care for the family as a unit.

Which of the following statements best describes how a family can meet the needs of society? a. By living and existing in the wider community b. By meeting the needs of the individual family members c. Through procreation and socialization d. Through productivity seen in employment positions

C. Through procreation and socialization The family fulfills two important purposes. The first is to meet the needs of society, and the second is to meet the needs of individual family members. The family meets the needs of society through procreation and socialization of family members.

Which of the following best describe why it is crucial that nurses who focus on the care of individual patients also be able to work with families? (Select all that apply.) a. Anytime a person is ill, his or her whole family is affected. b. By understanding the family, understanding of the individual is improved. c. Families often are very demanding if they feel their loved one isn't receiving the best care possible. d. Individuals depend on their families for care and support. e. Most important decisions are made by families as a whole, not individuals. f. Risks caused by genetics or environment affect the whole family, not just the individual.

A, B, D, F Reasons that it is important for nurses to work with families include that the family is a resource in giving care to its members and working together on health promotion and wellness activities; any dysfunction (illness, injury, separation) that affects one family member will affect the whole family; the nurse can often identify a health problem that involves risks for the entire family. Finally, understanding the whole family helps the nurse understand and provide more holistic care to the individual.

Which of the following factors make family nursing particularly challenging? (Select all that apply.) a. The health care system primarily focuses on care of individuals. b. Insurance reimbursement focuses on illness care and treatment of individuals. c. Family members are not always consistent in what they tell the nurse. d. More variables to be considered when completing an assessment e. Number of chronic comorbidities f. Most theories focus on intervention with individuals.

A, B, F Families have challenging health care needs that are not usually addressed by the health care system. Instead, the health care system most frequently addresses the individual. Traditionally, nursing has relied heavily, if not solely, on theoretical frameworks from the disciplines of psychology or social psychology, which target individuals.

A nurse was creating an ecomap for a family, which consisted of a 3-year-old girl, an 8-year-old boy, and their mother. Which of the following questions would be useful for the nurse to ask? a. "Are you involved with any groups or resources in the community?" b. "Can you tell me about your extended family wherever they live?" c. "Have you thought about what would happen if you needed help?" d. "What were the causes of death for your older family members?"

A. "Are you involved with any groups or resources in the community?" The ecomap is another classic tool that is used to depict a family's linkages to their suprasystems. The nurse can note people, institutions, and agencies significant to the family with some notations as to the nature of the ties that exist. Knowing what resources the family is currently able to assess will help the nurse know what resources to suggest to the family

A nurse asked of a family, "Could each of you tell me what you typically do during the week?" Which of the following would the nurse most likely say to follow up such an open-ended question? a. "Could you tell me about what you do at your job?" b. "Do you believe those choices are the best use of your free time?" c. "How do you feel about those activities?" d. "Is there anything you would like to do differently?"

A. "Could you tell me about what you do at your job?" Both of these questions pertain to data collection for the family health tree. The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination.

A young son was so physically fidgety that his mother was seriously embarrassed by his inability to be quiet and involved in the interview. Which of the following comments by the nurse would be the most helpful? a. "Isn't it marvelous how much energy your son has?" b. "Is there something your son could be doing for you that would use some of that energy?" c. "Is your son always so fidgety? Have you discussed his behavior with his pediatrician?" d. "Why don't you let your son go to his room until we're finished?"

A. "Isn't it marvelous how much energy your son has?" Sending the son to his room might be seen as punitive and would remove him from being informed about interventions planned and decisions made. A compliment reinforces family strengths and tends to further progress toward open trusting relationships. The comment took a flaw (physically fidgeting) and reframed it as an asset (high energy)

The current school year is now over, and the school health nurse spends time summarizing the records of all the children who had come into the school health office during the past school year. Which of the following best explains the rationale for this action? a. Because analysis can help establish priorities for future health programs b. Because annual reports are expected by the school board c. Because it's very personally rewarding to see all the help one has given throughout the year d. Because the nurse has to justify the school health office budget for each year

A. Because analysis can help establish priorities for future health programs Community health nurses (CHNs) are employed in ambulatory care centers, occupational health and school sites, housing complexes, day care programs, residential treatment and substance abuse programs, and other official and nonofficial agencies. At each of these sites, CHNs meet families and can assess and intervene at the family and community levels The challenge is to focus not only on individual students but extend practice to the whole school community of children. Fiscal constraints hold the nurse accountable for the best delegation of scarce resources. In times of limited budgets, the school health nurse, on the basis of the most frequent problems presented in the office, can draw conclusions as to what are the major health needs of children in the community. On the basis of those conclusions, health programs can be planned to maximize health promotion and disease prevention in the school.

Which of the following is an appropriate conclusion to draw from research based on network therapy theory? a. Nurses can help at-risk populations access or build support systems. b. Problems in our health care system are worsened by specialization and fragmentation. c. Social class places limitations on access to health care. d. The family is culturally anchored in American beliefs.

A. Nurses can help at-risk populations access or build support systems Network therapy theory involves changing the network of families, be it extended family or friends, who tend to maintain a dysfunctional status quo in the nuclear family. The nurse can help the family replace or expand their network with other resources from the wider system that would be able to provide more support and enhance family functioning

The local stream was full of trash. The Boy Scouts had a cleanup day so they could again canoe on the stream. Which of the following actions should be taken by nurses in the local community? a. Hold a dialogue with community members about the problem and its effects b. Fight for stronger "do not trash" laws and harsher penalties c. Lecture community organizations about the value of safe water for recreation d. Put all personal trash in appropriate trash receptacles

ANS: A An important nursing goal is to help people learn from their own experiences and analyze the world with an intention to change it. It is essential that those affected participate in the process of identifying and working to solve environmental problems. The nurse's role is to ask critical questions and help groups reflect on the environmental realities of their lives. The only way for the nurse to promote this involvement is through a dialogue with the community members. DIF: Cognitive Level: Apply (Application) REF: p. 265

Which of the following nongovernment organizations (NGOs) is active in improving health on a global scale? a. Carter Center b. Centers for Disease Control and Prevention (CDC) c. Pan American Health Organization d. UNICEF

ANS: A Collaborating with the United Nations are NGOs such as the Carter Center. The CDC is a governmental agency. The Pan American Health Organization is an international public health agency. UNICEF is an international agency. DIF: Cognitive Level: Remember (Knowledge) REF: p. 275

A woman who spoke English was an immigrant from the Middle East, attending the clinic for the first time with two female friends. When a male nurse attempted to get a health history, the woman refused to respond to his questions. Which of the following actions should be taken by the nurse? a. Ask a female nurse to talk with the client b. Ensure that the client has privacy, with the two female friends waiting outside before trying again c. Explain that the woman cannot see a physician until the nurse obtains a health history and does an initial examination d. Stress that the clinic is free and she does not have to pay extra to see both the nurse and the physician

