Chapter 25 Communicable Diseases, Community Final Exam - Chapter 22 "Homeless Population", Chapter 24: Populations Affected by Mental Illness, Community Chapter 30 Occupational Health, Chapter 31 Forensic and Correctional Nursing, Chapter 28 Natural...

true statements about the federal emergency management agency include

- FEMA provides funding for emergency programs and provides technical guidance and training - FEMA's response to a disaster is influenced by the severity of the disaster's impact on the community - FEMA is part of the department of homeland security - FEMA works closely with state and local governments - FEMA provides both direct aid and indirect services

what are the Health People 2020 objectives for rural populations r/t healthcare?

- access to care: increase primary care providers and sources of ongoing care, and decrease delays in necessary care/meds - cancer: increase behaviors that reduce UV exposure and sunburn

what is the poverty index?

- based on a calculated "adequate living wage" for the size of the family and the cost of necessary goods - people who fall below this line are considered poor

what are some topics of concern for urban populations?

- lack of steady employment - racial discrimination - poor quality of life - high infant mortality rate - ghetto counterculture - urban sprawl - programs for healthier urban people

what are the 3 general categories of health problems among the homeless?

1) health problems that contribute to the state of homelessness 2) health problems that are the consequence of homelessness 3) and treatment of health problems that is complicated by homelessness

what age group has the highest rates of binge drinking?

21-25

: p. 584 26. What is the typical effect of a restraining order? a. It depends; it would work only if the woman went to a shelter and stayed there. b. Negative; such an order will only make the man angrier and consequently more abusive. c. Positive; statistics suggest such orders do reduce contact, threats, violence, and injury. d. It will have a minimal effect one way or the other.

: C Evidence suggests that restraining orders actually are effective in reducing contact, threats, violence, and injury from an abusive partner, although certainly they sometimes do not have these effects. DIF: Cognitive Level: Comprehension

13. Who should create a disaster plan including emergency supplies and where to meet in case of an emergency? a. All families b. All government officials c. All public health employees d. Members of Congress and the Supreme Court

A

A community health nurse is meeting with a group of individuals who have been diagnosed with a serious mental illness. The nurse interprets this to mean which of the following? A. The clients have impaired level of functioning and quality of life. B. The clients' disorder is chronic and persistent. C. The clients have issues of impaired control and dependency. D. The clients have a significant behavior syndrome with present distress.

A

A new home health nurse realized that what was being observed and now being said by the client were very inconsistent with what had been documented while the client was hospitalized. What conclusion should be drawn? a. Amount of support available to the client is often different from what client stated earlier. b. The client had difficulty distinguishing truth from falsehood. c. The client had to admit the truth when it was obvious to the nurse. d. The family was embarrassed by their living situation.

A

What is the best use of the nurse's time while en route to the client's home? a. Assess the surrounding neighborhood and the exterior of the client's home b. Begin the client record using a computer or oral recording device c. Look for appropriate places to obtain food, fuel, or rest stops for the nurse d. Look to see if another home health agency might be closer to the client's home

A

Which employee is eligible for leave under the Family and Medical Leave Act ?

A female employee who has worked for a large metropolitan hospital full time for 1 year and requests 3 months' leave to care for her dying mother

Which of the following persons will have the most difficulty in obtaining adequate support services to find a long-term home?

A homeless person who has a mental illness and is an alcoholic

23. What is often found when female prisoners are interviewed for their health histories? Select all that apply. a. A history of physical and sexual abuse b. Evidence of active tuberculosis c. Extensive tattooing and body piercings d. Personal use of drugs and alcohol e. Positive test results for HIV and hepatitis f. Previous childbirth with living children

A, D, F

20. What might be the result of a medicolegal death investigation? Select all that apply. a. Clarification of the unnatural circumstances in which death occurred b. Court testimony as to cause of death based on evidence c. Consultation with defendant's attorney for a fee d. Consultation with prosecuting attorneys for a fee e. Death certificate with cause and manner of death f. Permission to use deceased organs for transplant

A, E

21. How would a legal nurse consultant best prepare for testifying in court as an expert witness? Select all that apply. a. By carefully analyzing the client's medical record and related documents b. By creating a PowerPoint slide presentation to help educate the jury c. By helping to examine all the witnesses in preparation for the court trial d. By personally doing or observing the autopsy on the deceased e. By preparing charts and tables illustrating the important legal points f. By summarizing the literature regarding the standard of care

A, F

An ICU manager is discussing a nurse's frequent absences and tardiness, which the nurse explains results from unreliable child care. The nurse states, None of the other nurses mind if I am late or have to miss a shift. My kids are important to me. I'd do the same for any of them. This is an example of which situation?

Absence culture

Coaching and discipline have failed and the nurse manager is faced with no alternative but to terminate an employee. Which aspect of this situation requires the most careful planning? A. When the termination will occur B. How to keep the human resources department informed C. Accurately documenting all stages of the situation D. Whether the termination will adversely affect unit staffing

Accurately documenting all stages of the situation

Which of the following statements best reflects the model of justice U.S. health care is based on?

All people have a right to whatever their own efforts allow them to purchase.

Which of the following individuals would be described as being "doubled up"?

An individual who is forced to live with friends

In what way is a hospice nurse different from any nurse who gives care to a client in the context of their family and home environment? Select all that apply. a. Hospice nurses approach care in a holistic fashion. b. Hospice nurses continue to support the family after the client has died. c. Hospice nurses focus more on care and comfort than cure and control. d. Hospice nurses are expert in both physical and psychosocial care. e. Hospice nurses are more skilled at pharmaceutical pain management. f. Some hospice nurses see patients at home and others in institutions.

B, C

13. Why are health care providers concerned over such social issues as mass transit, clean power, and the farming industry?

Because air pollutants are contributors to asthma and other health problems. 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.

Which of the following factors is strongly predictive for homelessness among women veterans?

Being unmarried

19. What sorts of behavior would you expect to see when a disaster first strikes a community? a. A sense of all is still okay and one can rebuild and go on b. Anger and despair that help offered is insufficient, slow, and inadequate c. Everyone tries to help strangers, as well as their neighbors, survive. d. People involved share their stories and relive what has occurred.

C

2. If a forensic nurse was employed in the most widely recognized subspecialty in forensic nursing, what would be the nurse's primary tasks? a. Be employed by insurance companies to review and interpret medical records b. Complete the death certificate, including causes of death c. Do a history and physical assessment and collect evidence d. With police officers, review the crime scene for insights

C

3. A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. What should the hospital immediately do? a. Ask the governor of the state to declare the area a disaster area so state help can be obtained b. Call surrounding hospitals to set up burn units as well because there will be too many patients for one hospital to manage c. Call in physicians and nursing staff who are experts in burn care d. Get in touch with the American Red Cross to assist families of the victims

C

7. Who is responsible for assuring the safety and welfare of communities? a. Federal government b. Federal Emergency Management Agency (FEMA) c. Local government d. State government

C

9. Why isn't health insurance helpful for persons with bipolar disorder? a. Health insurance that includes payment for mental health disorders is too expensive for persons with bipolar disorders. b. Persons with bipolar disorders prefer to self-medicate with alcohol or other street drugs. c. Persons with bipolar disorder have difficulty retaining employment with health benefits. d. Patients with bipolar disorder have difficulty paying the co-pays for mental health illnesses.

C

A patient is taking rather strong narcotics with good pain control, but today the patient 's family tells you the client doesn't want to become addicted. What is your response? a. "But you're dying, what difference will it make if you become addicted?" b. "You can try not to take so much so frequently if you are concerned." c. "You may develop tolerance but you can't be addicted when you're using the medication for pain control." d. "You need strong narcotics to control your pain; we want to keep you comfortable." e. "We'll keep you comfortable using some nonnarcotic drugs if that is what you prefer."

C

Although it was uncomfortable, a home health nurse finally learned to discuss finances with the client and family on the very first visit. Visits had to be reimbursed. Now that she is working for a different agency, funding was no longer such a concern. Why not? a. Because the nurse was an unpaid volunteer professional, visits made by that nurse had no cost to the agency. b. Only clients of high socioeconomic class were admitted for care, so the agency was always immediately reimbursed for care rendered. c. Taxpayers fund official home health agencies for care not reimbursed by third parties. d. The new agency has a large foundation that funds its activities from investment profits.

C

What is required for an agency to receive reimbursement for care given from Medicare? a. Application for recognition including signing a contract with the federal government b. Application for reimbursement from Medicare using the appropriate federal forms c. Demonstrating meeting federal quality standards for Medicare-covered services d. Providing specialty care such as dental oral surgery

C

What is the major assumption of Albrecht's conceptual model? a. Nurses are the only appropriate case managers for home health patients. b. Quality is best measured by using data from assessments, interventions, and outcomes. c. Patient outcomes depend primarily on the education and experience of the nurse. d. The most important outcome measure is the cost-effectiveness of the care given.

C

22. Why is the infection rate of HIV, tuberculosis (TB), and hepatitis so high among persons who are incarcerated? Select all that apply. a. Fecal oral transmission because of lack of cleanliness and hygiene among inmates b. Ignorance as to how infectious diseases are transmitted c. Inmates engage in tattooing, drug use, and unprotected sexual intercourse. d. Lack of access to health care while incarcerated e. Overcrowding, poor ventilation, and constant change in the population f. Poor nutrition and lack of exercise while incarcerated

C, E

the strategic national stockpile is organized and monitored by the

CDC

1. How does critical social theory (CST) differ from other nursing theories such as the health belief model or Orem's self-care deficit theory?

CST focuses on oppression and facilitates group action. CST 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.

the nurse is caring for a client who aggressive, demanding and verbally abusive toward staff and visitors. The client says im getting out of here, I am going to end it all. What immediate action should the nurse take?

Call security

3. What is a fairly recent surprise regarding infectious diseases in the United States?

Cervical cancer and coronary artery disease may be caused by infectious agents. Recent scientific discoveries on the infectious etiology of stomach ulcers, coronary artery disease, and cervical cancer, for example, suggest that infectious agents may be responsible for more morbidity and mortality than previously recognized.

An organization has not updated its sick day policy in the last 5 years and has experienced an increase in employee days off for illness over the last year. Which change to the sick leave policy might have a positive effect on the organization's absenteeism?

Change the policy to award personal use days rather than sick days

SATA Which of the following is a current challenge for occupational health nurses?

Changes in employee demographics including gender, ethnicity, and age Increase in managed care plans with need for case managers Moving from large manufacturing facilities to smaller service-based businesses Ongoing need to demonstrate cost-effectiveness of services rendered

A nurse hears screaming from a client's room. A male visitor leaves the client's room. Which is the nurse's priority action?

Check on the client

which health problems contribute to the state of homelessness?

Chronic schizophrenia Dementia Personality disorders AIDS Alcoholism Drug dependency Degenerative diseases

What is the best strategy the nurse manager can use to help retain nursing staff?

Closely review applicant's previous job history for length of commitment

A nurse is using an upstream intervention when working with the homeless population. Which of the following public health interventions will the nurse most likely use?

Community organizing

A night shift supervisor has been called to the ED to assist in managing a violent situation with a visitor. Once the violent has been contained and security and police have responded. What should be the supervisor's next action?

Complete an incident report

It has been reported to the nurse manager that an employee is repeatedly parking in the patient/visitor parking area. What action should the manager take? A. Confront the employee. B. Check the parking lot each morning. C. Discuss the issue at the next employee appraisal. D. Provide an education session for all staff regarding parking policy.

Confront the employee

When a nurse enters the room, the client states he has a gun and points to a male visitor. The nurse does not see a gun. What should the nurse do?

Contact security

A nursing unit is extremely short staffed. The manager calls a nurse who is on Family and Medical Leave to ask the nurse to return to work 2 days prior to schedule. When the nurse declines, the manager becomes insistent. What should be the nurse's first action?

Contact the HR director

Which of the following strategies have been used to improve the collection of prevalence data for the homeless population? (Select all that apply.)

Continuum of Care (CoC) concept Homeless Information Management System (HMIS)

Which of the following entities has been most active in creating change and alternative approaches in health care delivery?

Corporations

A client was quite ill and the family was doing their best. After careful assessment and diagnosis, the home health nurse was setting priorities for care. What should be the basis for deciding which intervention to implement first? a. Address the problem that is easiest to fix first so the client and family could see some success fairly quickly b. Address the most serious problem first for the client's long-term health c. Address the problem that is partly causing other problems first d. First address the problem that the client and family think should be addressed first

D

A nurse shared information with a family concerning a community resource, including a brochure with telephone number. The family agreed to follow up. How does the nurse know if the family wants to use those resources? a. If the agency calls the nurse to share that they will be offering services to the family b. If the family always agrees with the nurse's suggestions c. If the family asks the nurse to please call and set up the service d. If the family calls and sets up the service

D

19. What would be one of the first steps in attempting to control a disease?

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

A CNO is contacted by the organization's supervisor on a Saturday night regarding a problem in the hospital's emergency department. The supervisor describes an incident in which an orderly was assaulted. Why is the CNO not surprised about this report?

Health care violence is more likely to occur in the ED

6. Which nursing actions may be most helpful to the community's long-term health?

Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations 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.

what are some community factors that are commonly associated with poverty? (many are similar to health-related factors)

High proportion of underrepresented ethnic groups Single mothers High rate of unemployment Low level of education Low wages Violence Discrimination Communicable diseases Premature death

what are some health-related factors that are commonly associated with poverty?

High rate of infant mortality High morbidity and mortality Complex health problems Physical limitations secondary to chronic illness Trauma-induced injuries Death by violence

A charge nurse on the night shift did not notify the anesthesiologist regarding an emergency case. The manager investigated the matter and learned the charge nurse thought the primary care nurse would call the anesthesiologist. Which response by the manager would be most appropriate? A. "It is in your job description and your duty." B. "It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse." C. "It's not the surgery nurse's responsibility to call anesthesia!" D. "Why was this considered an emergency case?"

It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse

Which of the following factors would prevent a homeless person from accepting employment adequate to pay for housing?

Lack of adequate resources to pay for other necessities

The ED staff has been caring for a client who exhibited violent behavior when pain medication was denied. Once the situation was resolved, which action by the ED manager would be appropriate?

Organize a training program to educate staff on how to manage these types of situations

Which of the following best describes what the Code of Federal Regulations, especially Title 29, requires of the occupational health nurse?

Postwork-related injuries, illnesses, and death records must be recorded early

An occupational health nurse reminds employees to put on their safety glasses and use other personal protective equipment. Which of the following levels of prevention is being implemented?

Primary

15. The nurse couldn't find a vaccine in the refrigerator. The unopened vaccine vial had been put in a storage cabinet with the other medications. The nurse drew up the appropriate dose in the syringe and then put the vial of vaccine in the refrigerator. What will be the probable result?

Primary vaccine failure Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that may render the vaccines ineffective, improper administration route, or exposure of light-sensitive vaccines to light.

12. A case of viral hemorrhagic fever (Ebola) was diagnosed immediately on signs of illness at a tourist site in Africa. What should be done to protect the badly needed income from tourist dollars?

Quarantine the ill person and use isolation techniques in giving care Although students may not know the screening of or treatment of Ebola, they should know to isolate persons with infectious diseases. Ebola is not highly infectious until symptoms occur. Treating infected persons, whether they are symptomatic or not, is effective in preventing transmission of pathogens directly to others.

The nurse manager identifies a minor problem with the way a staff nurse documents client care. The manager meets with the nurse and discusses the issue, but does not issue a warning. What is the manager's next action? A. Report the meeting to human resources. B. Enlist the aid of a more experienced nurse to help monitor the documentation. C. Record the specific behavioral steps discussed for future reference. D. Tell the nurse that failure to comply with steps discussed will result in a written warning.

Record the specific behavioral steps discussed for future reference

The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use?

Remain calm and speak in a moderate tone, Speak in simple terms, Allow the client to speak

A hospital's safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made?

Security cameras throughout the facility, Curved mirrors in the corridors

Which of the following are the most frequent problems suffered by the chronically homeless?

Severe mental illness and substance abuse disorders

Which of the following factors are most likely to contribute to homelessness?

Shortage of affordable housing and insufficient income

A newly hired certified nurse's aide (CNA) has been 15 minutes late returning from mealtime 4 days this week. The nurse manager coaches the employee and finds the CNA thought meal breaks were 45 minutes. What is the most appropriate response from the nurse manager? A. Document the tardy behavior in the CNA's record. B. Show the CNA the break hours in the employee handbook. C. Warn the CNA tardiness is not tolerated and follow up in 2 weeks. D. Warn the CNA that the charge nurse will be timing future meal breaks.

