Co Ch 7,8,9,10,12

11. Which of the following persons would be most at risk for contracting an infectious disease? a. The woman who has been taking antituberculosis medication for 3 months b. The elderly woman who recently emigrated with her family from Asia c. A full-time nurse at the local public health clinic d. A volunteer nurse aide at the sexually transmitted disease clinic

ANS: B The elderly emigrant who has two risk factors (age and emigration status) would be the most vulnerable. DIF: Cognitive Level: Analysis REF: pp. 195-196

11. The school nurse set up a "don't smoke, don't start" program that focused on children who did not smoke. Which of the following stages of disease was the focus of the program? a. Adaptation b. Convalescence c. Pathogenesis d. Prepathogenesis

ANS: D Before smoking, the students would be in the prepathogenesis stage because no disease is currently present. They would be susceptible to disease if they began smoking. DIF: Cognitive Level: Application REF: p. 165

A nurse has completed an assessment and diagnosed a family's problems. Which of the following actions should the nurse take next? a. Determining which problem should be addressed first b. Emphasizing the family's adaptability, strengths, and resources c. Sharing conclusions with the nurse's employing agency d. Writing the diagnoses in the order of their priority

B Family theories have changed from concentrating on the pathologic process within families to focusing on family strengths, resources, and adaptability. The primary resource the nurse has to use in assisting the family is the family's adaptability, strengths, and resources.

Which of the following actions should a community/public health nurse perform when providing care with the use of a family perspective? a. Assessing all individuals for necessary services and interventions b. Engaging in therapy on the basis of theories of communication and symbolic interaction c. Maximizing the health and well-being of all individuals within a family d. Suggesting appropriate roles for various family members during a crisis

C All baccalaureate nursing graduates can conduct basic family assessments and interventions. Family nursing maximizes the health and well-being of all individuals within a family. This approach includes seeing the family as the unit of care and as the context of care.

Which of the following information would the nurse document when conducting an exposure assessment with a client? a. The chemicals used at work or in hobbies b. The substances used to clean the house or keep the yard/garden beautiful c. The home, work site, and neighborhood d. The environmental and psychological stress that is encountered

C An exposure assessment of potential environmental hazards questions the primary environments for most individuals: namely, home, work site, and community.

Between what two aspects does the ecologic systems model distinguish? a. Ecologic disasters and lifestyle behavior problems b. Housing and school or employment hazards c. The immediate environment and the broader environment d. The United States and the rest of the world

C The ecologic systems model distinguishes between the microsystem immediately around the person (family and home) and the macrosystem, or the larger context (culture, government, and physical environment).

Upon what variable are Duvall's developmental stages based? a. Age of the oldest child b. Age of the parent or parents c. Family function d. Family structure

A Duvall defined developmental tasks and stages of the family life cycle according to the age of the oldest child in an "ideal" family structure of father, mother, and children.

What is one of the most prevalent and noxious pollutants in modern America? a. Noise b. Sewage in septic tanks c. Unsafe discarded medications d. Unsafe water

A Noise, although considered innocuous, has major effects on hearing, stress-related conditions, mental illness, social maladjustment, and pathologic conditions.

A nurse saw a man from an Arab country asking a physician how his wife was doing. As the physician responded to the question, the physician backed away. The man again moved up close to the physician to ask another question, which the physician answered while again backing up. Which of the following conclusions can be drawn by the nurse? a. Both were trying to arrange the space between them to be comfortable. b. The man had poor personal hygiene, so the physician was distancing himself from the client. c. The physician did not want to stand that close to an Arab. d. These things happen; there is no particular meaning to this event.

A Space is a physical boundary. As the gentleman from the Arab country tried to set up the appropriate amount of space for a fairly intimate conversation, the American backed up to add the social space expected for a professional conversation.

Which of the following factors help families make the most healthful adjustment possible to a family crisis? (Select all that apply.) a. Appraising the crisis as a challenge that can be met b. Experiencing an emotional upheaval, including fear, anger, denial, and frustration c. Having developed effective problem-solving and coping behaviors d. Having limited prior experience in dealing with a crisis e. Having resources such as friends or a church available to help f. Using distancing as a coping mechanism

A, C, E The family type or amount of resiliency, resources (including problem-solving and coping behaviors), and appraisal of the stress lead to adjustment. If the crisis is appraised as a challenge that can be managed, then family members will probably adjust fairly well.

19. Which of the following definitions of pathogenicity is accurate? a. How easily the agent can mutate to a form that can survive b. How invasive and virulent the organism is c. How much of the agent must be present to produce an illness d. How specific the host must be for the organism to thrive

ANS: B Pathogenicity reflects invasiveness, or how easily the organism can affect more body systems, and virulence, which is how much morbidity and mortality the organism can cause. DIF: Cognitive Level: Knowledge REF: pp. 204-205

1. What was one of the first public health measures legislated by the U.S. federal government? a. Funding local government provision of safe water b. Using the power to impose quarantine c. Requiring pasteurization of all milk d. Regulating disposal of waste (garbage and feces)

ANS: B Quarantine was the first measure used on a federal level to restrict spread of infectious diseases. DIF: Cognitive Level: Knowledge REF: p. 191

9. Which of the following groups is most at risk today for an outbreak of pneumococcal pneumonia? a. Adolescents who have not yet received their booster shots b. Persons older than 65 who live in nursing homes and other extended-care facilities c. Elementary school children who have not been immunized d. Young adults who have never been exposed to the agent before