ANS: A He should ask a female nurse to talk with the client. Many culture groups have strong norms regarding appropriate gender behavior. Norms are the rules by which human behavior is governed and result from the cultural values held by the group. All societies have rules or norms that specify appropriate and inappropriate behavior. Individuals are rewarded or punished as they conform to, or deviate from, the established norms. Thus, this woman is likely to not deviate from these cultural norms and should be given the opportunity to speak with a female nurse. The other responses do not address the cultural needs regarding gender that this client needs to have addressed. DIF: Cognitive Level: Apply (Application) REF: pp. 225-226

Which of the following has been a common result in countries with a severe HIV/AIDS epidemic? a. Birth rate is high, but life expectancy is only 35 to 40 years. b. Free clinics have begun distributing condoms to stop the spread. c. International aid has begun to lower the infection rates. d. Missionaries are establishing orphanages within their churches.

ANS: A In countries severely affected by the HIV/AIDS epidemic, life expectancy has dropped to 35 to 40 years. In these countries, the working age population has dwindled while the birth rate has risen. International aid, orphanages, and condom distribution may be present in these countries; however, the main problem is that the birth rate is high and life expectancy is short. DIF: Cognitive Level: Understand (Comprehension) REF: p. 273 Which of the following best explains why many people decide to move to large urban areas? a. To be eligible for social aid b. To be with friends c. To join family who are already there d. To seek employment @ANS: D As the world population grows, a global trend toward urbanization occurs; people live closer together and migrate to urban areas for employment. Thus, most people are choosing to move into these urban areas for employment. Being closer to friends and family or being eligible for aid may also occur with the move to the urban area, but it is not the main reason why people are deciding to move. DIF: Cognitive Level: Understand (Comprehension) REF: p. 273

A nurse is called by a friend who complains of symptoms of a cold. Which of the following responses would be the most appropriate by the nurse? a. Ask the friend what she usually does for a cold and suggest that be done b. Tell her to go to the urgent care center for assistance c. Suggest that she make an appointment to see her health care provider d. Point out to her that nurses are unable to treat patients

ANS: A Seventy percent to 90% of all illness episodes are treated first, or exclusively, through self-care, often with significant success. Symptoms of a cold do not seem to require drastic action such as going to the urgent care center or seeing a health care provider. Engaging in traditional healing interventions, learned in the family, will be comforting and probably will help. DIF: Cognitive Level: Apply (Application) REF: p. 238

A patient had wrapped a tummy band around her newborn's abdomen. What should the nurse say to the new mother? a. "Can you explain to me the purpose of wrapping a band around the baby's tummy?" b. "In the hospital, we prefer to expose the umbilical cord to air so it's easier to put medication on it as it dries up." c. "Let me put some medication on the baby's cord, and then I'll put the tummy band back." d. "Please remove that band; it is not helpful as the umbilical cord needs to be kept clean and dry."

ANS: A Unless a particular action is harmful, the nurse should engage in culture care preservation and maintenance. Before acting, it is helpful to know why the mother is engaging in this behavior. If the mother responds, "I'm not sure; it's just always been done," the nurse can educate the mother on how to care for the cord. If the mother appears to believe the tummy band is very important, the nurse can cooperate with the behavior, because tummy bands will not hurt the baby. DIF: Cognitive Level: Apply (Application) REF: p. 223

A woman comes to the clinic, and the nurse believes that she is speaking French. She seems to understand English. A provider will need to complete a physical examination to confirm the health problem. Which of the following actions should be taken by the nurse? a. Ask the client if she prefers a male or female provider b. Ask a female provider to assume care c. Ask the physician provider to see her immediately d. Ask the secretary in the office who speaks French to assist in collecting a health history from the client

ANS: A When in doubt, the best way is to ask the client about culturally relevant aspects of male-female relationships. This should be done at the beginning of the interaction before an opportunity arises to violate culturally based practices. It is not appropriate to ask other staff members to serve as interpreters during nurse-client interactions. DIF: Cognitive Level: Apply (Application) REF: pp. 234-235

What have been the foci of international nursing research? (Select all that apply.) a. Development of home care or transition from hospital to home b. Diverse clinical experiences c. Educational exchange programs for students and faculty d. How to integrate technology into developing country health care systems e. How to use a career in nursing to change the cultural expectations of gender roles f. The importance of sharing resources with poverty stricken countries

ANS: A, B, C Since 1990, international nursing research has focused predominantly on the following three areas: (1) student and faculty educational exchange programs, (2) diverse clinical experiences, and (3) the international development of home care or transition from hospital to home. International nursing research has not focused on integrating technology into the health care systems of developing countries, using a career in nursing to change cultural expectations of gender roles, or the importance of sharing resources. DIF: Cognitive Level: Understand (Comprehension) REF: p. 279

Which of the following aspects of a developed country would be most worthwhile to be copied by a developing country? a. Education of health care professions b. Health care reform policies to improve health care delivery c. Advanced technology with its miracle interventions and cures d. Our approach to rationing health care

ANS: B Although transferring specialized medical technologies from developed to developing countries may not always be appropriate, developing countries are currently learning from health care reform policies and the technological revolution in developed countries. The health care reform policies will improve healthcare delivery and be more helpful than changing the education of health care professionals. There is not a rationing approach to health care services in the United States that could be used by other countries. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

A client, accompanied by her son, spoke only Spanish while the nurse did not. Which of the following actions should be taken by the nurse to best meet the client's need? a. Ask the woman if it's OK if the son translates for her b. Call until she finds a Spanish interpreter employed by the agency c. Let the son translate because he's obviously informed about the problem d. Use gestures and pantomime to make oneself clear

ANS: B Asking the son would violate confidentiality, and gender issues may also arise. The only safe approach is to obtain a Spanish interpreter who is knowledgeable about medical terminology and procedures, as well as comfortable with cultural beliefs and health prac- tices. It is important to have an interpreter rather than trying to make gestures and pantomine so that the communication between the nurse and client is clear and accurate. DIF: Cognitive Level: Apply (Application) REF: p. 233

When using an environmental perspective, which of the following would be the most important question for a nurse to ask when assessing potential health problems? a. "Can you tell me how you have been feeling?" b. "Can you tell me what you do at work?" c. "What brings you here today?" d. "What problems have you been having?"

