Chapter 30

ANS: C African Americans in 2009 had the highest death rates from heart disease and stroke compared with other racial and ethnic populations. They also had the highest death rates from homicide, with rates among African American males highest across all age groups among males (Centers for Disease Control and Prevention (CDC) Health Disparities and Inequalities Report, 2013). Cognitive Level: Analysis Associated Chapter Objective: 6, 7, & 8 REF: p. 675

A new primary health clinic is established in a predominantly African American neighborhood to address the top causes of mortality in the local adult population. The nurse at the clinic uses a community-focused nursing process to plan interventions aimed at reducing the incidence of: a. cardiovascular accident, lung cancer, and alcoholism. b. depression, alcohol abuse, and obesity. c. heart disease, stroke, and homicide. d. mental illness, drug and alcohol abuse, and heart disease.

ANS: C Among women older than age 50 years in the United States, approximately one in two will experience an osteoporosis-related fracture at some point in their lifetime. Primary prevention measures include consumption of a diet rich in calcium and vitamin D, and supplementation with calcium and vitamin D only if needed. Weight-bearing exercise is also important in maintaining bone density. Weight-bearing exercise includes activities such as walking, running, stair climbing, and weight lifting. Swimming is not a weight-bearing exercise. Limiting alcohol consumption and avoiding smoking are also important. Community-oriented nursing includes empowerment of community members as peer educators and change agents. Cognitive Level: Analysis Associated Chapter Objective: 5, 6, & 8 REF: pp. 682-683

At the request of a local senior women's group, a nurse is developing an osteoporosis primary prevention program. An appropriate strategy for the program would be to: a. design a nurse-directed program instead of a peer-directed program. b. encourage exercise and consideration of HRT. c. promote diets rich in calcium and vitamin D and daily weight-bearing exercise. d. promote swimming and supplementation with calcium and vitamin D.

ANS: B For decades, many U.S. women used HRT, even though HRT remained untested by rigorous scientific study. A clinical trial launched in 1991, the Women's Health Initiative, set out to test specific effects HRT had on women's health, especially its effect on heart disease and osteoporosis. Researchers concluded that HRT did not prevent heart disease and that to prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol intake, maintain a healthy body weight, and be physically active. Scientists also concluded that HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medications. Cognitive Level: Application Associated Chapter Objective: 6 REF: p. 682

Counseling regarding hormone replacement therapy (HRT) should include the following information: a. menopause is a result of hormone deficiency, and therefore HRT is appropriate for all women to treat all symptoms. b. HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medication. c. research concludes that HRT does prevent heart disease in menopausal women. d. HRT should be considered for prevention of osteoporosis in all women.

ANS: A, C, D Diabetes is a serious public health problem and is epidemic in the United States. One in 12 adults in the United States has diabetes, and for every three people who have been diagnosed with diabetes, there is another who does not know he or she has it. Research supports the importance of also addressing social and economic factors related to health and well-being when treating diabetes. These social determinants of health include the characteristics of clients' communities, such as income distribution, educational level, and segregation. This broader perspective also includes attention to policies that affect the availability of healthy foods. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 7 REF: p. 678

Diabetes mortality rates continue to rise for all ethnic and socioeconomic groups, but evidence shows that which of the following are true? (Select all that apply.) a. Addressing the diabetic epidemic involves more than a focus on individual factors. b. Community-based education programs have done little to address the problem. c. Complications and mortality rates are highest among low-income and minority groups. d. Selection of healthy food options is both an availability issue and an education issue. e. Standard of living does not affect decision making.

ANS: A Men are often employed in dangerous jobs and incur more work-related injuries than women. Men do not participate in health care to the same level as women, apparently because of the traditional masculine gender role learned through socialization. Men are socialized to ignore pain, be self-reliant, and be achievement oriented. Large numbers of men do not receive the health screenings intended to prevent and identify disease. Cognitive Level: Application Associated Chapter Objective: 6 REF: p. 683

In comparison with women, men: a. incur more work-related injuries. b. experience lower survival rates in the first year after myocardial infarction. c. metabolize alcohol more efficiently. d. more actively initiate preventive health care interventions.