ANS: B The outbreaks in chronic care facilities were determined to be the result of failure to vaccinate at-risk populations, particularly persons older than 65 who live in or visit community settings with many older adults. Because the majority of deaths caused by pneumococcal disease and influenza occur in persons older than 65, nurses should make an effort to ensure that such vaccinations are routinely administered in institutions that serve the older adult population. DIF: Cognitive Level: Comprehension REF: p. 194

8. A nurse was assigned to work with technology-dependent schoolchildren. What kind of study would the nurse most likely conduct to help determine the needs of these children? a. A case-control study to compare these children with children who are not technology-dependent b. A cross-sectional study of school-based variables affecting the children c. A descriptive study regarding prevalence of technology dependence among the total school population d. An analytic study to determine causes of the children's problems

ANS: B There would be no point in comparing the technology-dependent children with children who are not technology-dependent or in trying to determine the causes of the children's problems. A descriptive study of prevalence might be helpful if it focused on the different types of dependencies, which might provide hints about community problems. However, a cross-sectional study (performed at one time) to determine other needs might be very useful as the nurse plans nursing care for the group. DIF: Cognitive Level: Synthesis REF: p. 163

17. The community/public health nurse invites a dietitian to a healthy lifestyles program to discuss fun ways to eat vegetables and fruits as snacks. Which of the following best describes this nursing intervention? a. Disability limitation b. Primary prevention c. Secondary prevention d. Tertiary prevention

ANS: B This intervention would be considered primary prevention, as poor eating habits may lead to obesity and chronic diseases such as diabetes later in life. DIF: Cognitive Level: Application REF: p. 166

13. Why, after each hike, did the nurse insist on the scouts checking each other for ticks? a. Ticks can carry noroviruses, which are then easily spread from person to person. b. Ticks can carry hantavirus, which is 30% to 40% fatal. c. Ticks can carry Lyme disease, which is the most common vector-borne disease in the United States. d. Ticks can carry West Nile virus, which causes disease that is currently considered an epidemic.

ANS: C Lyme disease is the most common vector-borne disease in the United States. The vector (carrier) is a tick infested with a spirochete. It is crucial to promptly remove any attached ticks. Noroviruses are transmitted through contaminated food and water and account for most cases of nonbacterial gastroenteritis. Hantavirus does have a significant fatality rate, but it is spread through exposure to aerosol secretions and excretions from rodents. West Nile virus is becoming an increasing problem in the United States, but it is spread by infected mosquitoes. DIF: Cognitive Level: Application REF: p. 197

15. Which of the following persons would be most likely to experience illness? a. The young woman who has just passed the National Council Licensure Examination (NCLEX) and is beginning employment b. The middle-aged man who, along with a wife and oldest child, works at a relative's restaurant c. The young woman whose first child has just been enrolled in daycare d. A middle-aged woman who cares for her elderly mother and father in their home when not at work as a receptionist

ANS: C None of the persons mentioned in the options seems to be in a high-risk aggregate such as infants, undernourished elderly persons, individuals with chronic disease, or immunosuppressed individuals. However, young preschool children spend a lot of time in groups and often bring illnesses home to their caregiver. DIF: Cognitive Level: Analysis REF: pp. 199-200

19. Why is the data from the National Notifiable Diseases Surveillance System (NNDSS) not absolutely accurate? a. A great deal of data is lost en route from physician to NNDSS. b. Computer operators do not always enter data accurately. c. Not all cases of such diseases are managed or are reported. d. Not all physicians know or obey the law to report cases to the NNDSS.

ANS: C The law requires reporting diseases to the state agencies, but reporting to the Centers for Disease Control and Prevention (CDC) or NNDSS is voluntary. Furthermore, not all affected patients receive medical care, and not all treated cases are reported. In addition, the completeness of reporting varies. DIF: Cognitive Level: Comprehension REF: p. 168

12. In a "don't smoke, don't start" program, the school nurse decided to focus on all aspects of the epidemiologic triangle. Which of the following would the nurse include? a. The benefits of smoking, the risks of smoking, and the expense of smoking b. The pleasures of smoking, the risks of smoking, and the costs of smoking c. The risks of nicotine, genetic factors related to nicotine absorption, and media pressures to smoke d. The risks of nicotine, the cost of smoking, and the taxes on cigarettes

ANS: C The three aspects of the epidemiologic triangle are the agent factors, host factors, and environmental factors. This is best represented by the risks of nicotine (agent), genetic factors related to absorption (host), and the media pressures to smoke (environmental). DIF: Cognitive Level: Analysis REF: p. 165

16. The community/public health nurse is performing tuberculosis screening for newly hired employees at the local hospital. Which of the following best describes this nursing intervention? a. Not required by law and unnecessary b. Primary prevention c. Secondary prevention d. Tertiary prevention

ANS: C This screening constitutes secondary prevention because the screening would lead to possible diagnosis and treatment of those with tuberculosis. DIF: Cognitive Level: Application REF: p. 167

2. A nurse noted that 15 people became very ill while eating at the school banquet for the basketball team. To calculate the rate of illness, what other fact does the nurse need? a. How many athletes were honored for being on the team b. How many parents and family members attended the banquet c. How many people ate at the banquet d. How many people live in the school district

ANS: C To be able to calculate the rate, the nurse needs to know how many (15) of the total population (the missing number) became ill at the event. Therefore, the nurse needs to know how many people ate at the banquet. DIF: Cognitive Level: Application REF: p. 162