ANS: B Because 25% of worldwide preventable illnesses are caused by poor environmental quality, nurses need to ask critical questions about their clients' work and home environments to help discern the contributions of specific hazards to their health. This can be accomplished by an environmental health history. The other responses do not address a question that would be addressed during an environmental health history. DIF: Cognitive Level: Understand (Comprehension) REF: p. 250

In a community presentation about asthma, a nurse explained the causes of asthma in children, how to observe for "triggers" that lead to an attack, and how to use an inhaler. Which of the following statements best identifies what was omitted from this presentation? a. The nurse did not ask the attendees to disclose if any of them smoke around children. b. The nurse did not address actions that should be taken to improve air quality and only focused on the treatment of asthma. c. The nurse did not address the need to avoid exposure to others who may have a communicable disease. d. The nurse did not review the genetic components related to asthma in families.

ANS: B By placing responsibility for the cause and cure of health problems exclusively on the individuals, the belief is reinforced that all individuals are free to control their lives. Such a perspective absolves society, government, industry, and business from accountability. Research suggests that changing individual behaviors does not lead to significant reductions in overall morbidity and morality in the absence of basic social, economic, and political changes. Thus, the nurse must include information in the presentation that addresses the need to improve air quality. DIF: Cognitive Level: Apply (Application) REF: pp. 263-264

How does critical theory differ from other nursing theories such as the health belief model or Orem's self-care deficit theory? a. Critical theory can be used by professionals other than nurses. b. Critical theory focuses on oppression and facilitates group action. c. Critical theory is not directly related to health promotion. d. Critical theory confronts changing an individual's beliefs.

ANS: B Critical theory is an approach that raises questions about oppressive situations, involves community members in the definition and solution of problems, and facilitates group interventions. The other two theories focus more on individual beliefs and choice of action. DIF: Cognitive Level: Understand (Comprehension) REF: p. 250

Which of the following statements best defines Leininger's term "culture universal"? a. The preference to be cared for by someone from their own cultural group for maximum ease and comfort b. The commonalities of values, norms, and life patterns that are held in all cultures c. The particular values, beliefs, and patterning of behavior that is universal within a particular culture d. The health care roles, norms, and behaviors that are involved when illness or injury occurs

ANS: B Culture universal is used by Leininger to refer to the commonalities of values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles and form the basis for formulating theories for developing cross-cultural laws of human behavior. DIF: Cognitive Level: Understand (Comprehension) REF: p. 223

At a military base, a family from Qatar, a Muslim Arabic country, came in to the prenatal clinic because the wife believed she was pregnant. Which of the following providers would be the most appropriate choice for this client? a. A male obstetrician, expert in high-risk pregnancies b. The female nurse midwife c. The male obstetrician with a female nurse always in the room with the wife d. Whichever provider was on duty until the pregnancy was confirmed

ANS: B During pregnancy, many female clients will prefer female health care providers and may refuse to be examined by a man. People from Arab Muslim countries feel even more strongly about males touching a female. DIF: Cognitive Level: Apply (Application) REF: p. 234

Which of the following best describes why a nurse working in a U.S. urban area should be knowledgeable about infectious diseases common to areas of Africa? a. Nurses have an ethical commitment to care for others throughout the world. b. Every infectious disease is just one airplane ride away. c. Infection could occur if a nurse goes out in public. d. Nurses meet people who may originally have been born elsewhere.

ANS: B Infectious diseases do not recognize or respect country borders. With rapid international travel, an infected person could easily be in any country in a very short period of time. Problems throughout the globe can threaten human life. Although nurses have an ethical commitment to provide care, infections can occur anywhere, and nurses may care for populations who were originally born outside of the United States, the primary need for the nurse to have this knowledge exists because infectious diseases can spread throughout the world in a very short period of time because of the ease of travel in the world. DIF: Cognitive Level: Understand (Comprehension) REF: p. 272

Which of the following conclusions can be drawn concerning efforts to decrease environmental pollution? a. The Environmental Protection Agency (EPA) sets priorities for environmental problems and funds action. b. Federal policies have been weakened, and enforcement lacks funding. c. Federal recycling mandates have decreased waste products. d. Legislation is increasingly being passed to force companies to lower toxic waste emissions.

ANS: B Legislation in the 1970s was aimed toward a comprehensive national environmental policy. The momentum slowed in the 1980s, with policies being reversed and regulation losing its funding. This trend has continued. The EPA sets rules but lacks resources to accomplish the goals. There are no federal mandates for recycling, but local communities have made great strides in this area. DIF: Cognitive Level: Understand (Comprehension) REF: p. 262

Which of the following statements best define epidemiological transition? a. A change from morbidity due to a particular infectious disease to a different infectious disease b. A change from mainly infectious diseases to chronic diseases c. A change in infectious diseases caused by a difference in agent, host, or environment d. A change in life spans of various age groups in a specific country

ANS: B Many developed countries experienced an epidemiological transition from having an infectious disease profile to having a chronic disease profile and are now plagued by chronic diseases. Once plagued with high rates of infectious disease, developed countries significantly reduce high mortality rates from these diseases through improved sanitation, nutrition, and immunization and improved health care. Most developed countries have a more stable economy and a wide range of industrial and technological development. These countries experience an epidemiological transition. The other statements do not define epidemiological transition. DIF: Cognitive Level: Understand (Comprehension) REF: p. 274

Before interviewing an Hispanic family, what is the most important action for the nurse to take? a. Compliment each member on some visible asset b. Establish rapport, and gain trust and confidence c. Greet them in Spanish even if badly spoken and accented d. Recognize the male as the authority figure in the family

ANS: B Regardless of the culture of the client family, it is crucial to establish rapport and gain trust and confidence before attempting to gather data. First impressions are important and the nurse should ensure a mutually respectful relationship is created. Thus, starting by providing compliments, greeting them with poor Spanish, or assuming that the male is the authority in the family may all lead to an unacceptable first impression of the nurse to the family. DIF: Cognitive Level: Apply (Application) REF: p. 231 | p. 232

It has been learned that a particular industry has vastly polluted the surrounding neighborhood. Which of the following actions would most likely be taken by those living in the neighborhood? a. Band together to shut the industry down b. Nothing, because of family ties and cost of relocation c. Immediately move to a different neighborhood d. Seek legal reimbursement for the hazard exposure

ANS: B Residents may be unwilling to disrupt family ties and cultural roots to start over elsewhere, or they may be unable to afford to move. Residents are revictimized by the difficulty in obtaining compensation. Attempting to shut the industry down, seeking reimbursement for the hazard exposure, and immediately moving to a different neighborhood are all costly interventions and in most cases cannot be easily accomplished by most residents. DIF: Cognitive Level: Apply (Application) REF: p. 254

A woman stood very close to the nurse and asked a question about her husband's condition. The nurse took a step back and shared the requested information. No other questions were asked. Was this a successful interaction? a. No, because the nurse should not answer any questions about a client, even if the wife is the one asking b. No, because the woman and the nurse had different perceptions of personal space c. Obviously yes, because the woman sought information, received it, and had no further questions d. Yes, because the nurse was knowledgeable and able to respond appropriately

ANS: B Sense of spatial distance is significant because culturally appropriate distance zones vary widely. Many cultures stand closer for important conversations, whereas the nurse stepped back because being so close made the nurse uncomfortable. DIF: Cognitive Level: Apply (Application) REF: p. 232

Which of the following issues exists from communities using solid waste landfills to dispose of trash from private residences? a. Landfills are too wasteful, as solid waste can be burned to produce energy. b. Methane gas may move through the soil to cause fire or explosions nearby. c. There is an ongoing need to purchase more land as landfills eventually fill up. d. People do not use landfills but dump their garbage anywhere they will not be seen.