Show the CNA the break hours in the employee handbook

An OB manager discusses a nurse's performance with the chief nurse officer (CNO). The CNO learns the nurse has had multiple client and physician complaints that the manager investigated and for which counseling was provided. The behavior continues even though the nurse has received verbal and written warnings. Which course of action would be most appropriate at this time? A. Issue a written warning from the CNO. B. Place the nurse on suspension pending a new investigation into the complaints. C. Terminate the nurse. D. Transfer the nurse to another department under another manager.

Terminate the nurse

The ED has seen as increase in violent behavior over the past year. The manager has voiced concerns over to the CNO regarding the safety of the ED staff. What should be done as a first step in addressing this issue?

The CNO should review the management of violent incidents procedure policy

3. In what way is environmental health (EH) different from the usual practice based on evidence?

The Precautionary Principle suggests action even if causative factors have not been confirmed. The Precautionary Principle says, "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause-and-effect relationships are not fully established scientifically."

A nurse has complained to the human resources (HR) director regarding unfair treatment by the nurse's manager. The nurse describes receiving a written warning, unlike other nursing staff who exhibit similar behaviors but are not reprimanded. Which concerns would the HR director discuss with the hospital chief nursing officer? A. The unusual management styles within the department B. Confronting the manager's direct supervisor about allowing this situation to occur C. The apparent inconsistencies in discipline within the unit D. The potential for litigation that arises from this complaint E. The need to terminate this problem employee

The apparent inconsistencies in discipline within the unit, The potential for ligation that arises from this complaint 3, 4

18. A local factory was told to clean up or face a large fine every day until it did. The local factory closed, although it had been extremely profitable. What action may probably follow?

The company will move to a country where it can continue to pollute. As corporations become global entities, many escape U.S. standards by moving operations to unregulated areas of the world.

Which of the following led to a vast increase in the number of occupational-health nurses?

The health of workers involved in manufacturing during World War II was crucial

SATA In which of the following ways are occupational health nurses role models of good community health nursing?

The majority of OHNs are prepared at the baccalaureate level or higher OHNs actively influence policy in health and safety within a particular area OHNs focus on health promotion and avoidance of injury or disease OHNs plan and implement health programs and populations of employees

An ICU nurse manager has been struggling to correct client care issues on the unit and has asked the unit director for assistance. The director says, "Training and discipline on your unit is your responsibility. I have other things to do." Now, the manager is faced with disciplining a nurse regarding another client care issue. What is the most significant reason this manager is hesitant to administer this discipline? A. The nurse may quit. B. The nursing staff is a cohesive group and might retaliate. C. The manager is not comfortable with confrontation. D. The manager does not feel supported by the director.

The manager does not feel supported by the director

Which of the following best describes the recent trends in homelessness?

The number of people in homeless families is increasing.

During a 3 month period, a nurse has missed work on six occasions due to unreliable child care. Another nurse has missed 10 days due to a minor food surgery. How should the manager categorize the reliability of these nurses?

The nurse with involuntary absences is more reliable

During the orientation an newly employed nurse asks about the process of reporting such things as bomb threats to the organization. The person conducting the orientation says Well I guess you call 911. What is incorrect about this statement?

The person who is doing the orientation should be aware of the reporting policy, The nurse should have been told to notify security, The nurse should have been told to follow the reporting policy

When the unit manager is on vacation, the charge nurse fills in the leadership role. While in this role the charge nurse senses a change in the nursing staff's morale. The staff appears happier, more energetic and productive. The charge nurse believes this change is a direct effect of which variable?

The staff's relationship with the nurse manager

An ICU unit has experienced an influx of aggressive behaviors by visitors against nurses. The ICU manager has instituted a policy to limit visiting hours. An employee asks the manager why the change in visiting hours has been implemented. Which response is likely the most accurate?

The visiting hours allowed for added stress and commotion to the nursing staff

Which of the following groups of people is most likely to experience homelessness?

Those who have substance abuse problems

Which of the following best describes the purpose of the Vulnerability Index?

To identify and prioritize the need for housing among the homeless

Which of the following responsibilities does the occupational health nurse have in relation to an injured employee and the Workers' Compensation Act?

To work with the employee to keep the employee informed, limit disability, and provide opportunity for rapid return to employment

11. What is the first step in preventing further spread of a particular sexually transmitted disease (STD)?

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

A nurse is frequently absent on Fridays. The nurse phones and reports as sick, but the manager discovers that the absences are due to child care issues. How should the manager document this on the critical incident form?

Voluntary absence on multiple Fridays due to child care issues

A nursing supervisor is seeking staff input while developing policies regarding violence prevention. A staff nurse says we have lots of threatening behavior on our unit. what is the most important question for the supervisor to ask?

When you report threats to your manager, is action taken quickly?

A nurse is being terminated due to continued violation of hospital policy. What statements by the manager are appropriate? A. "Your actions have been degrading to the profession." B. "You may wish to resign rather than being terminated." C. "Human resources will answer any questions you may have about benefits." D. "I'm sorry you could not be happy here." E. "You are being terminated for the policy violations I have just outlined."

You may wish to resign rather than being terminated, Human resources will answer any questions you may have about benefits, You are being terminated for the policy violations I have just outlined. B, C, E

Which child is most likely to be a victim of bullying?

a child with attention deficit/hyperactivity disorder (ADHD)

what is a vulnerable population?

a group that shares common risks or combinations of risk factors, such as those who are impoverished

14 of 31 A principal called the school nurse into his office and asked, "Will this student be able to attend our school?" after handing over the medical record of a severely handicapped prospective student. Which of the following would be the most appropriate response by the nurse? a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." b. "The student clearly won't be comfortable here; other students can be so cruel. Let me talk to the student's family." c. "There are schools that specialize in the care of the severely handicapped. Let me get in touch to see if one of those schools has the needed resources." d. "This student is so handicapped there is no way to manage the needed care; the family needs a home schooling teacher."

a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." In 1976, Public Law 99-142 was enacted, giving all students, including those who are severely handicapped, the right to public education in the least restrictive environment possible, regardless of mental or physical disabilities. The Education for All Handicapped Children Act of 1973 and the subsequent Individuals with Disabilities Education Act of 1990 enhanced the opportunities for children previously served in acute care and long-term care settings to have access to public education.

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

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

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

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

21 of 31 Everyone in a high school was very upset over the fact that one of the students had shot and killed another student. The nurse decided this was an appropriate time to establish a program to help prevent violence. Which of the following groups of students should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. The students who knew the victim and his assailant

a. Elementary school grades 4, 5, and 6 Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children.

which substance is involved in the majority of traffic fatalities?

alcohol

9 of 31 Which of the following is one of the most frequent health complaints of school-aged children? a. Anxiety over grades b. Dental caries c. Headaches in response to stress d. Stomachaches

b. Dental caries One of the most frequent complaints of school-aged children is dental caries. Causes include poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for dental care. Half of children aged 12 to 15 years will have dental caries. Approximately 75% of those between the ages of 12 and 19 years have had tooth decay. Dental caries occur as a more frequent complaint than anxiety over grades, headaches in response to stress, and stomachaches.

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

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

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

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

8 of 31 Which of the following is the most commonly used illegal drug among children and adolescents in the United States? a. Inhalants b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

b. Marijuana The most commonly used illicit drug among youth in the United States is marijuana. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine (3.8%), and steroids (3.6%). Inhalants are the most widely abused.

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

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

how are rural populations defined?

based on geography, environment, and economic base (farming, mining, etc)

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

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

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

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

27 of 31 In a nationwide survey, which of the following was identified by school health nurses as the most crucial research priority for their specialty? a. Emergency preparedness b. Health education c. Obesity and nutrition d. Role of the school health nurse

c. Obesity and nutrition Gordon and Barry surveyed 263 school nurses in 2006 to identify what the nurses believed to be the top research priorities for the specialty. The first most crucial response was obesity/nutrition—nutrition and weight-loss counseling programs, eating disorders, obesity in children and teens, and importance of exercise.

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

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

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

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

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

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

Which type of child abuse is characterized by failure to provide for the child's basic needs?

child neglect

who is considered a consumer of a home health care agency

client receiving care

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

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

6 of 31 Which of the following is the single leading preventable cause of death in the United States? a. Alcohol b. Firearms (guns) c. Overweight and obesity d. Tobacco use

d. Tobacco use Tobacco use is a major problem in this country and is the single leading preventable cause of death in the United States. Overweight and obesity is the second leading cause of preventable death in the United States. Alcohol and firearms (guns) are not leaders in the causes of preventable death in the United States.

A common early warning sign of a stressed caregiver is:

fatigue

the suicide rate in rural areas

has been increasing

what are some areas of concern for rural elderly populations?

isolation, loss of mobility, risk for injury, lack of resources

what does "near poor" mean?

it describes families with incomes just above the poverty index line

what was the Stewart McKinney Homeless Assistance Act of 1987?

it was a big step in the federal government's efforts to reduce homelessness, followed by many programs that started up in the 1990s (yet homelessness has still grown)

what is the most commonly used illicit drug in the US?

marijuana

a situation with a large number of casualties, usually more than 100, that significantly overwhelms available emergency medical services and resources is called a:

mass casualty incident

a home care agency that meets the conditions of participation is considered to be

medicare certified

there has been severe flooding in your state. what would be the first action of the state's governor?

open the state's emergency operations center

a disaster has occurred in the community and the emergency plan has been activated. this describes which phase of the disaster?

postimpact phase

what are some areas of concern for rural adolescent populations?

unintentional injury from bikes and cars, intentional injury (homicide, suicide, dating violence), substance abuse, sexual activity (STIs and teen pregnancy), and agricultural hazards

what is a significant problem with housing in rural areas?

worse conditions of housing, but higher home ownership --> more homelessness

what population is most vulnerable to substance abuse?

young people

A nurse manager is investigating a report made by a staff nurse. The nurses state that a visitor backed the nurse against a wall and was verbally abusive but did not touch the nurse. How should the manager describe this incident to the HR director?

As violence against the nurse

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

B

11. What should you and your family do when the national threat level is color-coded green or blue? a. Continue to listen to radio or television for updates on events and needed action(s) b. Develop a personal family emergency plan c. Prepare to evacuate when asked to do so by government officials d. Prepare to shelter-in-place until the all-clear is given

B

14. A prisoner was bleeding where another inmate had attacked him with a fork. What is the correctional nurse's first and most crucial responsibility? a. Do a complete physical to be sure there were no internal injuries during the scuffle b. Maintain an escape route to help assure personal safety c. Report to administration who was responsible for injuring the inmate d. Stop the bleeding, apply an antibiotic, and bandage the wound

B

2. How is a disaster the same as or different from an emergency? a. A disaster is personal, whereas an emergency is community-wide. b. An emergency is personal, whereas a disaster is community-wide. c. Both emergencies and disasters are devastating. d. Both emergencies and disasters are failures resulting in extensive insurance claims.

B

when compared with urban americans, rural people (select all that apply)

- have higher infant and maternal morbidity - have higher rates of mental illness - have higher rates of chronic illness - are less likely to have health insurance coverage that includes pharmacy plans - spend 25% more on prescription durgs

what are some characteristics of homeless people (from table 25-3)?

- individuals: more male than female, 19% employed, 13% vets, 22% under 18 - families: 36% - resources: 22% not receiving needed resources, 71% of surveyed cities turning away families with children due to lack of beds - race and ethnicity: most Caucasian, then African American, then some Hispanic and others - health: 30% severely mentally ill, 17% physically disabled, 16% victims of domestic violence, 3% HIV+

what steps can clients take in the home to prevent the development of infectious disease? (select all that apply)

- keep a clean kitchen and bathroom - maintain an optimal nutritional status - avoid cleaning birdcages and cat litter boxes - maintain daily personal hygiene - use a soft toothbrush after every meal

what are some consequences of substance abuse?

- loss of job - loss of relationships - greater risk for death (from a variety of causes) - chronic health problems - nutritional deficiencies - low self-esteem - greater risk for STIs

what are some common characteristics of rural populations?

- non-metropolitan - large proportion of elders - health and social services deficient - poverty - ethnic and racial minority populations are growing

in order to be certified under medicare and medicaid, a rural health clinic (RHC) must (select all that apply)

- offer primary outpatient services - have a physician on-site at least once every two weeks - provide routine diagnostic services, including clinical laboratory services - employ at least one physician or nurse practitioner - maintain health records on all clients

what are some tertiary prevention strategies for substance abuse?

- physical, mental, and social treatment procedures - detox - institutionalization - outpatient drug-maintenance programs

what factors contribute to homelessness? (box 25-4)

- poverty - changes in labor market - lack of affordable housing - devaluation of the dollar and federal assistance - unemployment - violence/crime - crisis, abuse, neglect - lack of kin support - mental illness - deinstitutionalization - substance abuse - stigmatized diseases (HIV, etc)

in order to be admitted into hospice, a client must have (select all that apply)

- provided informed consent - a prognosis of 6 months or less - a terminal illness

what are some ways to improve urban health? (from p. 713)

- reclaim dangerous neighborhoods - build learning communities - learn effects of stress, understand the culture - reach out to immigrants - target cancer prevention - eliminate disparities - improve DM treatment - use positive peer pressure and connectedness - anticipate expanding needs - prevent risky behaviors - highlight healthy foods - train mental health mentors - address trauma of violence - prevention!

what are some common health problems of the homeless population (table 25-6)?

- skin and traumatic disorders (ulcers, parasites, cellulitis, abrasions, lacerations, bruises, sprains, burns, etc) - acute disorders/diseases (TB, pneumonia, flu, asthma, GU infections, DM complications) - chronic disorders/diseases (mental problems, cancer, anemia/nutritional deficiencies, CV disease, arthitis, STIs, seizures, etc) - mental illnesses (personality disorders, crime, drug/alcohol abuse, lack of support, poverty, etc)

what are some common topics of concern among the homeless population?

- substance abuse - racism - violence - limited education - crime - poverty

how have history and perspectives affected vulnerable populations?

- the common perspective used to be that hard work and morals could fix/prevent poverty, and that people in poverty basically did it to themselves (this was influenced by the Industrial Revolution) - after the Great Depression, Social Security, and later Medicare, went into place - since then, eligibility criteria for assistance have become quite stringent - caring for the poor has shifted from the federal government --> the private sector

who are some vulnerable populations with special needs?

- uninsured and underinsured, medically indigent/working poor (people who work and earn too much to qualify for assistance, but don't have enough money for insurance) - children and adolescents - elders - underrepresented ethnic groups - women

what are the Health People 2020 objectives for rural populations r/t injury and violence protection?

- unintentional injury: increase access to trauma care, reduce firearm-related deaths and injuries - occupational safety: reduce deaths from work-related injuries in mining, construction, transportation, warehousing, agriculture, fishing, hunting, and forestry; reduce work-related injuries and occupational skin diseases among workers

what are the Health People 2020 objectives for rural populations r/t the environment?

- water quality: increase drinking water supply that meets Safe Drinking Water Act regulations, reduce waterborne diseases, improve water conservation - toxics and waste: reduce pesticide exposure, reduce toxic pollutants released into the environment, increase use of information systems and monitoring of diseases/conditions r/t environmental hazards - infrastructure and surveillance: reduce exposure to environmental chemicals, reduce schools sited within 500 feet of interstates/federal highways

The hospital is hiring several new nurses for an expanded OB unit. The manager explains to the current staff that due to a shortage of nurses, salary compression is occurring. How should the current nurses interpret this statement?

The new nurses' starting salaries will be close to what the current nurses are making

what is the definition of substance abuse?

the use of any drug (alcohol, street drugs, prescription and over-the-counter medications) that results in a loss of control over the amount taken and when it is taken

which describes a victim who is experiencing acceptance after a disaster?

the victim tries to solve the problems cause by the diseaster

what is the challenge with programs such as DARE?

they only have a short-term effect and only make a lasting difference if reinforced by positive family influence

what types of families are considered vulnerable families?

those who have a member who is chronically ill or disabled, has a chronic mental illness, or abuses substances; also families who encounter unexpected events such as sudden death of a child or unemployment

what does it mean to be disenfranchised?

to basically feel unimportant and helpless, separated mainstream society (includes homeless, mentally ill, prisoners, refugees, etc)

what is the primary goal of tertiary prevention for substance abuse?

to prevent reactivation of substance-abusing behaviors

A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee's claim? A. The nurse manager wrote notes on the expectations discussed during disciplinary sessions. B. The terminated employee's last evaluation discusses problems with performance, but no coaching is described. C. When problems with the employee arose, the manager's average time of intervention was less than 1 day. D. There are notes in the employee's record from human resources indicating the nurse manager had discussed issues with the HR director. E. In one note, the manager describes the employee as "petulant, immature, and uncaring."