8. A mother wanted her child vaccinated against measles. When she read the "benefits and risks" sheet, she changed her mind. Her child was the only one in the class who did not get immunized. What is the probable risk of her child getting measles in elementary school? a. Fairly high, as there is no way to prevent being exposed to measles during childhood b. Fairly low, as measles usually hits in late adolescence now c. Low, as most of the child's playmates have been immunized d. Very high without the protection of immunization

ANS: C Vaccination of 90% of susceptible groups provides substantial protection. Consequently, if the susceptible child was the only one not immunized, there is no one-at least at the school-who could pass on an infection to that child. DIF: Cognitive Level: Application REF: p. 194

14. People are fearful of the West Nile virus. Which of the following statements could a nurse truthfully say to them? a. "You should avoid forested areas to protect yourself." b. "Don't touch any dead birds or other small animals." c. "Wear insect repellent because the disease is spread by infected mosquitoes." d. "The disease is present in only isolated areas of the United States."

ANS: C West Nile virus is spread over a wide geographic area, and the disease is considered an epidemic. Because it is spread by infected mosquitoes, people should consider using insect repellent. DIF: Cognitive Level: Application REF: p. 199

3. A rate might be accurately defined as a. Another term for ratio. b. A way of determining the incidence of disease in a group. c. A way to make comparisons among equal-size populations. d. The number of events divided by the number of persons at risk.

ANS: D A rate is a fraction in which the numerator is the actual number of events and the denominator is the total population at risk; this fraction is converted to a standard base to enable comparisons between various population groups of any size. DIF: Cognitive Level: Knowledge REF: p. 162

3. In what way are antibiotics important in reducing the spread of communicable diseases? a. They help keep the environment free of the infectious agent. b. They help the host resist the infection. c. The kill the entire infectious agent upon contact with it. d. They reduce the time during which the disease is contagious in the infected person.

ANS: D Antibiotics have many effects, but they reduce the spread of communicable diseases by decreasing the time during which an infected host can spread a disease. DIF: Cognitive Level: Knowledge REF: p. 192

4. Which of the following actions have had the most success in protecting the public's health? a. Creation of effective broad-spectrum antibiotics b. National immunization campaigns to protect children c. Growth of hospitals and medical and nursing schools in the twentieth century d. Safe water and sewage systems, as well as milk pasteurization

ANS: D Public health practices such as safe water, safe disposal of sewage, and pasteurization of milk have created safer environmental conditions that are primarily responsible for health protection. Other chapters (such as Chapter 5, "International Health") stress that safe water and sewage disposal are among the most important health protection measures that can be taken. DIF: Cognitive Level: Comprehension REF: p. 192

4. A nurse was asked whether the agency should offer additional health promotion programming for young mothers in the Two Oaks neighborhood or the Centerville neighborhood. Two Oaks is a village that has a population of 4000 persons, of whom 50 are single mothers, whereas Centerville is an urban area of 15,000 people, of whom 150 are single mothers. On the basis of this information, which of the following would be the best response by the nurse? a. Additional programming will be helpful and appropriate in either neighborhood. b. The nurse needs to know the total number of children in these neighborhoods before making a decision. c. The nurse should choose to focus on single mothers in Centerville. d. The nurse should choose to focus on single mothers in Two Oaks.

ANS: D Single mothers are a population that is considered to be a high-risk group. Because Two Oaks has a higher rate of single moms than Centerville does, it would be important for the nurse to offer additional health promotion programming in this community. DIF: Cognitive Level: Synthesis REF: p. 170

14. Which of the following facts would be most helpful to the nurse who is creating a campaign to prevent teenagers from using alcohol? a. The number of advertisements for alcohol that are currently being published in national magazines and newspapers b. The number of lead characters in national TV series who consume alcohol on camera c. The number of local physicians who stress avoiding alcohol use while examining their teenage clients d. The prevalence of alcohol use among students in the nurse's school

ANS: D There are multiple factors associated with the choice made by teenagers to consume alcohol. The nurse must analyze the factors and determine what factors can be influenced through a campaign. All of the answers reflect factors in use of alcohol by teenagers; however, the only factor the nurse can influence is the alcohol use by students at the nurse's school. DIF: Cognitive Level: Synthesis REF: p. 166

A male nurse was admitting a woman from Italy who spoke perfect English. The nurse had no idea what would be considered appropriate behavior for a male nurse with a female client from outside the United States. Which of the following statements should be made by the nurse? a. "Can you tell me about Italy? I've always wanted to go there." b. "I don't know much about care in your country. Could you tell me what you expect from a nurse in a hospital?" c. "I understand you have national health care in your country, but you do understand that here you will have to pay for all your care?" d. "You'll probably prefer a female nurse. I'll have a female colleague come in shortly."

B Asking the client about her expectations will give the male nurse a chance to explain health care in the United States and how he may be able to help her. Also, if there are issues related to gender and having a care provider of a different gender, his opening will give her an opportunity to express any reservations.

Which of the following groups is most likely to experience an unintentional injury resulting from a fall? a. Adults who are always in a hurry, rushing from here to there b. Adults who are older than 65 years c. Toddlers who are just learning to walk d. Young children who run around without looking where they are going

B Falls are a major cause of unintentional injuries, accountable for about 22,500 deaths in 2007, especially in adults older than 65 years.