ANS: B Solid waste landfills accumulate methane gas, a by-product of decomposing organic wastes. Without proper venting, this volatile gas can move through soil and cause fires and explosions in nearby areas. Waste incineration is not the best solution because it causes particulate air pollution. Illegal dumping of garbage and purchasing additional land for more landfills are concerns related to the disposal of trash from private residents, but methane gas explosions is of primary concern. DIF: Cognitive Level: Understand (Comprehension) REF: p. 261

Which of the following nongovernmental groups has been expending millions of dollars to reduce the impact of infectious diseases with profound effect on prevention and treatment for HIV/AIDS, tuberculosis (TB), and malaria? a. Carter Center b. Bill and Melinda Gates Foundation c. Families for Freedom Foundation d. Bradley Foundation

ANS: B The Bill and Melinda Gates Foundation has local, national, and global objectives. Globally, the foundation focuses on reducing extreme poverty, improving health, and increasing public library access. Within Africa, the foundation has had a profound effect on improving access to antiviral medications and prevention and treatment for HIV/AIDS, TB, and malaria. The objectives of the Carter Center are to prevent and resolve conflicts, to enhance freedom and democracy, and improve health. The Families for Freedom Foundation provides education and support to families who are affected by deportation. The Bradley Foundation supports public policy organizations and conservative causes. DIF: Cognitive Level: Remember (Knowledge) REF: p. 277

Which of the following statements best describes how the population of the United States is changing? a. Growth will occur because of a decrease in the death rate. b. Growth will occur because of ongoing immigration. c. Growth will occur because of an increase in the birth rate. d. Growth will occur because of lengthening of the normal life span.

ANS: B The number of immigrants and refugees in the United States is projected to continue to increase. The U.S. has grown largely through immigration. The growth will not occur because of changes in death rate, birth rate, or life span. DIF: Cognitive Level: Understand (Comprehension) REF: p. 222

Which of the following best describes a food desert? a. The inability to store foods at an acceptable temperature b. The inability to have healthy foods at home c. A neighborhood with little to no access to healthy foods d. A neighborhood that has experienced a recent food-borne illness

ANS: C A food desert is a neighborhood with little or no access to healthy foods. There are significant disparities in access to healthy and fresh food supplies, with poor minority families being more likely to live in a food desert. The other responses are not the correct definition of a food desert. DIF: Cognitive Level: Understand (Comprehension) REF: p. 259

A nurse felt very good about an Asian man who had responded positively to the instructions given to him. Later, the nurse heard him tell his wife that there was no way he could implement the suggestions. Which of the following best describes the problem that the client is experiencing? a. Polite response may not equal agreement. b. Men do not take instruction from women. c. His culture may value harmonious relationships over expressing disagreement. d. The nurse told him what to do but did not ask if he could do it.

ANS: C Asian clients may provide the nurse with the answers they think the nurse wants to hear. This behavior is consistent with their cultural value for harmonious relationships with others. The other responses do not recognize this cultural variation among this population that the nurse should recognize. DIF: Cognitive Level: Apply (Application) REF: p. 233

What is meant by discriminatory land use? a. Backlash against companies that do not protect the environment b. Daily insults to people who live in a particular community c. Locating industrial hazards in low-income communities d. Political recognition that companies support a safe environment

ANS: C Discriminatory land use ensures that many impoverished and marginalized groups, especially people of color, live in close proximity to industrial contamination. Members of these communities are at risk for illness and injury. The other responses do not correctly define discriminatory land use. DIF: Cognitive Level: Understand (Comprehension) REF: p. 253

Which of the following best explains why it is difficult to get others interested in environmental health? a. Environmental problems just are not interesting or dramatic. b. It's difficult to get media interested. c. People respond more to an acute crisis than chronic environmental problems. d. People respond more to an individual asking for help than a community asking for help.

ANS: C People respond to acute crises with dramatic media coverage (such as hurricanes or earthquakes), but ongoing consistent pressure is needed to ensure day-to-day environmental integrity. Chronic environmental problems are rarely addressed effectively. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 251-252

Which of the following statements supports why it is believed that the risks of various employment positions are inaccurate? a. Companies refuse to share employee injury information. b. Because factories reimburse employees directly, the injury is not reported. c. Individuals assume it is a personal problem, not an employment issue. d. Most employment positions do not have known risks.

ANS: C Statistics do not reflect unreported health problems. Collective problems related to employment or occupation are often perceived as individualized injuries, and no one "connects the dots." Companies are willing to share employee injury information and recognize the risks of employment, but the information may be inaccurate because of the perception of individualized injuries. DIF: Cognitive Level: Understand (Comprehension) REF: p. 254 | p. 256

Which of the following assumptions underlies the Declaration of Alma-Ata? a. Communities should be encouraged to cooperate with national health goals. b. Gross inequalities and disparities will always exist. c. Health is a fundamental human right. d. Public health agencies are responsible to plan and take action to improve health.

ANS: C The concept of primary health care stresses health as a fundamental human right for individuals, families, and communities; the unacceptability of the gross inequalities and disparities in health status; the importance of community involvement; and the active role of all sectors. DIF: Cognitive Level: Understand (Comprehension) REF: p. 275 | p. 276

Crying, a clinic patient explained that she knew she had this breast lump because she had spread nasty gossip about her neighbor. Which of the following actions by the nurse would likely be the most successful? a. Explain the causes of a breast lump and the usual treatments b. Refer the woman for an immediate biopsy to determine the status of the lump c. Suggest that she has to repent and as much as possible undo her sin, but also make an appointment for a biopsy d. Suggest that she has to repent, apologize to her neighbor, and pray for forgiveness

ANS: C The woman has expressed a magico-religious perspective on illness. Because evil has caused her illness, she must undo the evil. However, the nurse, as a practitioner of the biomedical perspective, must also arrange for a biopsy as soon as possible so treatment can be begin. DIF: Cognitive Level: Apply (Application) REF: p. 236

Which of the following statements best describes the relationship between the environment and health? a. Because of the large number of variables involved, the relationship between environment and health cannot be researched. b. Because the environment has such long-term effects on health, research findings are not yet available. c. Research shows that a healthy environment has limited impact on one's health. d. Research shows that a healthy environment increases quality of life and years of healthy living.