ANS: A Chronic disease has become a public health problem of great proportions with the most common and costly chronic diseases being heart disease, diabetes, stroke, cancer, and arthritis. Chronic disease is the leading cause of preventable deaths, disability, and decreased quality of life. Heart disease is the leading cause of death for both men and women. Uncontrolled hypertension leads to heart attack, stroke, kidney damage, and a host of other complications and only two-thirds of people with hypertension are aware that have high blood pressure because there are no associated symptoms. Cancer is the second leading cause of death in the United States. Early screening and detection, promotion of healthy lifestyles, expanding access to services, and improving cancer treatments will help reduce the burden of cancer and disparities. Screening activities (secondary prevention) make a difference in death rates and early detection can promote a cure, whereas late detection typically ensures a poor prognosis. Overweight and obesity are topics addressed numerous times in Healthy People 2020 because of their link to many chronic health diseases (risk factor for diabetes and heart disease). A dietary assessment, along with physical and psychological assessments, helps nurses to identify women at-risk for appropriate referrals. Cognitive Level: Synthesis Associated Chapter Objective: 4 & 5 REF: pp. 676-677

To detect the presence of the leading cause of disease burden for women in the United States, a screening program for women would include: a. blood pressure screening, mammography, and dietary assessment. b. testing for HIV/AIDS and sexually transmitted diseases. c. pap smear, screening for smoking, and assessment for exposure to violence. d. questions about a family history of depression, employment status, and chronic diseases.

ANS: A, C, D Senior centers were developed in the 1940s to provide social and recreational activities. Now many centers are multipurpose, offering recreation, education, counseling, therapies, hot meals, and case management, as well as health screening and education. Nurses caring for elder populations strive to help maximize functional status and minimize functional decline. Senior centers are effective platforms for nurses to provide interventions related to primary, secondary, and tertiary prevention, health promotion and maintenance, and disease prevention. Senior centers are multipurpose and provide safe, stimulating recreational opportunities. Many of the changes traditionally associated with aging can be delayed or prevented by positive health practices and proactive intervention. Cognitive Level: Synthesis Associated Chapter Objective: 4, 7, & 8 REF: p. 688

A community-oriented nurse is developing goals for a community health center's senior center. The goals should focus on which of the following? (Select all that apply.) a. Meeting social and recreation needs b. Helping elders accept the inevitability of the debilitation of aging c. Maximizing functional status and minimizing functional decline d. Implementing secondary and tertiary prevention measures

ANS: C According to the National Cancer Institute, approximately 15% of men will be diagnosed with prostate cancer in their lifetime. It is the most common non-skin cancer and the second leading cause of cancer deaths in the United States. African American men have higher rates of prostate cancer compared to all races. Prostate cancer is linked to changes in the DNA of a prostate cancer cell and high levels of male hormones, but the exact cause of prostate cancer is unknown. Cognitive Level: Application Associated Chapter Objective: 4 & 6 REF: p. 684

Although all men are at risk for developing prostate cancer, those at greatest risk are men who: a. have erectile dysfunction. b. fail to undergo prostate-specific antigen testing or digital rectal screening. c. are African American. d. have multiple sex partners.

ANS: B Heart disease is the leading cause of death for both men and women. The lifetime risk for stroke is higher in women (~1 in 5) than men (~1 in 6). Since women live longer than men and strokes increase with age, more women are likely to die from stroke than men. Cancer is the second leading cause of death in the United States surpassed only by heart disease. Cognitive Level: Analysis Associated Chapter Objective: 3 & 8 REF: pp. 677-678

To develop a baseline for a presentation at the local women's club about the status of women's health in the community, a community-oriented nurse researches national vital statistics to establish the leading cause of women's deaths in the United States. In the United States, the leading cause of death for women is: a. cancer. b. heart disease. c. stroke. d. infectious disease.

ANS: A The prevalence of frailty in the older population poses a major public health dilemma since the majority of this group will reside in a community setting, placing new demands on health care systems, family caregivers, and community resources. To improve the health of frail elderly, community-based nursing programs will need to address racial/ethnic and socioeconomic disparities. Cognitive Level: Analysis Associated Chapter

To improve the health of frail elderly, community-based nursing programs will need to address: a. racial/ethnic and sociological disparities. b. culture, ethnicity, and race. c. media and marketing initiatives that target elderly concerns regarding quality of life and degree of disability. d. national vital statistics on morbidity and mortality.