Which of the following statistics related to diversity in the United States is accurate? a. One per five people belongs to an ethnic or racial minority. b. One per three people identifies with an ethnic or racial minority. c. The percentage of people identifying with a minority group is decreasing. d. The percentage of people identifying with a minority culture has become the majority.

B More than 110 million, or one per three, people self-identify with one or more of the federally recognized racial and ethnic minority groups. Professionals are expected to respect all people. There continues to be growth among racial and ethnic minority populations. Currently, the majority of the population is composed of non-Hispanic white people (63.7%).

A nurse learned that a client was taken to the hospital with carbon monoxide poisoning after neglecting to turn off the car parked in the garage. Which of the following would be the most appropriate intervention to suggest at the next nursing visit? a. Encourage the client to leave one window open a crack, so there is always a constant supply of fresh air from outside the home. b. Advise the client to install a carbon monoxide detector in the home. c. Suggest that the family move to a house with a detached garage. d. Teach the family the symptoms of breathing carbon monoxide gas so they can act quickly to get out of the house.

B Nurses must make reasonable suggestions, and leaving windows open in winter or moving to a different residence is not reasonable. The use of a carbon monoxide detector will allow the family to leave the house before harm is done. Because carbon monoxide is odorless, families cannot be taught to smell the gas and leave.

A nurse assessed the home while visiting a home care client. What would be an appropriate primary intervention in relation to burns? a. Assessing the client for evidence of environmental hazards b. Encouraging the client's family to install a smoke detector c. Encouraging the whole family to practice "stop, drop, and roll" exercises d. Suggesting that the family purchase a first aid kit with first aid information

B Primary prevention is education and avoiding hazards. In relation to home safety, installing smoke detectors would alert the client or family to leave the home if smoke from a fire was present.

Which of the following events marked the beginning of the most outstanding improvements in public health? a. Discovery of antibiotics b. Creation of safe water purification and sewer systems c. Implementation of surgery as a clean procedure in the operating rooms d. Physician education on the benefits of hand-washing between procedures

B The biggest improvements in health occurred after the germ theory began to be accepted and sewage disposal and water purification systems were installed in cities in the United States

A nurse went to a convention in a large city with which the nurse was unfamiliar. The nurse was somewhat anxious about finding the convention center, but once there, the nurse relaxed and eagerly entered into interaction with other attendees. Which of the following would have been the most likely reason the nurse became comfortable? a. Enjoyment in learning more about topics that were relevant to current practice b. Understanding the perspective of most nurses c. Eagerness about hearing the keynote speaker d. Being an extrovert who loved interacting with people

B The nurse was comfortable with other nurses because they share a non-ethnic culture based on occupation or profession with shared experiences and perspectives

A nurse was proud of having completed a professional education program on cultural care of Hispanics. It was surprising when the Hispanic client for whom the nurse had been caring did not seem to act very "Hispanic." Which of the following considerations is the nurse not taking? a. The client may have been trying to demonstrate behaviors to please the nurse. b. The client may have customs that are not identical with the Hispanic culture. c. The client may be in too much pain to demonstrate cultural behaviors d. The client may not have been truthful when claiming to be Hispanic.

B The nurse, who had just learned about the Hispanic culture, may have been assuming that a given custom is shared by all members of a culture, which is not true.

The nurse is caring for a family who is very anxious and tense. Which of the following would be the most appropriate nursing intervention? a. Being supportive as the family debates what should be done about the problems b. Calmly discussing the family's perception of their problems and coping mechanisms c. Sharing with the family the interventions to be made and the goal of the interventions d. Telling the family what should be done to reduce their anxiety and fearfulness

B When families are very anxious and tense, the nurse should remain very calm in order to thoughtfully relate to the family. Such an approach is more effective than trying to find a way to fix the family problems.

What are the two phases that families experience after a major life event? a. Asking for help and accepting assistance b. Seeking assistance and relying on the family's own resources c. Temporary adjustment and long-term adaptation d. Reduction of stressors and adapting to reduce tensions

C According to the resiliency model, families respond to life events and transitions in two phases: the adjustment phase, which consists of transitory changes families make in response, and the adaptation phase.

Which of the following is the most significant barrier to Americans seeking appropriate health care? a. Culture b. Ethnicity c. Lack of insurance d. Race

C Although all the options can be barriers to seeking and obtaining appropriate health care, lack of insurance or other means to pay for health care is the most crucial barrier.

A nurse stressed to an oncology patient the importance of returning to the outpatient clinic promptly at 8 AM for the next treatment, but the client arrived at 3 PM. Which of the following would be the most likely explanation for the client's tardiness? a. The client needed the appointment written down so the client could remember the exact time. b. The client's employment had to come first, so the clinic visit was second in priority. c. The client's perception of time was not linear or future oriented. d. The client was having too much discomfort from the treatment to have another treatment so soon.

C Although all the options could be true, the least obvious but perhaps most important was that the client's perception of time may have differed from that of the nurse. Nurses focus on linear time, watches, and being accurate and punctual. Some persons see time as circular and never ending and as a gift to be enjoyed, so they may not be concerned with punctuality.

The nurse was determined to become more culturally competent with at least one cultural group besides the nurse's own. Which of the following actions would be most useful for professional practice? a. Buying groceries from a small ethnic grocery store in the neighborhood b. Buying only items made outside the United States c. Learning conversational Spanish d. Moving into an apartment house owned by a member of another ethnic group

C Although all these actions might well be excellent learning experiences, learning Spanish would be most useful because Spanish is the second most commonly spoken language in the United States. By learning a language, a person also learns a great deal about the values of that culture.