ANS: D A healthy environment increases quality of life and years of healthy living. Accumulated evidence shows that the environmental changes of the past few decades have profoundly influenced the status of public health. Globally, environmental factors contribute to nearly 25% of all deaths and increase disease burden (World Health Organization, 2006). The safety, beauty, and life-sustaining capacity of the physical environment are unquestionably of global consequence. DIF: Cognitive Level: Understand (Comprehension) REF: p. 250

The nurse made a follow-up appointment for a client at the clinic, but the client did not come. Two days later the client presented at the clinic explaining that a temporary job had come up and he could not come back until he had finished and been paid for that job. Which of the following actions should be taken by the nurse next? a. Explain that patients are seen by appointment only, and set up another appointment for the client b. Reinforce the need to plan ahead before arranging another appointment c. Stress that health is the number one priority, and try to fit the client in sometime the same day d. Understand that some clients are present oriented, and fit the client in so care can be given

ANS: D Although health care systems are set up according to the expectation that clients can plan for the future, some clients focus on the present with little attention to the future. For the patient to receive care, the nurse should try to fit him in that day. Setting up an appointment would possibly be useless because the client may not attend the future appointment either. Poverty-stricken persons would be wise to accept employment when it becomes available. DIF: Cognitive Level: Apply (Application) REF: p. 226

Which of the following actions should be taken by a small community group who hopes to accomplish goals against a large powerful corporation? a. Appeal to the chief executive officer's conscience b. Ask the corporation's employees to encourage change c. Begin legal action to force the corporation to change d. Form coalitions with other groups that have similar goals

ANS: D Brainstorm about all possible groups that might have a stake in the outcome of the issue. Nurses can help make connections with larger, more powerful organizations. DIF: Cognitive Level: Apply (Application) REF: pp. 265-266

A nurse was assigned to create and implement a community education program with the goal of preventing diabetes among the Hispanic population. As the nurse did not speak Spanish and was just beginning to be comfortable with the neighborhood Hispanic culture, which of the following would be the best approach for the nurse to take? a. Be sure to use appropriate images in the handouts. b. Copy literature and procedures found successful in other Hispanic communities. c. Tell the supervisor the nurse is not competent for this task. d. Try to find Hispanic volunteers who may be able to do the actual teaching.

ANS: D By using volunteers, the program can disseminate culturally appropriate information in a culturally appropriate way. The success of educational efforts is often determined by the credibility of the source and the sensitivity of the speaker in communicating information in a culturally appropriate manner. DIF: Cognitive Level: Apply (Application) REF: p. 239

After being given negative news about a health problem, the client, with tears running down her face, asks, "Why did this happen to me?" Which of the following is the most appropriate response by the nurse? a. "Could someone have cursed you?" b. "Do you feel your life is out of balance?" c. "God has a plan for each of us even if we do not understand it." d. "Why do you think it might have happened?"

ANS: D Each response represents a particular belief about illness, but without knowing the patient's perspective, the wrong one could easily be chosen. It is difficult to be comforting without knowing the client's beliefs about the causation of illness. The best way to discover this is to query the patient. DIF: Cognitive Level: Apply (Application) REF: p. 235

When one woman asked her friend to stay while a painful procedure was done, it was explained that only one immediate family member could be in the room. The woman asked the nurse, "How do you define family?" Which of the following would be the best response by the nurse? a. "A person's husband, wife, or children" b. "Anyone related to you by law or by blood ties" c. "Someone who lives with you and has ties of commitment" d. "Whoever you tell us is your family"

ANS: D Families are changing from the norm of husband, wife, and children to single parents, blended, extended, committed, or cohabitation with domestic partners. Consequently, rather than debate the definition of family, it is more practical and comprehensive to ask the client whom he or she considers to be family. DIF: Cognitive Level: Apply (Application) REF: p. 227

Which of the following is a direct result of global warming? a. Decreased prevalence of infectious diseases b. Increased water pollution from soil erosion c. Decreased protection from the ozone layer d. Increased number of parasites and insects

ANS: D Global warming is the gradual increase in the average temperature of Earth's near-surface air and oceans since the mid-twentieth century and its projected continuation (Easterling, 2011). Rising global temperatures may enhance the quantity and distribution of parasites, insects, and other disease vectors, potentially increasing the prevalence of a variety of infectious diseases. DIF: Cognitive Level: Understand (Comprehension) REF: p. 262

Which of the following statements best describe why environmental health is more challenging than other variables related to an individual's health? a. Environmental health affects susceptible individuals more than groups. b. Environmental health demands that individuals be willing to change their beliefs. c. Environmental health is dependent on social neighborhoods, as well as geography. d. Environmental health requires social, economic, and political changes to improve.

ANS: D Intervening to improve environmental conditions requires basic social, economic, and political changes. Aggregates must work together to create such change. The other responses do not address the multiple dimensions that must be impacted in order to impact change within environmental health. DIF: Cognitive Level: Understand (Comprehension) REF: p. 250 Which of the following nursing actions would be the most helpful to the community's long-term health? a. Careful assessment, diagnosis, planning, and giving care to individual patients and their families b. Dialogue with community members concerning what health issues are of importance in that community c. Focusing on family health through school-based neighborhood clinics d. Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations @ANS: D The ultimate goal is liberating people from health-damaging environmental conditions by using collective actions. Mechanisms have included strategic organization, litigation, public hearing testimony, letter-writing campaigns, legislative lobbying, and mass demonstrations. Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations shows how collective action can be applied. The other interventions do not demonstrate the use of collective action. DIF: Cognitive Level: Understand (Comprehension) REF: p. 251

Which of the following is one of the biggest threats faced by developing countries that are trying to grow economically and make a better life for their citizens? a. Lack of education and knowledge b. Political unrest c. Environmental hazards d. Large population

ANS: D Large populations create pressure. In developing countries, famine, trade problems, and war may occur. Malnutrition, disease, or death may result. The poor suffer excess mortality and morbidity. Quality of life is less. Overcrowding leads to pollution, stress, disease, and violence. Each of these challenges represents a major barrier to economic growth. Thus, the large population can cause there to be problems with lack of education, political unrest, and environmental hazards. DIF: Cognitive Level: Understand (Comprehension) REF: p. 273

A nurse made a home visit for prenatal care and teaching for an Asian woman. The nurse noted the woman was having a hot lunch of foods the nurse did not recognize. When the nurse suggested some appropriate cold protein foods be added to the meal, the woman looked horrified and distrusting. Which of the following best describes what has happened in this situation? a. The interference with eating seemed incredibly intrusive and inappropriate. b. The nurse was giving advice when advice had not been sought. c. The nurse had suggested foods unknown to the woman. d. The yin and yang theory requires only hot food be eaten when female yin energy is dominant.