The terminated employee's last evaluation discusses problems with performance, but no coaching is described, In one note, the manager describes the employee as petulant, immature and uncaring 2, 5

An OB nurse is caring for an unmarried woman who is in labor. The nurse learns the client is unwilling to name he baby's father. A male visitor who comes to visit the client raises the nurse's concern that he might be violent. Which behavior would raise this concern?

The visitor moves into the nurse's personal space when asking about the client's status

On the basis of all the work done by social scientists, approximately how many homeless persons should be expected and tolerated in our society?

There should not be homeless persons in America.

The hospital operator announced over the paging system Dr. Strong, fourth floor, A-wing, Dr. Strong, fourth floor, A-wing. A newly hired nurse asks another nurse Who is Dr. Strong. The nurse replies this is the announcement that alerts security there is violent behavior on that unit. Which statement would be an appropriate report to this unit's manager?

There was an incident in which a staff person did not know what Dr. Strong meant. Could we have an in service on this policy?

Which personal characteristics would increase a nurse's potential for voluntary turnover?

Through task force meetings, the nurse has become friends with several nurses who work in different organizations in town, The nurse has few personal ties to the city of current employment, The nurse has worked at several job-fairs in the area as a hospital representative

Which of the following best describes what happens when persons who work full-time and receive the typical minimum wage seek an apartment?

To afford housing, they need a job that pays at least three times minimum wage.

5. Which is true concerning tuberculosis infections in the United States?

Under certain conditions, susceptible hosts may be infected by the tuberculosis bacillus. The principle of multicausation emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Tuberculosis is caused by Mycobacterium tuberculosis; treatment with INH lasts for a year and is used when no active disease is present; patients can be contagious without having any symptoms.

which client would be considered homebound as defined by medicare

a client who attends adult daycare for the purpose of receiving medical care

31 of 31 A community health nurse is assigned to cover a school health office when the school's nurse is ill. A child is waiting for the nurse's arrival, saying a particular medication is needed. Which of the following can the nurse expect to find in the school health office? (Select all that apply.) a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) c. Approval from the student's teacher for the student to see the nurse for the medication each day d. The student's written assent for the medication to be administered when requested e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered

a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered The guidelines from the National Association of School Nurses indicate that medications should be in containers that are properly labeled with all appropriate student and medication information, accompanied by a written request from the health care provider and parent or guardian, and administered without violating standing orders or nursing protocols. The nurse would not typically find an approval from the student's teacher for the student to see the nurse each day for a medication or a student's assent for the medication to be administered. The parents and health care provider are responsible for the written request for the medication to be administered.

Forms of elder abuse are (select all that apply):

- financial exploitation - pyschological abuse - neglect - physical abuse - sexual abuse

17. A community health clinic put a tax levy on the ballot. An angry man asks you, "How can you ask me to pay taxes to buy immunizations for parents who don't want to pay for their kids to get their shots?" What is your response?

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

what are some key components of the nursing assessment for a substance abuser?

- first, self-awareness of personal beliefs/biases - drug of choice - route of admin - amount used - frequency of use - polysubstance use

what can be done to help vulnerable populations?

- get to know the community - schedule clinic visits for patients at times that are convenient for vulnerable populations - have bilingual nurses - be sensitive and nonjudgemental

what are some patient strengths and resources?

- hardiness (resilience, ability to overcome) - support networks

A hospital is experiencing a high nursing turnover rate. One manager suggests offering sign-on bonuses to fill positions. Why would the nurse executive veto this suggestion?

Current nurses can be discourages by this program, Sign-on bonuses do not recognize achievement and loyalty

every family should prearrange supplies in case of an emergency. items to include in the home emergency kids include

- battery-operated radio - 3-day supply of nonperishable food and water - working flashlight - first aid kid

what are some primary prevention strategies for substance abuse?

- education - knowledge of risk factors - legislation and law enforcement - programs to strengthen resistance to substance abuse

Which statements best describe the extent of violence in society today (select all that apply)?

- family members are most likely to murder a young child - women are usually victimized by people they know - most violent crimes occur between 6am and 6pm

A nurse manager is competing a critical incident form regarding a nurse who has missed two 12 hours shifts, three 8 hour shifts, was 2 and 1/2 hours late to one shift and left 3 hours early from another shift. The manager should document the total time lost as ____ hours

53 1/2 hours

: p. 581 22. What is the relationship between socioeconomic class and intimate partner abuse? a. Abuse is prevalent at all income levels in the United States. b. High income is a risk factor for intimate partner abuse. c. Families below the poverty level are at the lowest risk for intimate partner violence. d. Families in the middle socioeconomic classes are better at hiding abuse.

: A Abuse is prevalent at all income levels. There is, however, greater risk among poverty-level families. Risk factors for abuse include low income, low self-esteem, poor academic achievement, and alcohol use. DIF: Cognitive Level: Comprehension

: p. 576 3. Which of the following groups is most often the victim of violence? a. Adolescents b. Adults aged 46 to 60 c. Elderly persons older than 65 d. Women aged 30 to 45

: A According to statistics, adolescents are at especially high risk. DIF: Cognitive Level: Knowledge

: p. 579 12. Which of the following conclusions can be drawn from research on the effect of abuse on adults who become parents? a. Adults who were abused are more likely to abuse their own children. b. Adults who were abused avoid abusing their own children. c. Adults who were abused are no more or less likely to abuse their own children. d. There is no clear trend as to how previous abuse influences future abuse.

: A Adults abused as children are more likely to abuse their own children; intergenerational transmission of violence has been widely documented. Abused children are more likely to be abusive in later relationships, although not all children who grow up in violent homes become violent later in life. DIF: Cognitive Level: Comprehension

: p. 580 18. The school nurse suspects that a child has been abused after observing several bruises. What action should the nurse take next? a. The nurse should contact protective services as a mandatory reporter. b. The nurse should contact the classroom teacher to collect additional information. c. The nurse should not contact anyone and keep the information private. d. The nurse should contact the family for an explanation of the child's bruises.

: A All 50 states specifically require mandatory reporting of child abuse by health professionals, a category that includes nurses. The law requires that all suspected cases be reported. In every state, the law protects the health care professionals from legal action if the charges are unproved. DIF: Cognitive Level: Application

: p. 584 23. The husband was worried about losing his job and had been very tense all week. His wife was surprised when that night he picked up his supper plate and threw it against the wall. He screamed, "You can't even cook decently!" What might the wife expect her husband to do next? a. Apologize profusely after he calms down. b. Ask her to go to work to improve their economic prospects. c. Be fired when his anger flares at work. d. Return to school to improve his employment prospects.

: A Domestic violence occurs in a classic cyclic pattern known as the cycle of violence. The cycle consists of tension-building (being tense all week), battering (yelling and throwing the plate), and apologizing. DIF: Cognitive Level: Application

: p. 579 11. A new child moved into a neighborhood. The children next door asked him to come over and play. He thanked them but stayed home. Which of the following is an explanation for the child's behavior? a. He came from a violent neighborhood where children never played outdoors. b. He does not believe he knows the next door kids well enough yet. c. His mother works and does not want to be asked to take a turn babysitting. d. He has to take care of an ill family member after school.

: A In violent neighborhoods, fear of violence has a tremendous effect, causing residents to be suspicious of one another. Parents' increased concern and anxiety are related to lower levels of children's outdoor play and physical activity. DIF: Cognitive Level: Application

: p. 578 8. Which of the following interventions demonstrates a community/public health nurse engaging in primary prevention related to adolescent violence? a. Promoting youth engagement in social activities and employment opportunities b. Educating gang members about the dangers of staying in the gang c. Visiting jails or juvenile detention centers to see the consequences of violence d. Screening youth for risk factors to identify if they have a tendency toward violence

: A Primary prevention includes preventing youth from dropping out of school and strengthening social institutions to better provide activities and legitimate economic opportunities for youth. As gang members often report nothing else to do, availability of recreational activities is crucial. The other interventions demonstrate use of secondary and tertiary prevention. DIF: Cognitive Level: Analysis

: p. 577 5. A school nurse is providing education about the consequences of bullying. What information would the nurse want to include? a. Bullying has a significant and long-lasting effect on children's health. b. Children can be taught how to effectively deal with bullies. c. Most bullying occurs in elementary schools, especially on playgrounds during recess. d. Screening for bullying is almost impossible because no one wants to be seen as a tattletale.

: A Schools are the site of ongoing violence, from excessive teasing to pushing, shoving, bullying, intimidation, stalking, physical assault, and even murder. Because bullying is often accepted as a part of growing up, as temporary, and as having little effect, the nurse must stress that bullying has health consequences across the life span. DIF: Cognitive Level: Application

: pp. 584-585 27. The emergency department nurse listened as the woman said, "I know that this sounds stupid, but I was leaning on the door handle and I fell out of the car right into the traffic." The woman had a broken leg in addition to scrapes and bruises. What should the nurse be sure to ask? a. "Have you been hit, slapped, kicked, or physically hurt by someone during the last year?" b. "Were you been wearing your seatbelt before this incident?" c. "Have you been in an abusive relationship before?" d. "Were you using drugs or alcohol at the time of this incident?"

: A The nurse should always be alert to possible abuse, particularly when the type of injury and the supposed circumstances under which it occurred are suggestive of abuse. One of the four best questions to ask is, "Within the last year, have you ever been hit, slapped, kicked, or otherwise physically hurt by someone?" DIF: Cognitive Level: Application

: p. 591 3. What conclusions concerning firearms in the United States can be drawn? (Select all that apply.) a. No data support the assertion that gun-control laws decrease violence. b. Firearms are the second leading cause of death among 10- to 19-year-olds. c. Higher rates of family ownership of guns are associated with lower homicide rates. d. Laws have prevented sales of assault weapons but not handguns. e. Regulations concerning firearms are more restrictive in the United States than in other industrialized nations. f. Zero-tolerance laws have decreased firearm violence in schools.

: A, B According to a systematic literature review conducted by the National Research Council, no data supported the assertion that gun-control laws had an effect on reducing violence. Firearms are the second leading cause of death among 10- to 19-year-olds. Regulations related to firearms are more lenient in the United States than in other developed countries, and so firearms are accessible. Higher rates of ownership are associated with higher homicide rates. Evaluation of legislation has not demonstrated that legislation reduces firearm violence. DIF: Cognitive Level: Comprehension

: p. 594 9. Which of the following actions should a nurse take to help decrease violence against women? (Select all that apply.) a. Conduct public health campaigns about violence. b. Educate colleagues about the effects of violence against women. c. Establish appropriate outcome measures. d. Fight to publicize victim health records so others know the damage abusers cause. e. Help create appropriate protocol and documentation guidelines with local agencies. f. Support accreditation requirements for appropriate violence care.

: A, B, C, E, F Nurses may become discouraged at the continuation of violence in society. Change takes time. Nurses can effect more long-term outcomes by supporting political change through campaigns, providing one-on-one education, changing accreditation systems to support local efforts, and voting for increased funding for improving care. Under the Health Insurance Portability and Accountability Act (HIPAA), no nurse should share patients' records publicly. DIF: Cognitive Level: Analysis

: p. 591 5. A woman returns to an abusive relationship despite being referred to a shelter by the community/public health nurse. Which of the following explains why the client would not accept this referral? (Select all that apply.) a. If she attempts to leave, the man's reprisals may be even worse. b. She may lack money, skill, or employment opportunities. c. She secretly enjoys being dominated, like many victims of abuse. d. She believes marriage is forever and divorce demonstrates failure. e. If she moves to a shelter, she will not be safe there. f. She enjoys having a strong man be responsible for her life.

: A, B, D, E Women have many reasons for staying, including hopes that the man will reform, there being no other place to go, having children (which makes it harder to find adequate financial resources or appropriate housing), and a belief that divorce is shameful. The woman may be emotionally dependent on the abusive spouse or may fear living alone. Finally, reprisals may indeed be worse, since women are at greater risk of being killed when they leave an abusive partner. Thus, the fear of not being safe when she moves to the shelter is valid. DIF: Cognitive Level: Application

: p. 586 MULTIPLE RESPONSE 1. Which of the following factors are associated with increased risk of violence? (Select all that apply.) a. Access to guns in the home b. Extensive involvement in community activities c. High levels of stress in the family d. Low socioeconomic status e. Rigid sex role expectations f. Use of TV as a free babysitter

: A, C, D, E, F Factors associated with risk of violence are sociologic (such as poverty, drug dealing, access to guns, media exposure), developmental (rigid sex role expectations, peer pressure, high stress level), and family environment (social isolation, history of intergenerational abuse). DIF: Cognitive Level: Comprehension

: p. 587 2. Which of the following are possible reasons for an adolescent to join a gang? (Select all that apply.) a. Best protection from violence by others b. Employment so dull in comparison c. Friends all joined gangs (peer pressure) d. More fun than going to work e. Sense of belonging, family, and stability f. Sheer excitement about being involved

: A, C, E, F Gangs are often the only social option for adolescents, since no employment opportunities are available; peer pressure, protection, companionship, and excitement are also reasons for joining a gang. Gangs offer stability when families may not be stable. DIF: Cognitive Level: Comprehension

: p. 594 8. The teenage mother's behavior seemed consistent with a fantasy that the newborn was rather like a doll who would love her forever. Which of the following would be the most appropriate nursing intervention? (Select all that apply.) a. Enrolling the mother in a foster grandmother program b. Demonstrating that screaming will help calm the newborn c. Providing the mother a set of "how to be a parent" books d. Inviting the mother to join a support group with other teenage mothers e. Planning nursing assessment visits every 3 months during the first year f. Explaining appropriate maternal behaviors before hospital discharge

: A, D, E The new mother will need social support and information, which may be successfully implemented through foster grandmother programs, mother support groups, and nursing visits every 3 months during early life. Books might be useful for some women; however, in view of the low literacy rate, there is a strong possibility that the books would not be read or understood. Although the nurse's explaining appropriate behavior in the hospital might seem helpful, new mothers are under a high level of adjustment and stress, and this is not the best time for learning. Furthermore, new mothers are rarely in the hospital more than 2 days after a normal delivery. Screaming at an infant is an at-risk behavior and not an appropriate behavior for a new mother. DIF: Cognitive Level: Synthesis

: p. 593 7. A nurse working in obstetrics helps new mothers bond with their children. Which of the following observations would be of concern to the nurse? (Select all that apply.) a. The mother appears frightened of her newborn and avoids touching him. b. The mother continually praises her newborn and his nursing and sleeping. c. The mother constantly looks at and talks to her newborn. d. The mother touches her newborn, patting, hugging, and smiling at him. e. The mother says "Boys are tough" as she rather carelessly changes his diaper. f. The mother states that the newborn does not seem to like her.

: A, E, F Parental behaviors consistent with strong bonding with the newborn include making good eye contact; caring, gentle handling; talking to the infant; giving positive feedback with praising remarks; and showing affection with hugs, smiles, and pats. Poor bonding behaviors include having little contact, handling the infant roughly or carelessly, avoiding physical contact, and leaving the child alone. DIF: Cognitive Level: Application

: p. 585 28. A 15-year-old mother brought her 2-month-old infant to the clinic, complaining that he was a bad baby. When she fed him cereal, the infant spit it back out. This frustrated the new mother and then she stated she would spank the infant. What important instructions should this mother receive? a. Education about how to control her temper b. Information about normal infant behaviors c. Information about local support groups for teenage mothers d. Education about how to find a positive role model

: B Abusive parents often have unrealistic expectations of age-appropriate behavior for children. It is important to review child development so parents can recognize age-appropriate behavior. The nurse can validate realistic expectations for the child with the parent and dispel unrealistic ones. DIF: Cognitive Level: Application

: pp. 586-587 32. The nurse was caring for an elderly gentleman who lived with his son. The nurse is concerned about elder abuse. Which of the following would be the most important intervention to be implemented by the nurse? a. Counsel and recognize the son's efforts in relation to being a caregiver. b. Encourage the son to consider respite care or adult daycare for his father. c. Provide information to the son regarding nursing home placement. d. Suggest that other family members assist with caregiving.

: B Any and all of the options might be useful because all are aspects of counseling and supporting the son in relation to his caregiving. However, the most useful intervention is to obtain respite care in order to reduce stress on the caregiver. DIF: Cognitive Level: Application

: p. 584 24. After a husband slapped his wife, he apologized to her saying that his boss had been giving him impossible tasks and he had stopped for a drink after work. When the woman laughingly shared this story during a routine visit at the clinic, the nurse became concerned. What would have concerned the nurse? a. The husband had a drink after work rather than coming right home. b. The husband refused to take responsibility for his own actions. c. The woman felt this episode was worth sharing. d. The woman was laughing as she told the story.