A nurse was so angry at a family for not being home when the nurse arrived for their appointment that the nurse wanted to drop the family from the agency caseload. What would the agency supervisor need to point out to the nurse? a. Clients can have emergencies that interfere with plans. b. Communication about the time of the appointment may not have been clear. c. Nurses expect promptness and compliance, but not all clients feel the same way. d. Perhaps the nurse made an error in writing down the appointment date and time.

C Although any of the reasons may have been true in this situation, the fact that the nurse was so angry suggested that a cherished value had not been upheld. The nursing profession culture includes values of promptness, neatness, and organization. Tardiness, disobedience, and disorganization are antithetical to nursing values. The issue may have been a culture clash.

A nurse was teaching a client how to plan his diabetic diet. The client explained that he was on the road a lot and ate in truck stops where they did not serve that kind of food. Furthermore, both his mother and father had died of diabetic complications, and he knew he would probably have the same fate. Which of the following would be the most appropriate action for the nurse? a. Explaining why the client might have to change careers and be more optimistic b. Recognizing that the client has a present time orientation and stop wasting effort on teaching him about a diet he will not follow c. Reviewing the client's priorities and see what compromises in nutrition might be possible in his job d. Trying to help the client see the importance of planning for the future

C Although the client seems focused on present time orientation and is rather fatalistic, immediately giving up is not a viable option. The client's occupation and lifestyle probably cannot be changed immediately; therefore, only compromises are realistic. The nurse and the client will have to discuss what changes can be made in his eating habits.

A community/public health nurse is working with a family who is having difficulty with communication. Which of the following behaviors would cause the nurse to be concerned? a. Family members communicate through behaviors and verbal statements. b. Family members use rules to regulate behaviors in the family. c. Family members use double-bind messages. d. Family members communicate through metacommunication.

C Communication should be open, honest, direct, and congruent with internal feelings. Metacommunication occurs as messages have both a literal meaning and inform about feelings. All behavior communicates, but double-bind communication, in which two conflicting messages are sent, makes it impossible to respond appropriately because the messages are contradictory.

Which of the following is the best definition of culture? a. An appropriate way to behave within a group b. A choice of lifestyle behaviors by a group c. Learned and shared beliefs, values, and lifeways of a group d. Unconscious behaviors of a group

C Culture consists of the learned and shared beliefs, values, and lifeways of a group that are generally transmitted from one generation to the next and influence people's thoughts and actions.

What is the primary reason why there are differences in health outcomes among the various ethnic groups? a. There is decreased access to health care and few care providers from their ethnic group. b. Members of ethnic groups rarely have life insurance, so they cannot afford to obtain care. c. Professionals engage in discrimination, stereotyping, and uncertainty. d. Minorities are less educated, so they do not take care of themselves appropriately.

C Disparities exist because of the operation of the health care system and discrimination, biases, stereotyping, and uncertainty of the clinicians.

Why will the concept of ethnicity decrease in value to health professionals in the future? a. Assessment and treatment will become more accurate according to a person's race. b. Ethnicity as a concept mainly helps clients have a sense of belonging and loyalty. c. Persons from different ethnic groups are intermarrying, and their children are multiracial. d. The concept of ethnicity is less informative than the term race.

C Ethnicity is used as a way of self-identification and gives a sense of belonging. However, its usefulness to health professionals will decrease as groups intermarry and their children become multiracial.

Which of the following groups is the largest ethnic minority in the United States? a. African Americans b. Asian immigrants c. Hispanics d. American Indians/Alaskan natives

C Hispanics constitute the largest ethnic minority group, accounting for more than 16% of the total U.S. population. Black people constitute the largest racial minority group, accounting for 12.6% of the total population. Asians constitute 4.8% of the total population, and American Indians/Alaska Natives constitute 0.9%. All minority populations have grown.

A nurse was assigned to care for a client who was speaking with his young daughter in an Asian language. Because the nurse spoke only English, which of the following actions should be taken by the nurse? a. Ask the young daughter whether she knew English and could translate. b. Ask the young daughter whether the client's wife was available to translate. c. Call the nursing office to see whether any nurse in the hospital spoke the client's language. d. Check the hospital resource manual for the telephone number of a translator who spoke an Asian language.

C The best choice, if available, would be a nurse who was bilingual. If not, an interpreter, preferably of the same gender, would be sought among the staff or by phone. Although the young daughter or the wife might know English, because of age and gender differences, having either translate would not be appropriate.

A nurse who had just undergone orientation for a staff position in the emergency department noticed a material safety data sheet attached to a solvent used to clean the skin around wounds. What is the purpose of this sheet? a. Hospitals are now attaching such documents for emergency department nurses, who are at high risk for trauma and injury from chemicals that patients use. b. It is part of the risk management program of hospitals that do not want to be sued by employees who misuse chemicals. c. It is required by federal law so that employees know the potential effects of the chemicals with which they are working. d. The sheet is the equivalent of a drug information sheet and should be given to patients who have their wounds cleaned with the solvent.

C The material safety data sheet is required by the Occupational Safety and Health Administration (OSHA) under the "right to know" legislation so that employees know what chemicals they are working with and their potential side effects.

Which of the following variables makes some families more vulnerable to dysfunction than others in facing a particular crisis? a. A family member's moving away b. Addition of a new family member c. Additional stressful events d. Previous experience with stressful events

C The more events being experienced by the family, the more vulnerable the family will be.