ANS: D Many Asians ascribe to the yin-yang theory in which health is believed to exist when all aspects of the person are in perfect balance. Yin energy is female. Yin Yang foods are hot. Therefore to maintain balance, she has to eat hot foods. Thus, in the other responses the nurse is not considering the cultural background and needs of the client in this situation. DIF: Cognitive Level: Apply (Application) REF: pp. 235-236

A nurse was responsible for setting up a health fair with free pizza being served during lunch. The nurse observed a few people who did not eat but just talked quietly during lunch. Which of the following actions should be taken by the nurse? a. Assume it was a religious fast day, and not worry about it b. Discuss with the supervisor what are traditional foods in that neighborhood c. Offer to let those who did not eat take the leftover pizza home for a meal later in the day d. Talk to the group, and ask what foods might have been more acceptable

ANS: D Many ethnic groups prefer certain foods as part of their cultural identity. The nurse should take this opportunity to learn foods preferred by the community. It cannot be assumed a supervisor would know preferred foods of the community. Making assumptions about the community or offering the leftovers to those who did not eat would not be culturally sensitive approaches for the nurse to take with this population. DIF: Cognitive Level: Apply (Application) REF: p. 230

A nurse was explaining a problem to the client so the client could make an informed decision about alternative treatment approaches. The client responded, "The doctor will choose the best treatment. Do whatever the doctor says." Which of the following actions should be taken next by the nurse? a. Ask if the client would like to discuss the choices with her family b. Explain that the client has to decide, and wait for the client's decision c. Explain that physicians cannot decide; perhaps the client could just flip a coin? d. Nothing; simply accept that some fatalistic-oriented clients literally do not know how to choose e. Suggest that the client discuss the situation with her ancestors and wait for guidance

ANS: D One of the three ways people are oriented is destiny, in which people must endure and accept whatever comes in a fatalistic, inevitable manner, as destiny cannot be changed. The other responses do not address the perspective of destiny that has been indicated by the client in the initial response. DIF: Cognitive Level: Apply (Application) REF: p. 226

How does participatory action research differ from other research methods? a. Participatory action research does not use a control group. b. Participatory action research does not require randomization. c. Participatory action research is not based on a predetermined hypothesis. d. Participatory action research poses solutions to the problem.

ANS: D Participatory action research calls for nurses, community members, and other resource people to work together in identifying health problems, designing the studies, collecting and analyzing the data, disseminating the results, and posing solutions to the problems. The research process (use of control groups, randomization, and using a predetermined hypothesis) is part of participatory action research. DIF: Cognitive Level: Understand (Comprehension) REF: p. 266

Which of the following is the leading cause of lung cancer among nonsmokers? a. Secondhand smoke b. Living near a nuclear power plant c. Exposure to pesticides d. Radon gas

ANS: D Radon exposure is the leading cause of lung cancer among nonsmokers in the United States. It is estimated that radon causes an estimated 21,000 lung cancer deaths every year. DIF: Cognitive Level: Understand (Comprehension) REF: p. 258

Which of the following best describes how the United Nations (UN) is able to implement its decisions? a. Asking for funding from all member nations to obtain appropriate resources b. Through five permanent members of its security council c. Sending military units to developing countries d. Using its moral authority and world opinion

ANS: D Regardless of size, wealth, or political system, all member nations have an equal vote in the decision-making process. UN decisions reflect world opinion and the moral authority of the community of its 192 nations. The UN does not ask for funding from all member nations, as some of the nations do not have additional funds to provide to the UN. The security council is unable to implement decisions without support from all of the member nations. It is not feasible for the UN to send military units to developing countries to implement their decisions. DIF: Cognitive Level: Understand (Comprehension) REF: p. 275

A baby was dehydrated because of diarrhea. The mother explained that she had finally gone to a folk healer who told her to give the baby herbal tea, which did seem to be helping a bit, but the baby still seemed ill. Which of the following statements would be the most appropriate reply by the nurse? a. "Folk healers cannot cure such problems; let me give you appropriate fluids for your baby." b. "Let's go back to feeding the baby formula, and see how the baby does." c. "You continue to give the baby herbal tea, but let's put some sugar and salt in the tea." d. "Your healer is correct; fluids are crucial for your baby. Let me give you some special fluids for you to give the baby."

ANS: D Rejecting the folk healer's advice may cause the mother not to trust Western medicine. If possible, the nurse should build on what the mother is doing. It is usually helpful to include any behaviors that may be helpful or neutral in effect. In this case, the mother is encouraging fluid, which is crucial, and tea is boiled, so the water is clearly safe. Just adding salt and sugar is risky because of the need for careful measurement. Nothing in the example suggests the nurse recognizes what kind of tea is being given. It is easier to give the mother fluids with the appropriate electrolytes while supporting at least some aspect of the healer's advice. It must be remembered that most indigenous healing practices are innocuous. DIF: Cognitive Level: Apply (Application) REF: p. 224 A nurse carefully explained that the medication had to be taken three times a day, with each meal. The patient came to the clinic with symptoms of medication overdose. How should the nurse respond? a. "Can you explain what you believe happened to make you so ill now?" b. "Can you tell me when in the day you and your family eat?" c. "Please review with me when I taught you to take your medication." d. "Why did you take more medication than we suggested?" @ANS: B It is not helpful to confront the patient or accuse someone of noncompliance. A review of the prescription may have been helpful, but because the patient had an overdose, one might assume the medication is being taken more than three times a day. The nurse has engaged in cultural imposition—that is, assuming the patient's beliefs, values, and patterns of behavior are identical to hers. Not everyone eats exactly three times a day. The family may eat more or less than three times a day. DIF: Cognitive Level: Apply (Application) REF: p. 224

Which of the following would be the best example of service learning? a. Student nurses collecting gloves and coats to distribute to the homeless b. Student nurses distributing food on plates at a "feed the hungry" site c. Student nurses employed as nursing assistants for minimum wage on the weekends d. Student nurses volunteering at the free clinic doing health assessments