: B Batterers typically refuse to acknowledge responsibility for abuse; instead, they blame anything from alcohol and work problems to stress and the spouse. Abusers blame the victim until the victim actually starts believing that he or she is responsible for the abuse. DIF: Cognitive Level: Application

: p. 578 10. What known risk factors have been associated with violence internationally? a. Censorship of media (newspaper, magazines, movies, television shows) b. Drug, alcohol, and tobacco use c. Monarchies, not democracies, as government d. Strong-armed government militia

: B Drug, alcohol, and tobacco use is associated with increasing exposure to violence. DIF: Cognitive Level: Knowledge

: p. 586 29. What is the most common form of elder abuse? a. Emotional abuse b. Financial abuse c. Physical abuse d. Sexual abuse

: B Financial exploitation of vulnerable elderly persons is identified as the most common form of elder abuse. DIF: Cognitive Level: Knowledge

: p. 586 30. A home care nurse was caring for an elderly gentleman who lived with his son. The client kept falling asleep. Which action is most important for the nurse to take? a. Call the physician and ask for a daytime stimulant. b. Check the medications for consistency between pills and prescribed doses. c. Suggest that the client get a TV to keep himself entertained. d. Suggest that the client sit up or even try to walk and then try to sleep at night.

: B Overmedication, whether inadvertent or deliberate, may be used to control an elderly person. The nurse should review medications at every visit. The existing supply should be tallied to see whether the remaining medication matches what would be expected if the medication were taken as prescribed. DIF: Cognitive Level: Application

: p. 582 21. In addition to size and strength differences, what leads men to choose to batter women? a. They want more sex than women want to give them. b. They want the power and control in the relationship. c. They realize it is the only way to ensure that the woman acts appropriately. d. They recognize how women drive them to it.

: B Physical violence is primarily aimed at maintaining power and control. DIF: Cognitive Level: Knowledge

: p. 578 6. In which of the following places would violence most likely occur? a. Public government buildings b. Schools c. Shopping malls d. Workplaces

: B Schools are the site of ongoing violence, from excessive teasing to pushing, shoving, bullying, intimidation, stalking, physical assault, and even murder. DIF: Cognitive Level: Comprehension

: p. 579 15. Which child in a family is most likely to be abused? a. The son who looks just like his father b. The son who is handicapped c. The daughter who is very personable d. The daughter who is beautiful and brilliant

: B Sometimes abuse is inflicted on all the children in a family, but often one child is singled out or targeted to receive most or all of the abusive attention. In cases of abuse, usually a child who is different or who has a physical or emotional disability is at special risk for abuse. DIF: Cognitive Level: Application

: p. 579 17. The emergency department personnel were amazed when a child did not complain or flinch as the physician cleaned a rather nasty cut and then stitched it. What observation would cause the nurse even more concern? a. After the bandage was applied, the child ran immediately back to his mother and hugged her very tightly. b. The child said, "These things happen because I'm so bad." c. The mother held the child throughout the procedure saying, "It's my entire fault. I left the knife out." d. The mother said, "He is going through a growth spurt. I'll have to have more snacks around that don't require preparation."

: B The focus on being a bad child is suggestive of constant criticisms, a form of emotional abuse. The other responses all suggest either a strong mother-child bond or the mother's willingness to accept responsibility and possibly accept help. DIF: Cognitive Level: Application

: p. 584 25. A woman was at the emergency department with a broken arm and bruises all over her torso. Radiographs showed evidence of previous broken bones. Which behavior exhibited by the woman would be most worrisome to the nurse? a. Asking the nurse, "Do you know where I can go to get away from him?" b. Accepting the blame for the incident, saying "I'm such a rotten housekeeper. I can't do anything right." c. Crying, moaning, and begging for pain medication d. Saying, "Do you think I should tell the police?"

: B With long-term abuse, the victim accepts responsibility for maintaining the relationship and accepts blame for the abusive behavior. DIF: Cognitive Level: Application

how is risk defined?

health conditions that result from the interaction of many factors that subsequently make it more or less likely that a person will develop a particular health condition

: p. 592 6. Which of the following has been successfully used to combat abuse and stalking? (Select all that apply.) a. Encouraging victims to stand up for themselves and gain self-confidence b. Concentrating on the offender, with mandatory arrests at the first episode c. Encouraging men to teach nonviolence to the next generation of boys d. Improving supportive services for abused spouses, such as transitional housing e. Educating families about separation until the abuse is resolved f. Training professionals to recognize and intervene in abusive situations

: B, C, D, F New initiatives include training health care providers, encouraging men to teach nonviolence to the next generation, and improving crisis services for victims of rape and sexual assault. The federal Violence Against Women Act, reauthorized in 2005, also includes improving supportive services such as transitional housing. DIF: Cognitive Level: Comprehension

: p. 580 20. Which of the following activities would put a woman most at risk of being abused, injured, or killed? a. Being submissive and obedient b. Having an affair with a friend of her husband c. Being pregnant or threatening to leave the home d. Walking in a downtown urban area wearing a short skirt and high-heeled shoes

: C A woman is most at risk when pregnant, when preparing to leave the home, or after having left the home. The other behaviors do not put the woman at most risk for abuse or violence. DIF: Cognitive Level: Application

: p. 580 19. A woman who is 4 months pregnant states that she has not told her husband that she is pregnant because he is upset enough over having lost his job a few months ago. Which of the following questions would the nurse want to ask the woman? a. How much does she know about pregnancy and childbirth? b. How does her husband react to stress? c. Is she concerned that her husband will possibly hurt her when he finds out? d. What are her plans for obtaining financial resources for the family?

: C Although the nurse will want to educate the woman about pregnancy and childbirth, the family situation sounds at high risk for abuse. The husband has been unemployed for some time. The woman is fearful. It is known that a woman is most at risk for abuse when pregnant, when preparing to leave the home, or after having left the home. DIF: Cognitive Level: Synthesis

: p. 579 16. A nurse practitioner was working in the emergency department when a child with a stab wound in the abdomen was brought in by his mother. The mother explained that the child apparently had gone quietly into the kitchen, climbed up on a chair, and was peeling an apple when he fell and the paring knife went into his tummy. She heard his screams and brought him to the emergency department. What will the advanced practice nurse want to be sure to do? a. Ask the child what really happened. b. Ask the mother why the child was still hungry after bedtime. c. Examine the child carefully for evidence of past injuries. d. Stitch the wound, order an antibiotic, and apply a small dressing.

: C Because abuse is rarely an isolated incident, evidence of past injuries may be present when a child is brought in for treatment. However, children rarely admit this in response to a direct question with the abuser in the room. Abused children typically protect their parents. DIF: Cognitive Level: Application

: p. 577 7. What is a common finding related to violence in communities? a. More than 25% of students in grades 9 to 12 report physical fighting during the past year. b. Firearms are responsible for the majority of homicides in adults. c. Homicide is the second leading cause of death for young people aged 10 to 24 years. d. Most injuries caused by violence do not necessitate visits to the emergency department.

: C Homicide is the second leading cause of death in people aged 10 to 24; firearms are responsible for 84% of the homicides in people aged 10 to 24. Of youth in grades 9 to 12, 11% reported being in a physical fight in the previous 12 months. More than 656,000 people aged 10 to 25 were treated in emergency departments for injuries sustained through violence. DIF: Cognitive Level: Knowledge

: p. 586 31. A home care nurse cared for an elderly client who lived with her daughter and was incontinent and sometimes confused. The nurse found her lying in wet linens. The elderly woman asked the nurse to change the sheets and not worry about it. Why would the elderly woman sound so unconcerned? a. She may be ashamed that she has "accidents." b. She knows she mistreated her daughter early in life, so this is just justice. c. She may have nowhere else to live and prefers being at home with wet linens to a nursing home. d. She thinks all children treat their parents like this.

: C Many elderly persons who are abused are afraid of the caretakers, ashamed of the problem, or have limited alternatives. If they have nowhere else to live or feel that they will die in a nursing home, they will not complain about the abuse. Health professionals sometimes do not report incidents because of concern that alternative living arrangements might be less tolerable than the current one. DIF: Cognitive Level: Application

: p. 578 9. Which of the following is a crucial risk factor associated with being a victim of violence? a. Being very extroverted b. Lacking social activities c. Living in poverty d. Possessing low self-esteem

: C Poverty is an important risk factor associated with victimization by violence. DIF: Cognitive Level: Comprehension

: p. 576 2. Members of the community state they are afraid of being attacked, robbed, beaten, or killed by a stranger. What would be an appropriate response by the nurse? a. "All Americans must band together to protect our families and our neighborhoods." b. "As the media clearly report, violence in our country is on the increase." c. "Most violent acts are committed by family and friends." d. "You are right to be concerned. There are many actions you can take to protect yourself."

: C Statistics from the Bureau of Justice Statistics (2003) demonstrate that the incidence of violence by strangers is exaggerated. Most violent acts are committed by family and people one knows. Violent crime has been steadily decreasing since 1994 to the lowest rate ever in 2000. DIF: Cognitive Level: Application

: p. 579 14. During which period of life are young people at the greatest risk for dying from homicide? a. First 5 years of life b. First 2 years of life c. First week of infancy d. Teens (ages 13 to 19)

: C The most dangerous time in a child's life is the first day of life. The first week of infancy has the highest risk for death from homicide. DIF: Cognitive Level: Knowledge

MULTIPLE CHOICE 1. Why do nursing students study violent behavior? a. Americans are fascinated by stories about violence. b. Many nursing students are from families with a history of violence. c. The media often portrays heroes who use violence to win. d. Violence resulting in injury affects the whole community.

: D Although all of the options may be true, community/public health courses include content on violence because it is a major public health problem, not only because it is a major cause of death but also because violence, including suicide and homicide, is preventable. DIF: Cognitive Level: Comprehension

: p. 576 4. Which of the following explanations is supported by extensive research as to why a person might resort to violence? a. Children learn violent approaches from their peers. b. Violence is a fast way to resolve conflict, requiring minimal time. c. Children observe how movie heroes resolve problems. d. Violence is seen as a socially acceptable strategy to solve problems.

: D Although many heroes in all media, comics, books, movies, and television may use violence, violence is most prevalent when the culture accepts it as an appropriate strategy in the problem-solving process. Many American cultural institutions model and even encourage violence and aggression, as in sports, movies, television, and video games. Children may or may not be around peers who exhibit violent behaviors. Although children's movies may demonstrate violence to resolve problems, this is not always the case. DIF: Cognitive Level: Comprehension

: p. 579 13. Which of the following is a rationale as to why abusive parents continue to abuse their children? a. Children are born evil and have to have sin beaten out of them. b. Good parents care enough to use physical discipline to teach their children. c. Most parents consider strong physical punishment merely good discipline. d. There are no repercussions, and other people rarely interfere.

: D People abuse family members because there are few or no repercussions. Even if the abuse is known, other people rarely interfere. DIF: Cognitive Level: Comprehension

: p. 591 4. Why are colleges establishing programs about appropriate dating behaviors? (Select all that apply.) a. As a media campaign to assure parents that their children are safe in their college environment b. As an attempt to emphasize that women have the right to say no c. Because of feminist demands that men learn better self-control and appropriate social behavior d. Because the majority of victims know their assailants e. As public recognition that almost 25% of college-age women report an attempted or completed rape f. Because most college women report physical or sexual violence during their adolescent or college years

: E, F Violence during dating relationships is quite common during adolescence and the college years. Up to 25% of female college students reported an attempted or complete rape, 13% to 20% reported being stalked, and 88% reported at least one incidence of physical or sexual violence. Ninety percent of the assailants were known to their victims. DIF: Cognitive Level: Comprehension

23. When does disaster management begin? a. Before a disaster occurs b. Immediately after the disaster c. Throughout the disaster period d. When the disaster begins

A

3. If a forensic nurse is nationally certified, what subspecialty is the focus of the nurse's efforts? a. Child or adult sexual assault forensic examiner b. Coroner and death investigator c. Legal consultant and nurse attorney d. Forensic nurse examiner

A

5. What do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives? a. Create fear to intimidate and coerce to accomplish a political goal b. Encourage others with similar beliefs to join them and their cause c. Obtain publicity for themselves and their goals d. Obtain increased negotiating power and respect

A

A client needed assistance with personal hygiene and feeding. What should a nurse coming for an initial assessment suggest to the family? a. I'll teach you how to care for your family member to keep him comfortable or, if you can afford it, you can employ an aide. b. It's important that he try to take care of himself and, if he can't or won't, he'll have to deal with the consequences. c. Reimbursement is available for a nurse to come to the house each day if you would like this assistance. d. You can always have your family member readmitted to the hospital for care.

A

A nurse had shared a great deal of information with a new client. Time had passed, but the nurse had more to share and was energetically doing so. When should the nurse stop teaching and plan the next visit? a. After about an hour b. Depends on what other visits nurse had scheduled that day c. When the client or family members start fidgeting d. When the client begins to look tired e. When the client demonstrates symptoms of sensory overload

A

what is a major Healthy People 2020 focus for urban populations?

health equity and elimination of health disparities

The CNO notes that the nursing department has exceeded budget in salary expenses for the last 3 months and asks the hospital nurse managers why this occurred. Which would be a cause for increased salaries?

A higher turnover rate in nursing staff

The director of two nursing units is off on medical leave. The morale on these units has decreased over the past year. During the director's absence the CNO notices a marked increase in the staff's morale. This causes the CNO to be concerned about which factor on these two units?

A lack of authentic leadership

Which of the following persons would be called chronically homeless?

A person has been homeless for more than a year

SATA An occupational health nurse is walking through a hospital. Which of the following observations would be concerning to the nurse?

A wet floor without a warning sign or a dry walk area on one side A nurse starts an IV without using gloves An electric bed gives a shock when touched Some biologic substance on the floor and wall has not been cleaned Volume has been turned very high on several TV sets, necessitating very loud verbal interactions

An emergency department (ED) manager is disciplining a nurse with a history of multiple client and staff complaints. The last disciplinary action was a verbal warning. If the institution follows the progressive method of addressing disciplinary issues, the manager would prepare for which action? A. A written warning B. A counseling session C. Another verbal warning D. Termination

A written warning

What created the original expansion of home health care agencies? Select all that apply. a. Changes that decreased reimbursement for hospital-based care b. Cost containment in a managed care environment c. Meeting clients' preference for care in their homes, not institutions d. Offering new career opportunities for nurses who are tired of hospital nursing e. The requirement of third-party payers for care to be given in homes f. So they could serve as a profitable revenue source

A, B, C, F

24. Which disasters are NA-TECH disasters? Select all that apply. a. Constant rain led to mud slides, and whole neighborhoods were buried. b. Earthquake caused structural collapse of bridges and highways in the area. c. People stampeded out of the overcrowded arena, trampling people who had fallen. d. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. e. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. f. Volcanic eruption covered the town with ash, making it difficult to breathe.

A, B, D, E

The nurse has just been notified that a client is to be admitted from the emergency department with a diagnosis of alcohol intoxication. The ED nurse says they have been unable to obtain much history because of the client's lethargic state. Which action is an appropriate intervention by the nurse?

Approach the client with caution when obtaining vital signs and shift assessments

A nurse who is obtaining a bachelor's degree in nursing is formulating a project regarding nurse's job satisfaction. The nurse is aware that research has shown job satisfaction is related to which factors in the working environment?

Appropriate staffing, involvement in organizational decision making, being recognized for a job well done, good relationships among staff

A nurse has frequent visitors while working. The manager has discussed with the nurse the negative effect of these visits on client care. What should the manager do next? A. Ask staff if the visits have decreased. B. Arrange a follow-up meeting with the nurse. C. Counsel all nursing staff regarding the limitations of personal visitors. D. Arrange to be visible on the nursing unit when this nurse is working.

Arrange a follow-up meeting with the nurse

An ED has doubled its client visits within the past year. This has led to an increased wait time and overcrowding in the ED waiting room. Which recommendation by the ED nurse manager to the CNO would be the most effective?

Hire more ED nursing staff to manage the increased volume of clients

A family will most likely lose their primary nighttime residence within the next week. Which of the following terms best describes their situation in relation to homelessness?

Imminent risk of homelessness

how does education level affect rates of alcohol use?

higher level of education = more likely to use alcohol

Which of the following best describes a downstream intervention to solve the problem of homelessness?

Improved treatment of mental illness

what roles does the nurse play in the care of vulnerable populations?

Advocate and activist Case manager Educator and counselor Collaborator and partner Researcher

An occupational health nurse realizes that an injured employee is going to be temporarily disabled. Which of the following actions can the nurse take to avoid the employee having disability syndrome?