A nurse was very concerned about an elderly client who took care of himself in his own apartment. On the basis of statistics, which behavior would cause the nurse to be most concerned about his safety? a. The man frequently went on long walks through the neighborhood. b. The man often ate at the "all you can eat" buffet, sometimes spending several hours there. c. The man often tripped over the rug in front of the sink. d. The man smoked from the time he got up until he went to bed.

C The two major causes of death in the home are falls and poisonings. The kitchen rug tripping the man is a major concern with more immediate possible ill effects than the smoking or overeating.

Which of the following information will a nurse need to assist a family trying to cope with developmental changes? (Select all that apply.) a. A list of credentialed family therapists available as resources b. Ages of the extended family members c. Examples of apparent success of the family's previous coping strategies d. Current family strategies to meet demands e. The family's knowledge of current developmental demands f. The family's pattern of using professional health care

C, D, E To determine the family's stage in the life cycle in preparation for assisting the family, the nurse should include assessing the family's knowledge of current developmental demands, the strategies they are using to meet these demands, and their success at accomplishing them.

Which of the following actions would be the most appropriate method for the nurse to influence family communication? (Select all that apply.) a. Emphasizing the importance of listening to professional suggestions b. Pointing out when a family member communicates inappropriately c. Role-modeling appropriate communication patterns d. Stating very clearly and directly what should be done by family members e. Sharing what the nurse observes about family communication f. Telling the family members how best to communicate

C, E The nurse can influence the family situation by being careful about personal communication. The nurse's outside position allows for observation of family communication patterns that can be described to the family. The nurse can also demonstrate open, honest, direct communication, thereby role-modeling appropriate communication patterns. Emphasizing the importance of listening to professional suggestions, pointing out when communication is inappropriate, stating what family members should do, and telling the family how to best communicate are examples of a dominant role of the nurse with the family. The nurse's role should be collaborative to encourage improvement in communication patterns.

Which of the following would be better understood by the nurse after using a family map? a. Recognition of the communicator and leader who speaks for the family b. Description of the genogram or family tree of the family c. Identification of the geographic location of neighborhood resources for the family d. Roles and relationships within the family

D A family map is used to diagram spatial and relationship qualities of a family system and to understand hierarchies and roles, as well as subsystems, their boundaries, and their interactions

Which of the following is the best definition of a family for a nurse to use when planning nursing care? a. Related legally or by blood b. Considered "family" by the legal system c. Living in the same household d. Any person the client reports as being family

D Although all definitions are correct, the nurse will find it most helpful to include any person the client wants included.

When a home health nurse visits a family for the first time, what is the nurse's primary goal? a. Complete physical examinations on as many family members as time allows. b. Have the family complete as many assessment tools as time allows. c. Make sure all records, including third-party payer information, are accurate. d. Observe and interview the family to identify family strengths and needs.

D Although all these activities may be performed and may be of importance, the most important first task is to gather information and plan care with the family, on basis of the family's resources and strengths. D Although all these activities may be performed and may be of importance, the most important first task is to gather information and plan care with the family, on basis of the family's resources and strengths.

What is the relationship between race and ethnicity? a. Race is biologic, whereas ethnicity is psychologic. b. Race is skin color, whereas ethnicity is shared beliefs. c. Both race and ethnicity mean "visible subgroup." d. Race means "common physiology," and ethnicity means "common culture."

D Although sometimes used interchangeably, the terms have different meanings. Race refers to biologic features, whereas ethnicity refers to a shared culture.

After completing an assessment, the nurse discusses with the family some actions that needed to be taken and refers to the wife in the family as an incredible organizer. Which of the following goals is the nurse trying to achieve by making this statement? a. Making the husband proud that he had married his wife b. Making the wife feel very complimented and positive c. Encouraging the wife to volunteer to follow through on all the needed actions d. Reinforcing for the family some of the strengths of one of their family members

D Although such positive comments may have made everyone feel better, the nurse was also validating the presence of a strength, which made the strength more evident and thereby helped the family perceive one of their strengths.

After completing an assessment and discussing the plan of care with the family, upon which member would the nurse focus effort? a. The adult patient with the acute flare-up of chronic illness b. The child who, being young, was energetic and enthusiastic c. The extended family, who had to learn to become a resource d. The spouse, who was flexible and able to cope

D Change occurs most often when the member of the system who is most flexible and has some power in the family makes a change. Hence, the nurse will target intervention with the members in the system who have the strength and adaptability to carry out the intervention.

Which of the following is the most appropriate secondary prevention approach when a nurse is working in a community with known high lead levels? a. Educating parents about avoiding purchasing toys painted with lead-based paint b. Screening all minority children c. Educating parents about early signs of lead poisoning d. Screening all children who are living in poverty

D Developing targeted lead surveillance and intervention programs in areas with poor children who live in older housing stock has proved to be a successful form of secondary prevention. Educating parents about avoiding purchasing toys painted with lead-based paint and the early signs of lead poisoning would be examples of primary prevention.

Why do European countries have less of a problem with regulating chemical toxicity than the United States? a. European countries can afford more chemical products to increase their life span and comfort. b. The United States is more technologically advanced, with more new chemicals to help with health care. c. The United States has more resources to purchase new chemical interventions for clinical problems. d. European countries require product manufacturers to prove that their products are safe.