ANS: D Service learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities. Volunteering at a free clinic to perform health assessments is the best example of how this definition can be applied. Collecting gloves and coats and distributing food, while allowing the student to volunteer, does not allow the student to apply materials learned in the classroom. Student employment cannot be considered volunteering of services to the community. DIF: Cognitive Level: Apply (Application) REF: p. 284

Which of the following strategies should a nurse use to remember what should be included in a health history? a. Always use a preprinted form b. Depend on education to learn this c. Depend on experience to know what to ask d. Memorize the I PREPARE mnemonic e. Memorize the I HEALTH mnemonic

ANS: D The I PREPARE environmental exposure history mnemonic is a quick reference for primary care providers. I—Investigate Potential Exposures P—Present Work R—Residence E—Environmental Concerns P—Past Work A—Activities R—Referrals and Resources E—Educate This tool will help the nurse remember what to ask to determine environmental factors relevant to health. DIF: Cognitive Level: Understand (Comprehension) REF: p. 262

A nurse reviewed the treatment the surgeon recommended for a woman's breast lump. When the nurse asked the woman if she could be admitted to the hospital for immediate surgery, the husband thanked the nurse for her time and said they would get back in touch after they speak with other family members. Which of the following actions would be most appropriate for the nurse to take? a. Ask if there was some reason the woman could not be immediately admitted for treatment b. Explain to the woman why postponing the surgery was dangerous c. Point out it that it's the woman's decision, and stress that she should go to the hospital immediately d. Recognize that the husband and other family members may need to have input into this decision

ANS: D We typically focus on the individual as the central figure in decisions about the self. However, in other cultures female clients may seek assistance from other members of the family and allow male relatives to make decisions about important health-related matters. The husband has indicated by his response that collateral relationships are valued, thus decisions about the client may be interrelated with the influence of illness on the entire family or group. The other responses do not address the value of collateral relationships that the nurse must recognize and address. DIF: Cognitive Level: Apply (Application) REF: p. 227

A nurse asked a family if they'd work with her to create a family genogram. The mother asked, "Why would you want to know so much about our family?" Which of the following would be the most appropriate response by the nurse? a. "A genogram helps you see how some problems run in families. Your children will need to know this." b. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." c. "Please be assured you don't have to answer any question you don't want to answer." d. "Why would you want to keep your family members secret? Is there some problem?"

B. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." A genogram is an excellent opening to the discussion of family history and possible hereditary health problems. It may also point to a need for health education. Some families may be sensitive to the sharing of such information, but obviously any patient can answer with however much or little he or she wishes to share

Which of the following questions is crucial to ask very early in a family interview? a. "Do you see any way this problem could have been avoided—so future problems could be prevented?" b. "What do you all, as a family hope to achieve during your time with me?" c. "What would you like me to do for you today?" d. "Would you like to know my perception of what our goals together should be?"

B. "What do you all, as a family hope to achieve during your time with me?" Therapeutic questions are key questions that the nurse uses to facilitate the interview. One important basic theme is to determine the family's expectations of the interview or home visit.

Which of the following best describes what is meant by cohabitation? a. A living arrangement in which one adult is employed and the other is unemployed b. A living arrangement in which an unmarried couple in a long-term relationship lives together c. A living arrangement between two members of the same sex d. A living arrangement between two single mothers with children

B. A living arrangement in which an unmarried couple in a long-term relationship lives together The most comprehensive definition of cohabitation is a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage. One of the key aspects of this definition is the long-term relationship which is not mentioned in the other definitions.

A nurse is completing a first assessment interview with a family after entering the family's apartment for the first time. Which of the following would be crucial for the nurse to remember? a. Analyze the power relationships before focusing on needed information b. Be on best behavior with manners and courtesy, starting with a self-introduction c. Determine as soon as possible who makes decisions within the family d. Evaluate the safety of the immediate environment for self and the family

B. Be on best behavior with manners and courtesy, starting with a self-introduction Manners are common social behaviors that set the tone for the interview and begin the development of a therapeutic relationship. The nurse introduces himself or herself by name and title and always addresses the client and family members by name (i.e., Mr., Mrs., or Ms., unless otherwise directed by client).

Which of the following best describes why a nurse would ask about the meals of all family members, rather than focus on a nutritional history for the post-myocardial infarction patient? a. It is assumed that all family members eat the same food at the same time each day. b. Lifestyle choices among family members are usually consistent. c. Many parents eat whatever their children don't rather than throw away good food, so the nurse should know what the children eat. d. The nurse was afraid to assume that whoever cooked would only prepare one meal for everyone to share.

B. Lifestyle choices among family members are usually consistent. The family remains the focus because families experience similar risk factors (i.e., physiological, behavioral, and environmental). Family health practices influence lifestyle habits among family members. Consequently, although family members may or may not eat together, they will have a tendency to make similar choices.

A nurse needed to help a child who was not behaving consistently with the requirements of the new preschool program that began that fall. Which of the following actions would be most appropriate for the nurse to perform? a. Meet with the child each day to let the child have a safe play environment without the regular program frustrations b. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school c. Meet with the child's teacher to brainstorm ways to help the child cope with school requirements d. Point out to the child that if behavior doesn't improve, the child won't be able to play with all the other children at the school

B. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school The teacher can be assumed to be an expert in dealing with small children. If the problem is defined as a child not behaving within expectations, the most effective approach would be to discuss with the parents how to help the child. Systems theory provides direction in understanding how health care providers can expand family capacity by changing parenting and therefore changing child behaviors.

A family agreed to bring all the children in to the clinic at one time to begin to catch up on the children's immunizations, but they didn't keep their appointment. Which of the following conclusions by the nurse would be most accurate? a. Obtaining immunizations might have been the nurse's goal, not the family's. b. Some barrier or restraint interfered with the family's ability to come. c. The family had other, more important priorities. d. The nurse didn't adequately emphasize the importance of obtaining immunizations.

B. Some barrier or restraint interfered with the family's ability to come. Families most frequently served by the community health nurse are disadvantaged in that they are unable to buy health care from the private sector. However, constraints to obtaining needed health and social services are well documented and may come from characteristics of health and social services rather than individual family limitations. The nurse should note those constraints that prevent full use of the resource such as hours of service, distance and transportation, availability of interpreters, and criteria for receiving services

A 36-year-old woman had diabetes diagnosed at a free health-screening program at a large employer. Which of the following should be emphasized by the nurse when helping the woman make an appointment at the diabetic clinic for follow-up testing and treatment? a. "Bring a food diary of everything you've eaten for one week with you to the appointment to help with future meal planning." b. "It's really not that hard to learn how to inject insulin, and it really doesn't hurt." c. "Please encourage all your family members, including your parents, to be tested for diabetes as well." d. "They'll teach you how to manage your meals and medications to stay healthy."