Analyze the physical requirements necessary for doing specific jobs within the workplace Facilitate appropriate equipment or process changes necessary for the employee to be able to engage in temporary work functions Implement and monitor the employee's health to prevent adverse health effects from the injury Collaborate with the primary care provider to identify potential barriers in the employee's return-to-work process

The nurse appears in the nursing station with multiple facial lacerations and says a visitor hit me. What is the manager's priority action?

Ask a nurse to accompany the employee to the ED

1. How has the prevalence of violence and violent crimes changed the professional practice of health care providers? a. Vulnerable groups are now assessed for evidence of abuse. b. Keeps focus on patient care more than on issues such as personal safety c. It is now recognized that new specialties continue to be created. d. Each patient is now routinely screened for violence.

D

Which of the following disorders is experienced at a higher rate by homeless adults when compared with the general population? (Select all that apply.)

Asthma Hypertension Alcoholism

12 of 31 The school nurse only had the resources for one education program for all the schools' teachers and support staff. Which of the following topics would be the most important to address in this program? a. Asthma b. Diabetes c. Epilepsy d. Measles and mumps

Asthma In 2011, 9.6 % of children under the age of 18 had asthma, occurring most often among poor (13.5%) and non-Hispanic black children (17%). Asthma is one of the most common chronic childhood conditions, causing more than 4.6 million people to miss more than 1 day of school or work (CDC, 2011d). Because asthma is so prevalent, it is recommended that school-based support exists. Actions undertaken by some schools across the country include immediate access to asthma medications, development and implementation of asthma action plans, and student and staff education on asthma. Because of the severity and prevalence of asthma, this is the most important topic to address and should be addressed instead of diabetes, epilepsy, or measles and mumps.

1. What was the original treatment for mental illness in the United States? a. Humane attempts to understand b. Restraints, punishment, and forced labor c. Send patients to homeless shelters, jails, or prisons d. Surgery, pharmaceuticals, and hydrotherapy

B

14. How will a community know whether its disaster plan is adequate? a. After a disaster occurs and reports of deaths and injuries are fairly accurate b. By following practice drills involving various feasible scenarios as an initial step of planning c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the plan

B

15. A 14-year-old was found guilty of beating and raping a 73-year-old neighbor. The prosecutor had successfully argued for the child to be tried as an adult. The jury is considering a long adult prison term. What would you as a nurse suggest when called on as an expert witness? a. Child is mentally ill to have done such a thing and should be in a mental hospital. b. Child should be in a juvenile facility to avoid high risk of sexual assaults, beatings, and suicide in adult prison. c. Give a long adult prison sentence to protect society from such a predator d. That child be given an opportunity to complete high school while incarcerated in the adult prison

B

16. A family was very pleased with how well their child was doing now that he was on medication. They congratulated you on getting their child help and say they are so impressed that you cured him. How do you respond? a. You congratulate them on being so supportive to their child through this ordeal. b. You stress that the medication is controlling the symptoms and their child will continue to need their support. c. You thank them for their recognition of the role you—and all nurses—play in promoting health. d. You verbalize your observations of how well their child is doing.

B

16. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. What should be done? a. Put a green tag on his shirt and he can get in line to wait his turn for medical treatment b. Put a yellow tag on his shirt and then await transport to a medical facility c. Put a black tag on his shirt and give him a chair to rest in until something can be done d. Put a green tag on his shirt and ask him to use his good arm to help others make it to the staging area

B

17. A correctional nurse was preparing to give an inmate his psychotropic drug when the prisoner hit the nurse's arm, sending the medication flying, and yelled, "No more. I'm not taking that poison any more!" The prisoner is obviously mentally ill. What should the nurse do? a. Inject the medication rather than debate taking the oral pill with the inmate b. Recognize the prisoner's right to refuse treatment c. Throw the medication away, obtain another pill, and try to persuade the prisoner to take the drug d. With the help of two prison guards, force the medication down the prisoner's throat

B

17. A patient had a distorted thought pattern, which led to very uncomfortable feelings and inappropriate behaviors. What kind of therapy would probably be most successful? a. Behavioral therapy b. Cognitive-behavioral therapy c. Family therapy d. Group therapy

B

18. Which disaster would probably cause the most long-lasting mental health concerns for its victims? a. For the fourth year in a row a flood hit an area, demolishing several houses, but families heard the warning siren and evacuated in time. b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. c. A tsunami hit the beach with unbelievable force, water sweeping over the entire harbor, although most boats had been moved to deep water. d. A volcano erupted and lava destroyed the main road to the village where several houses burned, but no one died in the eruption.

B

2. What event in the 1950s was primarily responsible for improvement in treatment of the mentally ill? a. Creation of state mental hospitals where treatment could be given b. Discovery of antipsychotic medications such as Thorazine c. Electroconvulsive therapy was discovered to help depression. d. Establishment of community mental health centers for outpatient care

B

21. As a nurse as well as a citizen, what is your additional responsibility in relation to disasters? a. Assume you will be asked to volunteer to assist the American Red Cross with helping care for disaster victims b. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms c. Expect and plan for the possibility of being called to report to your employer for additional work efforts in caring for the sick and injured d. Expect to be a role model in preparing for and reacting to a disaster

B

3. What event in the 1980s was responsible for helping to develop pharmacological agents to treat mental illness? a. Data showing about one third of all Americans had mental illness led to increased funding for research. b. Development of neuroimaging showing anatomical and neurochemical functioning of the brain c. Public outcry against surgical interventions into the brain to control behavior d. Research findings demonstrating psychotherapy could not change behavior or improve patient outcomes

B

8. Who should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response? a. Federal Emergency Management Agency (FEMA) b. Office of Emergency Management c. State Disaster Office d. The National Disaster Relief Agency

B

8. Why does having parity in insurance coverage not always help persons with depression? a. Many persons find that the medications do not relieve symptoms. b. Most depressed persons do not seek treatment. c. Most depression is situational, and having insurance doesn't change the situation. d. Psychotherapists won't accept the low reimbursement offered by insurance plans.

B

9. The female nurse was called to the emergency department (ED) to help with a woman who had been beaten and raped. What are the nurse's responsibilities as a forensic nurse? a. Discuss with police officers what is known and what needs to be known to close the case b. Initiate the proper collection, preservation, and chain of custody of evidence with appropriate documentation c. Serve as chaperone while the physician completes the physical exam d. Be empathetic and supportive to the victim

B

A nurse was considering self-employment by starting a home health managed care agency. What risk is the nurse taking, particularly in the beginning? a. Because the nurse is a newcomer, most patient referrals may go to other, more long-term agencies. b. Managed care agencies assume the risk of providing all needed care within the amount budgeted. c. Most clients would not know the nurse and therefore would be unaware of the nurse's agency. d. Other nurses may envy the successful nurse and withdraw their friendship and support.

B

After teaching a group of women in the community about common mental health disorders affecting them, the community health nurse determines that the teaching has been effective when the group identifies which one of the following? A. Anxiety disorders and mood disorders occur twice as frequently in men as in women. B. Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. C. The three main types of eating disorders affect more men than women. D. The three main types of eating disorders include undereating due to food unavailability.

B

What can a home health nurse do to get in touch with a client if the client apparently has no telephone? a. Determine whether the client has family members in the area who might be able to get in touch with the client to ask the client to call the agency b. Go to the client's address and discuss making a home visit with the client c. Send a formal letter asking the client to call the agency for an appointment d. Tell the referral source you can't accept referrals without usable telephone numbers, so this client wasn't visited

B

What is the purpose of the Outcome and Assessment Information Set (OASIS)? a. To analyze the cost-effectiveness of health agencies b. To evaluate and improve clinical performance quality c. To measure and publicize hospital data on outcomes such as death rates d. To survey patient satisfaction with care received from health agencies

B

10. What is the primary goal of the federal government in relation to disasters? a. To continue to consolidate all existing agencies, groups, and organizations into a single department b. To distribute federal financial aid to disaster-stricken areas c. To enable appropriate response to assist a state having a disaster d. To ensure continuity of essential federal functions during any disruption

D

11. Who are most likely to abuse elderly Americans? a. Adolescents for the thrill and feeling of power b. Caregivers in extended-care facilities c. Strangers wanting money for drugs d. Their adult children

D

3. The residence advisor told the college nurse that a particular student was not attending classes or even eating but just staying in bed. When you visit the student's dorm room, he says he is fine; he is just really tired. What would interfere with this student's getting help? Select all that apply. a. Families don't want their loved one to be seen as mentally ill and will blame the college for any problems he is having. b. Many communities have very limited mental health resources available. c. The patient is too mentally ill to be able to successfully seek assistance. d. The emergency department would see the patient on an emergency basis but can't admit him as many hospitals are not set up for mentally ill patients. e. The student is just exhausted from all the activities available on a college campus and hopes the nurse will give him an excuse to skip classes for a while. f. The student is staying in bed until his family agrees to let him travel and see the world a bit before having to get a full-time job.

B, C, D

Why did home health care continue to grow until very recently? Select all that apply. a. Consumers prefer home care, so they will personally pay for it. b. Demographics—more elderly persons in U.S. society c. Home care does not cost much more than institutional care. d. Insurance companies are encouraging home care. e. Medicare is encouraging home care rather than institutional care. f. Physicians prefer to visit clients in their homes rather than institutions.

B, D, E

which legislation provided for the construction of health care facilities especially in rural communities

hill-burton act

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

B, C, D, E, F

19. With whom would the forensic nurse primarily interact during the day in addition to clients? Select all that apply. a. Case managers b. Officers of the court c. Physicians d. Police officers e. Psychologists f. Social workers

B, D

the home care provider who is primarily responsible for the personal care needs of the client, including grooming and bathing, is the

home care aide

who is responsible for determining the frequency and duration of client care?

home health care nurse

Which of the following best describes how the Continuum of Care (CoC) concept determines the number of homeless? (Select all that apply.)

By conducting a point-in-time (PIT) homeless persons count every other January By reporting the number of homeless persons who use emergency shelters or transitional housing during the year

19. A nurse explained the causes of asthma in a child, how to observe for "triggers" that lead to an attack, and how to use the inhaler. What does this nurse-patient interaction ignore?

By focusing only on the child, the nurse has absolved local government and industry from taking any action to improve air quality. By placing responsibility for the cause and cure of health problems exclusively on the individual, the belief is reinforced that all individuals are free to control their lives. Such a perspective absolves society, government, industry, and business from accountability.

A nurse had 5 years of experience in a community health clinic when she accepted a position in occupational health. Which of the following best explains how the nurse will know what to do in this new setting?

By following company procedures and relying on assessment checklists and clinical records

10. An emergency department nurse wasn't sure whether there was enough evidence one way or the other to suspect child abuse with a child client, as there wasn't much evidence of physical harm. The forensic nurse agreed to see the child. What would be the forensic nurse's primary focus? a. Ask the child whether the family has any secrets b. Assess for old injuries or injuries in the process of healing c. Observe the child's appearance and behavior and how the child interacted with other children and adults d. Question the parents concerning the child and any discipline problems

C

11. Because a person with obsessive-compulsive disorder (OCD) typically knows the ritual is senseless, why doesn't he or she just quit doing the ritual? a. As rituals become habit, others will worry about the person if he or she suddenly stops engaging in the ritual behavior. b. Engaging in rituals allows the individual to feel in control. c. If the compulsion is resisted, anxiety increases. d. Rituals, even if nonsensical, are comforting and reassuring.

C

12. What are the most common forms of elder abuse? a. Emotional abuse by caregivers b. Financial abuse when the elder person's resources are used without the elder's consent c. Neglect by self or caregivers d. Physical mistreatment resulting in injuries even if only bruising and abrasions

C

12. Which female would be most at risk for bulimia nervosa? a. A 13-year-old who is constantly snacking on food from her backpack all day b. A 14-year-old student who is known as a nerd c. A 15-year-old cheerleader who wants to be a professional ballerina d. An 11-year-old student with the highest GPA in the school

C

13. What is a particular responsibility of the forensic psychiatric nurse? a. Assisting with the deposition b. Collecting evidence to be used in future legal proceedings c. Judging intent or diminished capacity of the client during the incident d. Preparing to testify in court

C

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

C

16. The correctional nurse was completing an admission physical for a newly incarcerated prisoner. The nurse realized the prisoner was talking to someone other than the nurse. What does the nurse need to remember? a. Cell phones, including those with ear phones, are commonplace among everyone. b. It is common for persons to talk to themselves or think out loud. c. Prisons have become the residence of a very large number of persons who have mental illnesses. d. Prisoners get very lonely and often talk to mirrors or inanimate objects.

C

17. What questions are asked during disaster triage? a. Are you hurt? Do you need help? b. How can we help you? What do you need? c. Who are you? Are you hurt? d. Where were you when disaster struck? What did you notice?

C

18. What is considered appropriate preparation for engaging in forensic nursing specialty practice? a. Adequate number of continuing education credits plus licensure as a registered nurse (RN) b. Baccalaureate nursing program and previous community health experience c. College-based educational program including supervised clinical hours and internship d. Interest in and willingness to be employed in the field

C

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

C

4. Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. How are these patients different from the first patients to arrive? a. Burn patients probably have skin damage, whereas the firefighters have lung damage. b. Burn patients will need extensive care over time, whereas the firefighters can probably stay the night with oxygen treatment and then be discharged. c. The burn patients were direct victims, whereas the firefighters are indirect victims. d. The second set of victims may have scarring, shortness of breath, and persistent hoarseness for the next few days.

C

4. Other than poverty or lack of health insurance, why do people not seek care for mental health problems? a. They don't know where to go to get help. b. They don't recognize they have a problem. c. There's a social stigma with having a diagnosed mental illness. d. They are too embarrassed to admit they need help.

C

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

C

6. The legal nurse consultant (LNC) was surprised to find that former friends were no longer interested in a colleague relationship and one even accused the LNC of trashing clinical nursing practice in the courtroom. What would be the best response? a. "I've just accepted a position that pays an incredible amount more than staff nursing in a hospital." b. "I'm not part of clinical nursing; I'm part of the legal system now." c. "I'm defending the expertise and experience of skilled nursing clinicians by helping remove dangerous practitioners from the field." d. "I'm helping clients who were hurt by poor practice to obtain revenge."

C

6. What map is crucial to be included in any disaster plan? a. Communication map showing telephone wires and cell phone towers b. Geographic map showing, for example, roads, highways, and train routes c. Resource map showing potential resources in persons and supplies d. Response maps showing sites of first responders such as fire stations and police stations

C

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

C

7. The legal nurse consultant (LNC) was asked to submit an affidavit to both the prosecutor's and the defendant's office. What does the LNC have to include? a. List of all literature reviewed in preparation for being paid as an expert witness b. Notarized signature on a summary of the LNC's education and clinical experience c. Summary of nurse's educational and experiential credentials and an analysis of the case d. An opinion under oath as to what happened in the crime situation

C

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

C

A client was admitted to home care and was dismayed to find the nurse discussing such uncomfortable topics as advance directives, living will, and durable power of attorney. As that nurse, what is your response? a. "Don't be concerned; this is just routine." b. "I'm sorry, but the state law says I have to ask you to fill out these forms." c. "You get to make decisions about your care, but if, for any reason, you can't do this, these forms will tell us what you want us to do." d. "Your physician asked us to discuss these with you."

C

In addition to factual data such as name, address, and diagnosis, what information is crucial to the nurse when a referral is received? a. The amount of reimbursement the agency will receive for a visit b. The family's reaction to the suggestion that a nurse visit in their home c. The purpose of the referral for a home visit d. Whether the patient requested a home visit

C

What is the primary task to be accomplished during the initial telephone contact between the home health nurse and the client? a. Make sure that the name, address, telephone, and other data are accurate b. Confirm that the nurse will be a guest in their home so socialization can occur c. The client gives permission and agrees to a mutually acceptable time for a home visit d. Warn the family that the nurse will always need to immediately see the proof of insurance before proceeding further

C

What should be included when the nurse writes a proposed treatment plan for a home health client? a. Outline of specific client goals with measurable outcomes b. Specific nursing interventions to treat identified client problems c. Type of services needed and frequency of visits by each discipline d. Typical nursing care plan information from assessment to evaluation

C

12. How is the American Red Cross different from FEMA or NIMS? a. Funding includes both taxes and voluntary contributions. b. It emphasizes being prepared for emergencies, not just reacting to them. c. It has only volunteers as staff. d. It is a nongovernmental volunteer agency.