D Europe has a comprehensive policy that requires product manufacturers to prove that their product is safe. The U.S. policy allows products to come to market and has little or no way to withdraw the products if they are discovered to be toxic.

In the midst of anxiety and concern over the new diagnosis, it seems that every family member was distancing himself or herself from the rest of the family. What mechanism would the nurse recognize that the family members are using? a. Anger reduction strategies b. Double-bind communication c. Circumplex modeling d. Triangling

D People often try to maneuver into a distant position in a triangle to escape tension. Triangles are usually dynamic and changing as various family members engage in stressful situations. Although this strategy may be used to reduce anger, it is an example of triangling. Double-bind communication sends two conflicting messages. The Circumplex Model of family systems demonstrates how adaptability and cohesion interact within families.

The administrative team at a home care agency is discussing how they meet the Culturally and Linguistically Appropriate Services (CLAS) standards. Which of the following actions demonstrates the incorporation of these standards in practice? a. Requiring a small fee so that all patients will have a translator immediately available b. Using hand motions, pantomime, and touch to convey information c. Requiring all staff nurses employed in the hospital to be bilingual d. Using a computer to print index cards with essential phrases both in English and in the patient's language

D The CLAS standards suggest free language assistance, whereby bilingual staff and interpreter services are preferred. Although hand motions and pantomime may be used on a temporary basis, they are very prone to misinterpretation, and interpreters or a bilingual staff member must be sought immediately. The hospital cannot require any nurse to be bilingual, although such nurses should be actively recruited. Use of index cards is suggested in the text. In some geographic areas, so many ethnic groups use a particular hospital that having a computer program that could print the information needed in this instance would be a cost-effective way of being prepared.

Why would a family strenuously resist the nurse's efforts to be helpful? a. People have the tendency to want to stay the same. b. The family as a system operates on the principle of equifinality. c. The nurse crossed the family's coping boundary. d. The family system is trying to achieve entropy.

A As a system, the family will want to stay the same (morphostasis) and will therefore resist change, even when a suggested change would be helpful.

A nurse wanted to increase the safety of a family with a small toddler. Which of the following would be a secondary prevention measure in relation to poisoning? a. Assessing for hazardous materials in the home and suggesting that these materials be kept in a locked cabinet over the refrigerator b. Encouraging the family to minimize the use of household chemicals and pesticides c. Encouraging the family to use household chemicals only when proper ventilation is available d. Printing stickers for the parents to attach to the phone with the telephone number of the nearest poison control center

A Assessing for hazardous materials in the home requires the nurse to perform an assessment of the home, or screening, which is secondary prevention. The other interventions are primary prevention strategies: encouraging minimization of the use of household chemicals, using household chemicals only when proper ventilation is available, and printing stickers to attach to the telephone.

What, in basic terms, do Barry Commoner's laws of ecology state? a. Everything is connected to everything else, and everything must go somewhere. b. Long-term survival requires protection of our environment. c. Only humans contaminate their own environment. d. Take care of the planet; it's the only one we've got.

A Commoner's laws of ecology are the basic principle of ecologic systems: everything is interconnected and nothing disappears; everything is connected to everything else.

Which of the following would be an appropriate response by a public health department if there is some evidence of a relationship between a substance and human health but research has not yet drawn conclusions? a. Be cautious. b. Do not worry about it. c. Contact the Centers for Disease Control and Prevention. d. Refuse to be involved.

A The Precautionary Principle states that if there is some evidence about the relationship between toxic substances or environmental hazards and human health, even if scientific evidence about cause and effect is not available, precautionary measures should be taken to protect the environment and human health.

Among other variables, upon what does damage from a specific chemical depend? a. The dose b. The environmental factors c. The toxicology d. The virulence and infectivity

A The extent of biologic damage produced by a chemical depends on the amount of the exposure and the response of the person. This is called a dose-response ratio. The damage depends on the exposure or dose and the response of the person exposed. The higher the dose of the chemical, the greater the response usually is.

According to the ABCX model, with which of the following feelings or behaviors will a typical family react after a crisis occurs? a. Disorganization, recovery, and then reorganization b. Grief, anger, denial, and then frustration c. Loss, confusion, and then seeking answers d. Shock, denial, and then acceptance

A The family is thought to experience a rollercoaster course of adjustment, a process that involves disorganization, recovery, and a subsequent level of reorganization. Although some crises may involve loss and hence stages of grief, crisis can also result from a positive change or event, which also requires adaptation.

What are some reasons why community/public health nurses may choose to focus on the family as a unit of care? (Select all that apply.) a. A family perspective allows for a broader view than an individual perspective. b. A family perspective results in a better understanding of an individual who needs care. c. An individual's health depends on his or her family. d. An individual's ill health will affect the family. e. The family has always been the unit of focus of nursing care. f. The family perspective allows for higher reimbursement of nursing care.

A, B, C, D A nurse may choose a family perspective because family thinking gives a broader picture than an individual perspective, the family is a unit of care, the family assumes a crucial role in maintaining health, and dysfunction in one member may lead to added stress and depletion of resources for the entire family. Historically and traditionally, nurses have usually focused on the individual as a unit of care. Reimbursement depends on factors other than the nurse's perspective as the nurse provides care.

Which of the following nursing interventions can be implemented to assist families? (Select all that apply.) a. Providing anticipatory guidance for growth and development needs b. Assisting families with coping with illness or loss c. Explaining the family's situation so that other people may offer assistance d. Helping families cope with stressors or a crisis e. Referring families to sources of assistance or support f. Obtaining funds or supplies for the family in need

A, B, D, E Nurses assist families dealing with growth and development or coping with illness, loss, or external stressors and often give referrals to families with inadequate resources or support. However, nurses do not share information about a family or directly give funds and supplies to a family.