C. "Please encourage all your family members, including your parents, to be tested for diabetes as well." Although the nurse might make any of these comments, it is particularly important that the rest of the family also get tested. Any problem that affects one or more family members probably affects other family members and the family as a whole. Commonalities in risk factors and diseases shared by family members can lead to case finding within the family. Because families often choose similar foods and engage in similar lifestyle behaviors, they all are at similar risk for problems such as diabetes. The earlier the diagnosis and treatment, the more likely it is that secondary problems can be avoided.

Each evening, a newly disabled man becomes angry when his wife, just home from her new full-time job, does not have dinner on the table at 6 PM. Which of the following actions would be most appropriate for the nurse to take? a. Allow the wife to express her frustration and anger to you b. Explain to the husband that he is going to have to begin learning how to cook c. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone d. Suggest to the children who are old enough that they prepare some simple meals during the week with the mother doing the fancy cooking only on weekends

C. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone Roles refer to established patterns of behavior for a family. It takes other family members to keep a person in a particular role. Traditional roles are being challenged and are evolving with economic changes. Formal roles may come into conflict with roles set by family members. The husband has major life changes to which to adjust, as do all the other family members. His anger is a symptom of the painfulness of major life changes. The nurse can help the family members recognize the problem in preparation for addressing the issues.

A mother says to the nurse, "I know I should be feeling an empty nest sadness now that our youngest has left for college—but mainly I'm dying to turn his room into my craft room. Do you think that's normal for a mom? I really do love my kids." Which of the following would be the most appropriate response by the nurse? a. "Hmm, that is unusual. Would you like me to make an appointment with a psychologist for you?" b. "Maybe you've always wanted to be an artist and now you can, so enjoy the feeling—and the room!" c. "You're probably trying to put a positive spin on the situation to keep feelings of sadness at bay." d. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." e. "Would you like to talk about how you feel?"

D. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." To assess the family, the community health nurse must comprehend developmental phases and the struggles that families experience while going through them. The mother is recognizing the stage of launching family that occurs when the youngest child leaves home. The development requirement of this stage of life includes establishment of independent identities for parents—such as focusing on becoming a crafts person.

A man had been in an extended-care facility for five weeks and was now home. His wife tells the nurse, "He's trying to take up where he left off but we've adapted to not having him home. He keeps thinking things will be just as they were when he left, but they aren't." Which of the following would be the most appropriate response by the nurse? a. "Are the changes making him uncomfortable or are the rest of you uncomfortable?" b. "Do you want me to talk to him and try to explain?" c. "How can we make things as they were before he left?" d. "You all adapted to running the house without him; it will be challenging now to adapt back."

D. "You all adapted to running the house without him; it will be challenging now to adapt back." Family functional assessment, or how family members behave toward one another, is divided into two categories. The first is instrumental functioning, which refers to routine activities of daily living. This area takes on important meaning for the family when one member of the family becomes ill or disabled and changes were made. When the family member is better, the family must again adapt to changes, even if the change is to return to the original mode of functioning. It will help the family to be able to recognize the problem; labeling it makes it more manageable.

What has research suggested is a barrier to college students eating healthy? a. Lack of access to an exercise facility b. Lack of access to a primary care provider c. Lack of knowledge of the benefits of healthy eating d. Lack of knowledge related to food preparation

D. Lack of knowledge related to food prep Young adults, though identified as underinsured and having limited access to primary care, are identified as a group knowledgeable about the benefits of healthy eating. This age group (20-31) has been identified in numerous national surveys to not regularly engage in healthy eating habits especially eating below the recommended daily servings of fruits and vegetables and a diet high in fast foods. Earlier studies among college students identified the following barriers: cost, stress, lack of knowledge related to food preparation, and peer influence and lack of time to balance busy lives.

Record data demonstrated that there were a very large number of children in the school district whose insurance plan was the Children's Health Insurance Program (CHIP). Which of the following conclusions would be accurate for the nurse to make? a. There are a large number of parents who know how to abuse government programs. b. There are a large number of homeless families. c. There are a large number of unemployed poverty-stricken families. d. There are a large number of working, low-income parents.

D. There are a large number of working, low-income parents CHIP has greatly increased access to health care for many low-income children. The majority of these children live in families with working, low-income parents.

A family came in to discuss a problem with one of their children. Which of the following family behaviors would be concerning to the nurse? a. Each family member made supportive comments about each other. b. Every Sunday the family attends religious services together. c. Family members made humorous comments about their life together. d. The family seemed to rather quickly determine priorities for action. e. The family wanted the nurse to decide what they should do.

E. The family wanted the nurse to decide what they should do. Traits of a healthy family include open communication, ability to establish priorities, being supportive of each other, sharing a religious core, having a sense of humor, and knowing when to seek help. However, healthy families also engage in decision making and do not want others to make decisions for them.

Which of the following best describes what proportion of children live in a single-parent family? a. Fewer than 10% b. 11%-15% c. 16%-20% d. 21%-26% e. More than 30%

E. More than 30% In 2012, 34% of all U.S. children lived in single-parent homes

Which of the following statements best describes what has happened to air quality since the United States outlawed the use of chlorofluorocarbons, halons, and carbon tetrachloride? a. Air quality immediately improved. b. Air quality is slowly improving. c. Little change occurred because these chemicals remain in the atmosphere. d. Nothing has happened because other countries worldwide continue to extensively use these products.

ANS: C These chemicals, which were in widespread use, remain in the atmosphere. Thus, air quality has not improved. This is a global concern and is being addressed worldwide by the World Health Organization. DIF: Cognitive Level: Understand (Comprehension) REF: p. 257

A nurse was teaching a class on good hygiene at a local day care center when one child volunteered, "I have two mommies." Which of the following would be the most appropriate response by the nurse? a. "Don't tell anyone; that's a secret." b. "That's nice—why did you share that?" c. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." d. "Which mommy is your real mommy?"

C. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." The Human Rights Campaign (2009) urges that health professions acknowledge all types of families including gay, lesbian, and even grandparents as heads of family.

Which of the following best describes an unexpected result of the decrease in funding to traditional public and private forms of health care? a. Emergency departments where patients can't be turned away are overwhelmed with patients needing nonemergency care. b. Grants are increasingly being requested to pay for care. c. More people don't receive needed health care in a timely manner. d. Programs are developed as a result of community efforts.

D. Programs are developed as a result of community efforts Most of the choices are expected consequences of decreased funding. What is unexpected is the increase in the number and type of models being created, as traditional public and private models of health care decline because of funding and shrinking resources. The programs develop in part as the result of community efforts.