D

Why are home health care agencies that are part of national chains doing better in the competitive marketplace than individually owned agencies? a. Better media coverage and a nationally known "name" recognized by prospective clients b. By offering lower-quality care using less well-prepared caregivers, they are assured maximum profit. c. The chief executive officer usually has extensive experience and makes wise decisions. d. Lower administrative costs and easier negotiating when buying in bulk

D

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

C, D, F

25. Why would earthquakes be more frightening than floods to many people, even though both can cause extensive damage? Select all that apply. a. Death rate and scope are higher in earthquakes. b. There is a higher frequency of earthquakes. c. Imminence of earthquakes is unknown. d. It's not possible to prevent an earthquake. e. The intensity of earthquakes is higher. f. The predictability of earthquakes is lower.

C, D, F

22. Which group is especially at risk for sexually transmitted diseases (STDs)?

Teenaged girls Teenaged girls in particular may be more susceptible to STDs because they have fewer protective antibodies to STDs and a cervix that is biologically immature.

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

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

5. Which crucial question, needed by the nurse to determine health problems, might not be written on the health history form?

Can you tell me what you do at work? 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.

7. A day care center asked the nurse to come because they had several children out as a result of chickenpox. How might the nurse reassure the staff?

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

14. What seems to be the problem with action to reduce the amount of toxic elements in our housing?

Controversy exists because of the high cost in removing toxic substances. Much controversy surrounds the economic hardship that industry, government, business, and multidwelling owners would face if they were forced to reduce concentrations of toxic elements.

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

D

15. An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. What should the community do first? a. Send in ambulances to transport injured persons to medical facilities b. Send in media personnel to share the event and begin efforts to obtain donations for the injured c. Send in medical personnel to administer first aid and triage the injured d. Send in law officials to secure the area and assure the safety of the victims

D

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

D

20. A student said she wanted to discuss an issue with you but that it was confidential. Therefore, she asks you to promise as a professional to keep what she tells you a secret. She then shares that her roommate is very depressed; her older sister committed suicide, and she is planning on killing herself if she doesn't pass her final exams. What do you do? a. As a professional who made a promise, you teach the student how to recognize if her roommate is getting ready to actually do it and the phone number of the suicide hot line. b. As you promised secrecy, you can only encourage the student to encourage her roommate to seek help. c. You give the student brochures and information plus the suicide hotline phone number to share with her roommate. d. You stress that you cannot keep a secret when someone's life is at stake and immediately go to assess the roommate.

D

20. What might be your concern when a friend who was raped and beaten appeared to be coping well until recently when she dropped out of school and shared with you that nightmares during which it happens all over again were becoming impossible to live with? a. A late psychological reaction of despair and hopelessness b. Depression that no one rescued her and saved her from the traumatic event c. Guilt and concern over what she could possibly have done to invite such an event d. Posttraumatic stress syndrome disorder (PTSD)

D

5. What can a forensic nurse, serving in the elected office of coroner, bring to the situation compared with other professionals? a. Extensive knowledge of medicine b. Knowledge of the law c. Previous experience in testifying in court d. Superb communication and empathy skills

D

8. The legal nurse consultant (LNC) felt more than a little stressed after being cross-examined by both the prosecuting attorney and the defendant's attorney in intricate detail. What should the LNC do next? a. Get together with friends and share the experience b. Go out and have a stiff drink to relax and get over the stress c. Pray the case doesn't go to trial when the LNC will have to go through all this again d. Review the written transcript for accuracy

D

9. When would the National Guard become involved in a disaster? a. When the Federal Emergency Management Agency (FEMA) requests such assistance b. When the local government requests help keeping order in the community c. When the president has declared the area a national disaster d. When the state has been asked to help an overwhelmed community

D

A client needed a great deal of care. During a morning visit, the nurse shared information with the client's caregiver and demonstrated technical procedures. What is especially important for the nurse to assess? a. Client response to the procedures b. How the client thought the goals were being achieved c. If the client and the caregiver retained all the information the nurse gave d. The skill and comfort level of the client's caregiver

D

What is the most important task to be accomplished during the initial home visit? a. Assess the client and the family b. Discuss social topics c. Educate the client and the family regarding the health problem d. Establish rapport and trust

D

What is the primary factor in how a hospice nurse makes decisions while giving care in the client's home, surrounded by the client's family? a. To allow the patient a comfortable, pain-free death b. To assure the caregiver and the whole family that they are not hastening the client's death by anything they do to keep the client comfortable c. To encourage the family to grieve and confront the reality of the client being terminal d. To prevent a decline in the caregiver's health

D

What sort of documentation should the nurse expect to complete regarding the home visit? a. A carefully laid out nursing care plan for future visits b. Careful detail about assessment data and care given to document the nurse's effectiveness c. Documentation depends on agency policies and forms, so it varies widely. d. Medicare forms per HCFA regulations for reimbursement

D

Which 66-year-old client who needs skilled nursing care is eligible for home health care reimbursement by Medicare? a. A client who always worked for the state and is proud that net salary was not lowered by Social Security (FICA) withholding b. A client who needs his wounds cared for every day, including weekends, and expects the nurse to be at his house exactly at 8 AM every day c. A client who is a loner, without a spouse, family, or friends d. A client who is very loved by his wife, his children, and all the friends he had made during the 30 years he was employed in the factory e. A client who is an illegal immigrant who has lived in the United States for 25 years but begged the nurse not to tell

D

26. What are the Department of Health and Human Services' responsibilities in relation to disasters? Select all that apply. a. Contacting family members with up-to-date information regarding victims and their condition b. Coordinating local services to prevent duplication and fragmentation c. Delivering first aid and arranging for prescription medications that were lost to be replaced d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims f. Setting up safe and comfortable disaster shelters (emergency housing) for families

D, E

which health problems are more complicated to treat among the homeless population?

Diabetes mellitus Hypertension Renal disease Liver disease Peripheral vascular disease Schizophrenia Infant mortality HIV

mitigation refers to

the actions that can be used to prevent or reduce the damage caused by a specific disaster event

An emergency department client is demanding pain medication and threatening to harm staff if they do not provide it. The ED physician calmly continues to ask the client about the level and location of pain as the nurse steps away and notifies security. What is the physician attempting to do by asking these questions?

De-escalate the situation

Despite the nurse manager's best efforts to retain an experienced nurse, the nurse leaves for a job in a competing hospital. Which option reflects the most important thing the manager must do now?

Decreased the impact of the hospital grapevine

20. As the nurse in charge that day, you note that two patients had communicable infectious diseases and were treated appropriately. Should anything further be done?

Depends on your state health department's requirements Because state health departments have the responsibility for monitoring and controlling communicable diseases within their respective states, they determine which diseases will be reported within their jurisdiction.

An employee had recently had a heart attack and was just discharged from the hospital. Which of the following would be an appropriate action for the nurse to take?

Determine appropriate temporary, perhaps part-time, responsibilities to ease the employee's reentry to the workplace

The manager is contemplating terminating a nurse. What should the manager consider regarding the expectations of the job prior to proceeding with termination? A. Did the nurse receive and sign for a copy of the appropriate job description when hired? B. Was the nurse apprised of the criteria on which evaluation would be based? C. Have any changes to policy and procedure been discussed with the nurse and made available in writing? D. Was the nurse hired using the same documentation as others hired at the same time? E. Have others hired during the same time period been successful?

Did the nurse receive and sign for a copy of the appropriate job description when hired, Was the nurse apprised of the criteria on which evaluation would be based, Have any changes to policy and procedure been discussed with the nurse and nade available in writing? A, B, C

what are some factors that form the web of causation for vulnerable populations?

Disadvantaged socioeconomic status Lifestyle behaviors Low self-esteem Feelings of powerlessness Disenfranchisement

A director must discipline an ICU manager. The director and manager have become friends. When disciplining the manager, what is the best approach by the director? A. Notify the human resources director that the meeting will occur. B. Include the chief nurse officer (CNO) in the session. C. Ask a manager from another department to sit in on the meeting. D. Discuss the issue, concentrate on the issue, and do not make it personal.

Discuss the issue, concentrate on the issue, and do not make it personal

A nurse who receives frequent phone calls informs the manager the phone calls are related to a health crisis concerning a family member. Other nurses also receive personal calls, but not as many as the first nurse. Which action by the manager is appropriate? A. Tell the nurse to have family call the manager's office if there is a crisis. B. Discuss with the nurse how personal phone calls may affect client care and should be limited. C. Inform the nurse the phone calls are causing morale issues among the staff. D. Lift the policy against staff carrying personal cell phones for this nurse while the crisis continues.

Discuss with the nurse how personal phone calls may affect client care and should be limited

A newly hired nurse has incurred two absences with two pay periods. The nurse manager has scheduled a meeting with the nurse. What other action should the manager plan in addressing this issues?

Document the absences, review the attendance policy with the nurse, and provide a copy of the policy

1. Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster? a. American Red Cross b. Department of National Security c. Federal Emergency Management Agency d. The National Disaster Relief Agency e. The National Incident Management System

E

15. You are a college nurse. When a student comes in and tells you that his roommate is talking about killing himself and has given some of his possessions away and he believes the roommate has a gun, what do you do? a. Ask the student why he is telling you this story; what does he expect you to do? b. Call the police immediately, and have the student tell them the story c. Call the roommate, and set up an appointment for him to come to your office to discuss how things are going in his life right now d. Call the roommate, ask if he is thinking of killing himself, and, if so, how is he thinking of doing that? e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive

E

22. Which set of symptoms would be unexpected after a disaster? a. Confusion, disorientation, indecisiveness, and memory loss b. Depression, fear, or just numbness c. Fatigued with headaches, nausea, and dizziness d. Irritable, suspicious, argumentative, and inappropriate e. No unusual feelings or behavior

E

4. Which cause of death on a death certificate would need correction by the forensic nurse? a. Accident b. Homicide c. Natural d. Suicide e. Untimely

E

17 of 31 A school health nurse was concerned about the diagnosed eating disorders of three high school students. A nutrition and body image program was planned. Which of the following classes should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. Kindergarten students

Elementary school grades 4, 5, and 6 It is imperative that the school nurse recognize the association between feelings of inadequacy (e.g., low self-esteem, anger, anxiety, and depression) and unhealthy eating practices in adolescents and young people. These self-perceptions begin early in life; therefore education and counseling must begin in elementary school. This program would be offered too early for kindergarten students and too late for grades 7 through 12. Thus, the priority population would be the elementary school children.

2. In what way is environmental health (EH) more challenging than other variables related to an individual's health?

EH requires social, economic, and political changes to improve Intervening to improve environmental conditions requires basic social, economic, and political changes. Aggregates must work together to create such change.

Which of the following describes a dimension of the social determinants of health (SDH) defined within Healthy People 2020?

Education

A candidate's resume demonstrates a perfect fit for a position, but one glance showed the candidate was wheelchair bound. Which of the following suggestions should the nurse make to the employer?

Employ the candidate and rearrange the work area for easy access and exit for someone in a wheelchair

Which of the following best describes what the occupational safety and health act of 1970 requires?

Employers must keep the worksite free from recognized hazards

An occupational health nurse works in a state that requires continuing education units per year for renewing a nursing license. Which of the following courses would probably be most helpful in the role?

Ergonomics and toxicology

A nurse who has been working the evening shift on the hospice unit for 5 years resigns. The nurse says, "I just cant work here anymore. These clients are so sad." What is the best strategy for retaining this nurse?

Facilitating a transfer to another nursing unit

what was FERA?

Federal Emergency Relief Administration - supplied food, shelter, clothing, money, jobs, and health care to homeless individuals in the 1930s

17. What conclusion can be drawn concerning efforts to decrease environmental pollution?

Federal policies have been weakened, and enforcement lacks funding. 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.

16. A school had tried very hard to uphold the requirement for all children to be vaccinated. However, state law allowed parents to exempt their child if they had a religious reason for refusal. Two children had come down with chickenpox. What will be the probable result?

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

A manager is following up on an employee's injuries. The manager has contacted HR to initiate the process of worker's compensation. Which action would be appropriate by the manager?

Follow up with the employee to express concern and answer any questions regarding this situation

A certified nurse's aide (CNA) has been reported to the nurse manager for refusing to perform hand hygiene between clients when providing morning care. Which statement by the nurse manager would be the most effective? A. "Do you need a class on hand hygiene?" B. "Forgetting to perform hand hygiene between clients can spread infection." C. "Why do you refuse to perform hand hygiene?" D. "If I hear of any more instances of you not performing hand hygiene, I will write you up."

Forgetting to perform hand hygiene between clients can spread infection

21. How could a small community group hope to accomplish goals against a large powerful corporation?

Form coalitions with other groups that have similar goals 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.

The nurse manager charged with hiring staff for a new nursing unit explains the unit's rigid structure and scheduling policies to all potential applicants. The manager is most likely to lose the interest of applicants of which generations?

Generation X, Generation Y

21. Parents requested that their child be brought up to date on appropriate immunizations. After reviewing the child's medical history, you prepare to give the two immunizations. Is there anything else you should do?

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

8. A city that depended on tourist dollars had feedback that tourists were saying they were never returning because of the constant mosquito bites. What should the town do?

Have everyone in town search for and remove any standing stagnant water Knowing the reservoirs for infectious agents is important because, in some cases, transmission can be controlled by eliminating the reservoir, such as eliminating the standing water where mosquitoes breed.

20. The local stream was full of trash. The Boy Scouts had a cleanup day so they could again canoe on the stream. What should local nurses do?

Hold dialogue with community members about the problem and its effects 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.

4. Which component of the epidemiological triangle is primarily responsible for a female client having a fungal vaginal infection after being treated with antibiotics for strep throat?

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

The manager has just terminated a nurse. What statement by the manager is appropriate? A. "You may go back to the unit to say good-bye to your coworkers." B. "We have cleaned out your locker and have your personal belongings ready for you." C. "I have notified security to escort you as you leave the building." D. "As of this time, you are no longer an employee of this institution." E. "Please do not discuss your termination with any other nurses."

I have notified security to escort you as you leave the building, as of this time, you are no longer an employee of this institution

A valued long time nursing employee says to the manager, I am so tired of all the policies on this unit. I am thinking about retiring. What should the manager's response be?

I'd hate to lose you but have you thought about transferring to a different unit?

The hospital's new management company has assigned a "leadership coach" to groups of current nurse managers. Which statements made by a manager would the coach interpret as indicating the manager does not value this opportunity? A. "Why do I need a coach?" B. "I've been a manager longer than our coach has been a nurse." C. "I'm getting burned out with the way we manage." D. "Another new program to waste our time." E. "Coaching has helped my nurses improve their practice."

I've been a manager longer than our coach has been a nurse, Another new program to waste our time B, D

The manager has disciplined a nurse with a written warning. At the end of the session, the manager asks the nurse to sign the warning and the nurse refuses. What should the manager do? A. Tell the nurse that signing the form in mandatory. B. Indicate on the form that the nurse declined to sign. C. Sign the nurse's name to the form and include the manager's initials. D. Complete a second warning for the nurse's failure to follow procedure.

Indicate on the form that the nurse declined to sign

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.

Individuals assume it is a personal problem, not an employment issue. Statistics do not reflect unreported health problems. Collective problems related to employment or occupation are often perceived as individualized injuries.

6. One child in a kindergarten room had a slight fever and didn't eat lunch. Otherwise, the child seemed OK. Three days later, several children were absent from kindergarten. What happened?

Infectious diseases can be contagious before any diagnostic symptoms occur. The communicable period, or communicability, follows latency and begins with shedding of the agent. The incubation period is the time from invasion to the time when disease symptoms first appear. Frequently, the communicable period begins before symptoms are present.

18. How are infectious diseases any different from any other health problem?

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

A nurse enters a client's room andsees a visitor threatening the client. The nurse questions the visitor in a nonthreatening manner. The visitor begins to threaten the nurse. What should the nurse do in this situation?

Keep a safe distance from the visitor

what factors are barriers to health care for the homeless population?

Lack of access Lack of systematic communication with healthcare professionals Lack of transportation Lack of social and family support Psychological depression Lack of motivation

Which of the following best describes the term "literally homeless"? (Select all that apply.)

Lacking a fixed, regular, and adequate nighttime residence Living in a place not typically used for human sleeping

Which statement by the nurse manager is the best example of day-to-day coaching? A. "Can we meet this afternoon for about 30 minutes to discuss your progress?" B. "I think you need to get different day care that would allow you to be on time." C. "Over the past 6 months the narcotics count has been off on several days that you have worked." D. "Let me show you a method I have found to be effective in making patient assignments."

Let me show you a method I have found to be effective in making patient assignments

The nurse was reported for not following unit policy in relaying a client's complaint regarding another staff member. During a meeting, the nurse insists he managed the situation appropriately. How should the manager respond? A. "Let's schedule another meeting for later in the week after you have had time to reflect on the situation a little more." B. "Let's explore some alternative solutions to what happened." C. "I am going to request a meeting for both of us and the human resources director." D. "As I see it, the problem is your inability to follow the simplest of unit policies and to take direction."

Let's explore some alternative solutions to what happened

Hospital management is brainstorming ways to reduce absenteeism. Which suggestions from this session deserve further investigation?

Lets offer a salary increase for those with good attendance, Why not include attendance as part of the employee performance appraisal, I don't think we are enforcing the absence policies we have now. That is the logical part to start, We need to start at the top and be certain all of our management employees maintain good attendance

Which of the following best describes a major difference between women who have always had shelter and women who have been homeless?

Level of involvement with physical and/or sexual abuse

A school nurse was asked to see Lisa, a student in the fourth grade who was rumored to be living in a car with her mother. Which of the following would most likely have caused the teacher to become concerned?

Lisa may be developmentally delayed.

12. What has happened to air quality since the United States outlawed use of chlorofluorocarbons, halons, and carbon tetrachloride?

Little change, because these chemicals remain in the atmosphere. These chemicals, which were in widespread use, remain in the atmosphere.

8. What would be an appropriate term for intoxicated drivers, secondhand smoke, urban crowding, noise, and mechanization?

Living patterns risks Living patterns are the relationships among people, communities, and their surrounding environments that depend on habits, interpersonal ties, 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.

9. What is meant by environmental racism?

Locating industrial hazards in low-income communities Discriminatory land use ensures that many impoverished and marginalized groups, especially people of color, live in close proximity to industrial contamination. This is called environmental racism. Members of these communities are at risk for illness and injury.

An employee has consistently violated policy and has not responded to coaching. The manager has decided that discipline is required. What should the manager do first?A. Plan a private meeting for the disciplining. B. Wait for one more infraction to occur and discipline immediately afterward. C. Make certain that the information regarding policy violations is correct. D. Keep the human resources department informed.

Make certain that the information regarding policy violations is correct

Which of the following represents the largest group of homeless adults?

Males

Which of the following is one of the most challenging areas for occupational health nurses?

Managing ethical conflicts between responsibilities to management and responsibilities to employees

1. What are some problems with U.S. water quality today? Select all that apply.

Many aquifers are contaminated with pesticides and fertilizers. More than 42 million Americans drink untreated water. Sediment from construction, agriculture, and deforestation is often present. Underground water, if contaminated, can't be cleansed. Forty-two 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 can't be cleansed.

15. What issue exists from communities using solid waste landfills to dispose of trash from private residences?

Methane gas may move through the soil to cause fire or explosions nearby. 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.

A nurse has been pulled from the surgical unit to the ICU unit and is asked by an ICU nurse to administer a medication that requires monitoring the cardiac rhythm. When asked about the client's cardiac rhythm after the medication was administered, the surgical nurse states, "I don't know." What actions should be taken by the unit's nurse manager? A. Meet with the ICU nurse to discuss the situation. B. Meet with the surgical nurse to discuss the situation. C. Give a written warning to the surgical nurse for not following policy. D. Give a written warning to the ICU nurse for not following policy. E. Meet with the nurses together and issue an informal verbal warning to both.

Meet with the ICU nurse to discuss the situation, Meet with the surgical nurse to discuss the situation A, B

A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do? A. Go to the cafeteria and confront the assistant. B. Send a message with a nurse going to lunch for the assistant to return to the unit immediately. C. Call the cafeteria and ask that they send the assistant back to the unit. D. Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week." E. Anticipate that the assistant will give an explanation for the lateness.

Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week,", Anticipate that the assistant will give an explanation for the lateness D, E

The staff has complained that a nurse receives frequent personal phone calls, which is a violation of policy. In what manner should the manager address this nurse? A. Meet with the nurse privately and inquire as to the necessity of personal phone calls. B. Meet with the nurse and give a verbal warning. C. The manager should inform the nurse the other nurses are complaining about the phone calls. D. Tell the complaining nurses to handle the situation with peer pressure.

Meet with the nurse privately and inquire as to the necessity of personal phone calls

23. How might a nurse remember what should be included in a health history?

Memorize the I PREPARE mnemonic The I PREPARE environmental exposure history mnemonic is a quick reference for primary care providers. This tool will help the nurse remember what to ask to determine environmental factors relevant to health.

Which of the following best explains why occupational health nurses felt a need to create the Factory Nurses Conference?

Most OHNs practiced alone and wanted to be able to interact with peers

An employee has called in to report being unable to come to work due to care trouble. This is the third time this has happened in the last 2 weeks. The manager should question which variable in this employee's attendance?

Motivation

10. When it becomes known that a particular industry has vastly polluted the surrounding neighborhood, what would most persons living there do?

Nothing, because of family ties and cost of relocation 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.

Which of the following best explains why job opportunities for occupational health nurses have continued to expand?

Nurses are able to document cost savings to employers

As part of a presentation on health care workplace violence, the speak says injuries to nurses from violent acts in the work place are probably underreported. What rationale should the speaker offer for this statement?

Nurses may not clearly understand what constitutes workplace violence, Nurses may be unaware of how to report violent actions, Nurses may feel that dealing with violence is an unexpected part of the job, Nurses may believe that reporting a violent act will mark them as a weak employee

A nurse manager strongly believes that nurses should seek advanced educational degrees. The manager encourages this attitude in staff nurses. What are the dangers of this practice?

Nurses who achieve an advanced degree are more mobile, Staff members may need time off to attend school, Staff members may need to resign to attend school full time

A nurse manager has reduced absenteeism by increasing each nurse's job responsibilities. Why is this strategy effective?

Nurses who feel their job is important realize that others depend upon their presence at work, Having greater responsibilities enriches the job experience

A newly formed task force is addressing the preventing of violence in the health care organization. Which group of employees is most likely to experience violence?

Nurses working in a geriatric unit, Nurses whose work space includes large waiting rooms

The human resources department is considering motivating employees to maintain good attendance by changing some organization practices. Which items should HR consider?

Offering a discount on the host of on-site child care for employees with good attendance records, Banning an employee with more that two absences in a pay period from working overtime in the next pay period, Entering the names of employee who have no absences in a 3 month period in a drawing for a paid day off

22. How does participatory action research (PAR) differ from other research methods in seeking knowledge?

PAR also seeks to raise consciousness. Participatory action research has as its goal not only the production of knowledge but also the generation of debate that will raise consciousness of constraints.

An ICU nurse does not follow policy when administering a medication intravenously. Which would be the most appropriate action by the manager to assist the employee? A. Provide written instructions for administering the medication. B. Remediate the situation with the ICU staff. C. Provide a copy of the policy and discuss the rationale for the policy as it relates to client care. D. Reprimand the ICU nurse for giving the medication.

Provide a copy of the policy and discuss the rationale for the policy as it relates to client care

14. During an outbreak in the hospital, all staff members were given immunoglobulin if they were not already immune to the disease. What sort of immunity will the staff that received the immunoglobulin then have?

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

4. What is a factor that makes environmental health (EH) challenging?

People going about daily tasks ignore their surroundings or take them for granted Ordinarily, society takes systems and structures (buildings, schools, transportation, workplace) for granted, ignoring or overlooking potentially harmful environmental situations.

7. What is one reason it is difficult to get others interested in environmental health?

People respond more to an acute crisis than chronic environmental problems. 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.

Two nurses are in the day room when a visitor approaches and starts yelling about the care his other is receiving. One nurse says Im sorry you are upset, what can I do for you? This visitor continues to complain more loudly. What should the other nurse do?

Quietly direct other people out of the room, Leave the room and call security

16. What is the most common cause of health problems resulting from radiation?

Radon gas in homes The three primary sources and distribution of radiation exposure are radon (43%); medical exposure (20%); and other nonnatural sources such as nuclear weapons testing, nuclear waste disposal, and transportation, storage, loss, and misuse of radioactive sources (19%). Radon contamination is the second leading cause of lung cancer mortality in the United States.

2. What is particularly notable about infectious disease in the United States?

Rate of infection varies extensively by income and ethnic groups. Probably one of the most profound failures in infectious disease control in the United States and elsewhere is that the successes are not equally distributed in the general population. Infectious diseases continue to be differentially distributed by income and ethnic groups, and the poor and minorities continue to experience the greater burden.

An OB nurse has violated a unit policy. The OB manager is discussing the incident with the nurse. During the discussion the nurse informs the OB manager of the actions of other staff and the physician's attitude leading up to the event. How should the manager address these issues? A. Tell the nurse that physician's attitude is none of the nurse's business. B. Inform the nurse of the policy violation. C. Inquire about the physician's attitude and the staff actions during the incident. D. Redirect the nurse to focus on the issue.

Redirect the nurse to focus on the issue

A highly intoxicated client is brought to the ED. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client?

Remove any hemostats from the pocker, Take off the stethoscope and place it in the pocket enter the room calmly with a smile

An ICU nurse has just assisted the physician in placing a central line in a client. Over the past few days the client's son has just increasingly verbally abusive to nursing staff. The unit secretary tells the nurses that the son is at the nurse's station demanding to see the client. Which action by the nurse is most important?

Remove the central line tray from the room

1. Which infections continue to increase in the United States?

STDs Treatable sexually transmitted diseases (STDs), such as syphilis and gonorrhea, had declined until 2000 but increased in 2007 for the seventh straight year. At the same time, incidence of chlamydia, another treatable STD, has increased steadily since 1995, and the number of cases reached 1,108,374 (370.2 per 100,000 people) in 2007.

Which of the following best describes how health care professionals are involved in the problem of homelessness?

Serious illnesses or disability creates high medical bills, which may lead to homelessness.

which health problems are a consequence of homelessness?

Skin and blood vessel diseases Respiratory disorders Infections Malnutrition Parasitic infestations Foot and lower extremity problems Physical assault Rape trauma Periodontal disease Tooth decay Degenerative joint disease Sexually transmitted infections Cirrhosis Hepatitis

9. The daily patrons of a local town restaurant became ill with nausea, vomiting, and diarrhea. Without knowing the cause, what should be done immediately to help avoid future problems?

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

Which of the following underlying factors most likely contributes to homelessness?

Substance abuse

23. A young woman is panic-stricken. She hadn't realized how much she was drinking, and she thinks she had unprotected sex with several men last night. She is petrified and wants an HIV test immediately. What do you do?

Suggest she be treated immediately to be safe HIV infection is usually determined by the HIV antibody test, most commonly the enzyme-linked immunosorbent assay (ELISA). False-negative findings may occur, especially before the body produces antibodies after exposure. The student should be aware that treating HIV exposure with HIV medications has been shown to decrease the incidence of seroconversion and HIV infection.

Which of the following best describes the problem with the Section 8 housing program?

Supply is vastly less than the demand.

A manager has been informed by a reliable registered nurse that an assistant lied about bathing a client. The manager calls the assistant into the office with a written warning. Why is this action inappropriate? A. The registered nurse should issue the warning. B. The first warning should be verbal. C. The assistant should be allowed to discuss the matter. D. This type of action should be conducted by the human resources department.

The assistant should be allowed to discuss the matter

A geriatric client in a long term care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violet episode?

The client is moving slowly toward the room door, The client is staring blankly towards the nurse, the client raises his fist

The ICU staff has been dealing with several distractions over the last week. There was a scheduling error caused by a change in the staffing matric and miscommunication between management and administration. The staff is also caring for a client whose family has been verbally abusive and threatening. The manager notes an increase in absenteeism with the staff over the past 2 days. To which of these distractions is the absenteeism most likely related?

The decline in staff morale due to a hostile environment

The male home health nurse parked his marked car in preparation for visiting the next client when a young female walked over to the car and asked him if he would like to have some fun. Which of the following provides the best explanation for this behavior?

The girl may have hoped a nurse would give her enough money to eat.

A nurse manager has recently been transferred from OB to Pediatrics. The manager consistently stays in the office, does not relieve staff for lunches and rarely assists staff when the unit is to busy. Lately, the manager has noticed an increased in staff absences. Which options may contribute to the situation on the unit?

The manager has a lack of confidence in personal ability to provide care to pediatric clients, The manager is unable to confront staff regarding absences, The manager is not supervising the work of the unit, The manager has a lax attitude toward absenteeism

If not at a meeting or giving an educational program, which of the following best describes why an occupational health nurse would be absent form the health station during the nurse's employment hours?

The nurse planned a walk-through of the workplace

A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. This behavior has never been violent, but today its becoming more threatening. The nurse just came into the station and said- my nurse assistant is stupid, i am not going to put up with that much longer, she needs to be put in her place. How should the manager respond to this situation?

The nurse should be removed from the unit, A critical incident report should be written about the behavior, Security should be notified of the behaviors

10. Why are clinical areas so careful to assure sanitization of surfaces and equipment between each patient?

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

1. Why was the Vaccine Adverse Event Reporting System legislated into being? Select all that apply.

To determine whether changes should be made in procedures or biological agents, To provide assistance to families who experience a vaccine-related injury No drug is perfectly safe or effective. Changes are made on the basis of the collected data. For example, whole cell pertussis vaccine was changed to an acellular pertussis vaccine because of adverse side effects. To monitor actual and potential vaccine-related problems, health care providers must report specific postvaccination "adverse events" to the Vaccine Adverse Event Reporting System (VAERS). The National Vaccine Injury Compensation Program reviews all VAERS reports and provides assistance for individuals and families who experience a vaccine-related injury, including disability and death.

What is the primary reason a nurse manager would confront a nurse who has been reported for violating infection control policy? A. To punish the guilty B. To protect the institution from liability C. To set an example for other employees D. To encourage the correct behavior

To encourage the correct behavior

SATA An occupational health nurse has been asked to perform a complete physical examination, including drug testing, on both a prospective and a current employee. Which of the following best describe the purposes of these examinations?

To measure the strength of organs that may be affected by workplace responsibilities To document changes that may have occurred while the employee engaged in particular processes or in a particular work area To establish a baseline before the employee is exposed to possible workplace hazards

The night nurse on the pediatric unit has resigned. The night staff is pleased, because this nurse constantly complained about workload and alienated most staff members. What consequences may result from the loss of this nurse?

Use of agency nurses, Opportunity for overtime, Increase in enthusiasm, Unit performance improves

13. What can be used to protect staff at a community clinic when a patient walks in complaining of severe intestinal cramps and diarrhea?

Use universal precautions with all patients regardless of the situation In the late 1980s, the Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called universal precautions, to prevent transmission of diseases found in blood and other body fluids. These guidelines were developed because infected people may be asymptomatic and have no knowledge of their conditions; therefore health care workers must assume that all patients are infectious and protect themselves.

A nurse manager has required that all nursing staff attend an in-service in dealing with verbal threats. A staff nurse wonders why this is necessary since, Words don't hurt me - I just ignore them What is the nurse manager's most appropriate response to this statement?

Verbal threats often precede physical violence

The management staff is investigating ways to decrease absenteeism that will also help to promote greater job satisfaction over the long term. Which suggestions should they consider?

We could convert a specified number of unused sick days to vacation days, Is there a way we could convert unused sick time to retirement credit, I think we should stop putting a limit on how many sick days an employee can accumulate

The nurse executive and the human resources manager of a hospital meet to discuss the recent increase in nursing turnover. Which statement reflects the best source of information about this increase ?

What are the reasons given in the survey mailed out 6 weeks after resignation?

The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session? A. "What is causing you to be late?" B. "When you are late it throws the pace of the entire unit off and client care suffers." C. "Does it not bother you that your lateness makes everyone else's job more difficult?" D. "You have been late three times this week and that is not acceptable." E. "What are you going to do to avoid being tardy again?"

What is causing you to be late, When you are late it throws the pace of the entire unit off and client care suffers, You have been late three times this week and that is not acceptable What are you going to do to avoid being tardy again? 1, 2, 4, 5

A manager is preparing to write a critical incident regarding a nurse who has voluntary absences for several scheduled shifts. What information should the manager determine first?

What was the frequency and time period of the absences

Which of the following arguments would the occupational health nurse use when trying to convince a large employer of the need for a breast cancer education program?

Women employees who believe their employers are interested in their well-being are more productive and satisfied

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

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

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

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

7 of 31 Which of the following is the most commonly used drug among children and adolescents in the United States? a. Alcohol b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

a. Alcohol All 50 states and the District of Columbia have outlawed the sale of alcohol to anyone under the age of 21 years, yet it is still the most commonly used drug among children and adolescents. Marijuana is the most commonly used illicit drug in the United States. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine, (3.8%) and steroids (3.6%).

30 of 31 Which of the following screenings are typically administered in the school setting? (Select all that apply.) a. Blood pressure b. Chest x-ray c. Cholesterol and blood glucose d. Height and weight e. Scoliosis f. Visual and hearing acuity

a. Blood pressure d. Height and weight e. Scoliosis f. Visual and hearing acuity Height, weight, vision, and hearing screenings are provided at most schools. Scoliosis or postural screening should be done to identify spinal deviations and intervene early to prevent related secondary problems. The detection of high blood pressure during childhood is important in identifying children who have hypertension and who will benefit from early intervention and follow-up. Screenings in schools must be relatively fast, easy, and noninvasive. Blood work is invasive and cannot be done without parental consent. It is also expensive because test strips must be purchased. Due to the equipment needed, it is not typical that chest x-rays or cholesterol and blood glucose screenings are administered in the school setting.

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

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

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

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

28 of 31 Which of the following variables create differences from school to school regarding the health services that are available? (Select all that apply.) a. Community resources b. National statistics on health problems c. School leadership preferences d. State legislative requirements e. Students' needs f. Teacher preferences

a. Community resources c. School leadership preferences d. State legislative requirements e. Students' needs School health services goals and objectives vary from state to state, community to community, and school to school. These differences reflect wide variations in state regulation, student needs, community resources, funding sources, and school leadership preferences. The national statistics on health problems and teacher preferences do not create differences among schools in regards to health services that are available.

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

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

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

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

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

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

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

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

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

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

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

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

29 of 31 Which of the following best describes how schools can determine what their school health education priorities should include? (Select all that apply.) a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 d. Determine priorities by the education and expertise of the local school nurse e. Select priorities according to parent and student interests f. Decide on priorities based on whatever funding sources are willing to fund

a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 Healthy People 2020 sets goals that schools provide health education courses in priority areas. The six behavioral categories or topics identified include the following negative behaviors that often start in childhood or adolescence and persist into adulthood: (1) alcohol and drug use; (2) injury and violence; (3) tobacco use; (4) poor nutrition; (5) lack of physical activity; and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies. These problems and behaviors are preventable and lead to additional problems. In a comprehensive health education program, students should be given the opportunity to practice decision-making and communication skills. Funding may not fit local needs. All school nurses should be competent in teaching related to healthy behaviors or know experts who could assist. The priorities should be based on Healthy People 2020, not on the parent and student interests or on the basis of available funding sources.

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

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

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

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

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

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

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

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

what types of factors are considered "social determinants"?

access to resources, education, health care services, transportation, utilities, technology, socioeconomic status, housing, etc (think Maslow)

which industry has the highest morbidity and mortality rates

agriculture

how is vulnerability defined?

being more likely to develop a health-related problem and have more serious outcomes stemming from exposure to multiple risks

A woman is being emotionally abused by her husband. The day after a large argument her husband sends her flowers and invites her out for dinner. What phase of the cycle of violence is being demonstrated?

apologetic phase

professional isolation occurs when rural nurses

are uncomfortable making independent nursing decisions

how is an urban population defined?

at least 50,000 people in an incorporated or unincorporated area

5 of 31 In addition to their homes, where are children most likely to be injured? a. At entertainment sites (theaters, amusement parks) b. At school, especially on playgrounds c. At their part-time job settings d. Transportation (automobiles, school buses)

b. At school, especially on playgrounds Safety on the schoolyard and playground is also important for this age group, because about 200,000 children per year are injured on playgrounds in the United States. Thus, school playgrounds are the most likely place where children are injured. Injuries at entertainment sites, part-time job settings, and through modes of transportation are less likely to occur than injuries at schoo

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

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

10 of 31 Which of the following health problems has been reduced in school-aged and adolescent children? a. Chronic diseases (such as asthma or diabetes) b. Contagious diseases c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

b. Contagious diseases Vaccine-preventable deaths (VPD) are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. Chronic diseases have been increasing in school-aged and adolescent populations due to the increase in overweight and obesity. STDs and stomach flu have not been greatly reduced in school-aged and adolescent children.

20 of 31 Every day a child came into the school nurse's office with vague complaints, but sometimes it seemed to the nurse that the child just wanted to talk and be listened to for a while. Unfortunately, the child took up almost 15 minutes of the nurse's very busy day. Which of the following actions should be taken by the nurse? a. Ask a staff person to talk with the child so the nurse could complete required tasks b. Continue to listen while assessing for possible underlying problems c. Refer the child to a private physician for follow-up on the constant physical symptoms the child presented d. Talk to the teacher about not letting the child leave the classroom unless obvious symptoms (fever, vomiting) of illness were present

b. Continue to listen while assessing for possible underlying problems The nurse or teacher may be the only stable adult in the child's life who will listen without being judgmental. Therefore, one of the most important roles of the school nurse is to act as counselor and confidante. Children may come to the school nurse with various vague complaints, such as recurrent stomachaches, headaches, or sexually promiscuous behavior, and the nurse must look beyond the initial complaint to identify underlying problems.

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

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

25 of 31 A student had been absent 4 days out of the last 3 weeks. When the school nurse asked what was wrong, the student replied, "Headaches" in a rather angry tone. The student had previously been heard to complain that school was boring and it was hard to concentrate on such dumb stuff. Which of the following actions would be most appropriate for the nurse to take next? a. Emphasize the importance of completing school for lifelong success b. Express concern that the student was under a lot of stress and offer to help if possible c. Meet with the student's parents to discuss the headaches and the school absences d. Refer the student to a neurologist for a workup to see what is causing the headaches

b. Express concern that the student was under a lot of stress and offer to help if possible Warning signs of stress include angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or other ailments, and inconsistent school attendance.

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

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

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

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

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

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

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

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

26 of 31 A female coach walks into your office and shares that one student concerns her. The student will not change into her gym clothes and does not seem to "move right." Which of the following actions would be most appropriate for the nurse to take next? a. Call the student into your office and discuss the importance of physical education to one's health b. Meet with the student and ask directly about sexual or physical abuse c. Offer to attend the next physical education class and talk to the student d. Point out how female adolescents are very concerned over body image and are usually embarrassed by their own lack of perfection, and suggest the coach be more understanding

b. Meet with the student and ask directly about sexual or physical abuse Adolescents being physically or sexually abused may have symptoms that include changes in behavior; difficulty in walking, sitting, or other movements; and refusing to change into gym attire or participate in physical activities. It would not be appropriate to minimize the situation, call the student out in front of the class, or have a conversation about the importance of physical education. Rather, the nurse should address the potential signs and symptoms that have been displayed by this student.

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

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

18 of 31 Which of the following health problems continues to increase in school-aged and adolescent children? a. Contagious diseases b. Obesity and related problems (diabetes) c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

b. Obesity and related problems (diabetes) Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children.

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

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

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

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

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

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

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

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

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

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

in a prospective payment model, the agency is reimbursed

based on the anticipated cost of providing care

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

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

15 of 31 The new principal stopped the school nurse in the hall and said, "I need to get oriented here. We seem to have a lot of handicapped children. Please make me a copy of their medical records so I can be prepared to meet with the parents if they come in." Which of the following is the most appropriate response by the nurse? a. "I'd be happy to help you get oriented to our students. I'll prepare a summary of our special students' needs and problems for you." b. "I'm so happy to hear of your interest; I'll get those records to you immediately." c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." d. "Let me check our school board policies regarding sharing of information and get back to you."

c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." The Family Educational Rights and Privacy Act, a strong privacy protection act, protects student education records, including the health records. Student health records should be afforded the same level of confidentiality as that given to clients and patients in other settings.

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

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

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

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

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

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

1 of 31 Which of the following best describes why the numbers of children seen by the school health nurse is increasing? a. Higher expectations for performance by parents and school administrators b. Increasing school enrollments c. Lack of another source of regular health care d. Overcrowding within the community

c. Lack of another source of regular health care Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care.

19 of 31 Which of the following best explains why the school nurse and the principal athletic director of the school would frequently be working together? a. As neither are teachers, each is susceptible to job layoffs if the community school tax levy does not pass. b. As support staff to teachers, they have many mutual problems in communicating how they can help teachers be more successful. c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. d. Both have to create a budget plan and allocate funds for their department for the year.

c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. Obesity and its prevention or treatment must be of concern to the school nurse. Although many of the underlying causes of obesity are not well understood, several contributing factors have been identified, including reduced access and affordability of nutritious foods, decreased physical activity, and cultural and genetic influences. The nurse and the athletic director would want to cooperate on how to increase physical activity of the students.

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

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

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

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

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

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

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

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

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

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

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

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

3 of 31 Which of the following led to school nurses moving beyond the role of screening, assessment, intervention, and exclusion of children for communicable diseases? a. A communicable disease outbreak, which led to the requirement that all children be vaccinated against common infectious diseases b. Federal legislation, which required immunizations for communicable diseases c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco d. The need for inspecting schools to identify children who were ill and exclude them until they were no longer infectious

c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco The federal government was not involved in school health because education and health are responsibilities of the state government. The first citywide vaccination program—against smallpox—was in the 1870s before school nurses were first employed in 1902. Other issues beyond treatment for minor problems quickly became part of school nurse school practice. In the early part of the twentieth century, the temperance movement led schools to teach about the effects of alcohol and tobacco.

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

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

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

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

23 of 31 A new school nurse was concerned about being accepted, as the previous nurse had been at the school for more than 20 years. Which of the following would be the best approach for the nurse to take? a. Do the best job possible of revising policies and approaches to reflect current information and trends b. Put all the nurse's credentials (degrees, certifications) in an obvious spot in the health office c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff d. Spend time with each student, making sure the students all think she is very helpful

c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff The school nurse can assist the faculty and staff by giving workshops on exercise and nutrition, screening for increased blood pressure, and establishing weight management programs.

2 of 31 Which of the following best describes how Lillian Wald helped encourage the idea of school nurses in the schools? a. She brought political pressure to bear on school boards through her political action movement. b. She persuaded very wealthy women to convince their husbands to fund such positions. c. She demonstrated that school nurses decreased absenteeism by 50%. d. She used volunteer nurses until school boards were persuaded to fund such positions.

c. She demonstrated that school nurses decreased absenteeism by 50%. In 1902, New York City hired the first nurses to help inspect children, educate families, and ensure follow-up treatment. Within a few years, the renowned nurse Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%.

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

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

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

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

4 of 31 Which of the following legislation marked the first entry of the federal government into school health? a. The Drug-Free Schools and Community Act b. The Education for the Handicapped Act c. The National School Lunch Program d. The Safe and Drug Free Schools and Communities Act

c. The National School Lunch Program The federal government did not get involved with school health until the passage of the National School Lunch Program in 1946. The School Breakfast Program was implemented 30 years later. The Drug-Free Schools and Community Act was implemented in 1986 to fight substance abuse through education and was expanded in 1994 to include violence prevention measures. The Education for the Handicapped Act in 1975 mandated that all children, regardless of disabilities, have access to educational services. The Safe and Drug Free Schools and Communities Act supports programs that focus on prevention of school violence and illegal use of alcohol, tobacco, and drugs.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

11 of 31 Which of the following does the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service include in its routine screening that may not be included in a typical private physician preschool physical? a. Comprehensive health and developmental history b. Immunizations c. Laboratory testing d. Lead toxicity screenings e. Unclothed physical examination

d. Lead toxicity screenings The EPSDT includes lead paint screening. Medicaid-eligible children are guaranteed access to comprehensive health care services and routine dental examinations. Screening services must include a comprehensive health and developmental history, an unclothed physical examination, plus immunizations and laboratory testing that are age appropriate, as well as lead toxicity screenings. Because these children are very-low income, they probably live in older housing that may have lead paint. Private physicians caring for children with insurance see children of higher income levels who probably live in newer, safer housing.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

24 of 31 A school nurse is conducting a program with high school students about adolescent sexuality. Which of the following information would the school nurse most likely include? a. Abstinence is the only way to avoid pregnancy and sexually transmitted diseases. b. Resources are available for assisting teenage parents with, for example, maternity clothing and baby needs. c. There are many sources of free or very-low-cost birth control measures. d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. e. Abortion is dangerous, is illegal in most areas, and can result in lifelong sterility.

d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. Although the nurse might want to include information on abstinence and birth control, it is important to convey the reality of teenage pregnancy. Adolescent fathers can confront a lifetime of paying child support. Teen mothers are less likely to complete high school and are more likely to be single parents and live in poverty.

22 of 31 Everyone is talking about the disaster that has been widely seen on the news programs. Which of the following suggestions would be most appropriate for the nurse to make at this time? a. That this opportunity should be used to discuss how to be brave in a crisis. b. That programs in collaborative problem solving should be created for students and staff. c. That the staff should reassure students that such a disaster would not occur here. d. That the school should develop an emergency management plan.

d. That the school should develop an emergency management plan. Every school is encouraged to develop an emergency management plan. In fact, many states mandate that schools develop plans to address the potential threat of another terrorist attack or a natural or man-made disaster. It would not be appropriate for the nurse to discuss bravery, student safety should come before bravery. Collaborative problem solving will not help the students be safer should this type of a crisis arise at the school. It is not appropriate to provide the students with reassurance as it is impossible to prevent all of these disasters, rather the school must develop an emergency plan so that they are prepared if this would happen at their school.

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

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

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

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

16 of 31 A school nurse was responsible for five schools. To give students required medications during the day, the school nurse teaches a particular office staff member in each school exactly what to give to whom and when, and they practice until both are comfortable. Which of the following remains as the nurse's responsibility in relation to the administration of medications? a. To begin teaching a second person at each school because the original staff member might occasionally not be available to give the medications b. To confirm with each student that they do not mind obtaining their medication from the staff person assigned to the task c. To continue to evaluate the comfort level of the staff person in completing the task d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs

d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs Not every school has a full-time nurse available on site. Often a nurse is assigned to three or four schools, resulting in delegation of certain tasks to unlicensed personnel. Each state's nurse practice act stipulates which procedures may be delegated. The responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. When tasks are delegated, the nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers.

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

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

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

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

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

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

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

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

what is the focus of secondary prevention for substance abuse?

detecting and arresting substance abuse before the person becomes physically addicted and the problem becomes a chronic condition

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

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

13 of 31 Which of the following medications can a school nurse expect to most frequently administer? a. Analgesics and antipyretics b. Antibiotics c. Antitussives d. Anticonvulsants e. Attention-deficit hyperactivity disorder (ADHD) medications

e. Attention-deficit hyperactivity disorder (ADHD) medications Medications used to treat ADHD are the most commonly administered. Medications commonly given in schools include analgesics and antipyretics, antacids, antitussives, anticonvulsants, antiemetics and antidiarrheals, antifungals, antihistamines, and antibiotics.

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

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

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

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

what is the first step in forming professional-community partnerships

identify the problem area

rural is defined

in different ways by different people

Which factor is associated with an increased risk for violence?

social isolation

what does the poverty guideline mean?

it's the minimum income level needed by a family or individual to meet basic needs of food, shelter, clothing, and other essential goods/services (adjusted by the US Department of Health and Human Services based on family size and inflation)

how do education levels affect rates of tobacco use?

lower education = more likely to use tobacco

what has been a major influence on increasing rates of substance abuse, especially among adolescents?

media influences (and also peer pressure)

do men or women have higher rates of alcohol use?

men

do men or women have higher rates of illicit drug use?

men

do men or women have higher rates of smoking?

men

are the rates of illicit drug use higher in rural or metropolitan areas?

metropolitan

a registered nurse has just been hired by a rural public health agency to work with clients in a 12-county area where there are limited health care providers. where would the nurse find information about the scope of nursing practice in this setting?

nurse practice act

falling buildings are considered a

primary agent

A nurse uses primary prevention when working with abuse victims by:

providing anticipatory guidance

which activity would be completed by a generalist nurse working in home care?

providing direct care to clients

what is ghetto counterculture?

racial segregation and underclass concentration in inner city urban areas, characterized by poverty, crime, drugs, deterioration of buildings, poor access to healthcare, poor education, and spread of disease

What is the legal responsibility of a nurse when confronted with a situation where child abuse may be occurring?

report the suspected case

an apartment building has burnt down, killing 20 residents and injuring several more. the community health nurse reports that the community is in the honeymoon phase. what observations has the nurse made to come to that conclusion?

residents who lived in the building comfort one another

A nurse uses secondary prevention with victims of abuse when:

screening for signs and symptoms of abuse

are homeless populations more prominent in urban or rural areas?

urban

which type of home care agencies are governed by a volunteer board of directors and supported primarily with nontax funds and reimbursements from third-party payers

voluntary agencies

what is urban sprawl?

when large numbers of of urban residents move to suburbs, which can lead to less walking (because most places aren't within walking-distance anymore), which can then lead to obesity and other health problems

what is the definition of dependence or addiction?

when there are physiological symptoms that occur with withdrawal of the substance

accessibility refers to

whether a person has the means to obtain and afford needed services