10. A man had a viral upper respiratory tract infection and was seen by a family nurse practitioner (FNP). The FNP gave the man both verbal and written information about over-the-counter drugs to control symptoms. However, the patient insisted upon a prescription for an antibiotic. Which of the following would be the most appropriate response from the FNP? a. "Antibiotics won't be helpful in treating this infection, but they may allow bacteria that will be immune to antibiotics to develop, putting you at high risk for getting sicker." b. "I'll write you a prescription for a special new research drug that works wonders with viral respiratory infections." Then the FNP writes a prescription for a placebo. c. "I'm the expert. I'll decide when you need an antibiotic. And you do not need one." d. "Of course; I always try to meet the needs of my clients. Which antibiotic do you find works best for you?"

ANS: A Antibiotics should be used prudently to reduce the emergence of drug-resistant strains. Drug-resistant strains are a threat to everyone. However, it is important for the provider to recognize the client's desire to receive an antibiotic and to educate the client about why an antibiotic is not the most appropriate choice at this time. DIF: Cognitive Level: Analysis REF: p. 195

5. Which of the following statements concerning infectious diseases in the United States today is true? a. They account for 25% of all physician visits and are still a major cause of death. b. They are not a community/public health problem in the United States. c. They are a major source of morbidity in the world, but not in the United States. d. They are rarely fatal in the United States.

ANS: A Infectious diseases are a major cause of death in many nonindustrialized countries. Even in the United States, infectious diseases are responsible for 25% of all visits to physicians and remain a leading cause of death. DIF: Cognitive Level: Comprehension REF: p. 192

15. When the school nurse discovered three sixth-graders smoking behind a delivery truck in the school parking lot, the nurse could accurately conclude that the three smokers were _____ lung disease. a. At risk for b. In the early lesional stage of c. In the latency period of d. In the pathogenesis stage of

ANS: A On the basis of the limited information in the question, only "at risk for lung disease" can be accurately concluded without more data as to length of smoking, number of cigarettes per day, coughing, other symptoms, and so on. DIF: Cognitive Level: Analysis REF: p. 167

17. Which of the following is a major ethical and legal issue for all community/public health care professionals? a. Ensuring total compliance by clients to their treatment regimens b. Balancing individual autonomy against community protection c. Providing home care versus insisting that the client come to the clinic d. Allowing human immunodeficiency virus (HIV) carriers, even if licensed professionals, to be employed within health care agencies

ANS: B An ongoing problem is the right of individuals to remain autonomous versus the community's right to not be exposed to contagious diseases unnecessarily. HIV-positive professionals can work in health care agencies with certain precautions. DIF: Cognitive Level: Comprehension REF: p. 201

13. Which is the best reason why children to choose to smoke? a. Movies that show heroes and heroines always smoking b. Multiple factors, including media and peer pressure c. The addictive effects of nicotine d. The tobacco companies, which advertise heavily

ANS: B As the web-of-causation model and other multiple causation models demonstrate, multiple factors, including media and peer pressure, interact to affect health behaviors. DIF: Cognitive Level: Analysis REF: p. 166

12. For what infection are health care professionals particularly at risk? a. Drug-resistant Salmonella infection b. Hepatitis B virus (HBV) c. Multidrug-resistant tuberculosis (MDR-TB) d. Sexually transmitted diseases (STDs), including acquired immune deficiency syndrome (AIDS)

ANS: B Blood-borne pathogens are an occupational risk for health care workers. Scrupulous adherence to universal precautions reduces that risk. DIF: Cognitive Level: Knowledge REF: p. 195 | p. 207

1. Who was the first nurse epidemiologist who pioneered the use of statistics to improve public health? a. Dorothea Dix b. Florence Nightingale c. Lillian Wald d. Sue Barton

ANS: B Florence Nightingale used statistics to show changes in outcomes as hospital conditions improved during the war because of nurses. DIF: Cognitive Level: Knowledge REF: p. 162

20. Which of the following is an example of indirect transmission? a. The backpacker refilled his water container from a faucet in the park labeled "potable water." b. The biologist decided to set up his living quarters in one of the dusty caves, which he first swept out. c. The nursing assistant first put on a pair of gloves and then picked up the soiled dressing. d. The waiter went to the rest room, scrubbed his hands, and then returned to serving the meal.

ANS: B Indirect contact involves passive transmission from contaminated water, dust, or objects. Hantavirus, for example, is inhaled from dust containing rodent feces. DIF: Cognitive Level: Application REF: p. 205

16. Which of the following populations within the hospital should be the focus of infection control when a nurse is trying to decrease the rate of nosocomial infections? a. The staff working in the operating room and the emergency department, where open wounds are frequent b. The clients with indwelling portals of entry, such as Hickman catheters c. The cleaning/maintenance personnel, who must maintain high standards of cleanliness in the hospital d. The visitors coming into the facility, who are bringing outside organisms into the hospital

ANS: B Infections can occur rapidly when there is easy internal access to the body, as seen with central venous pressure catheters, intracranial pressure monitors, and respiratory nebulizers. DIF: Cognitive Level: Analysis REF: p. 201

6. A nurse was given the following data about the children attending school in two area communities: School Asthmatic Children Number of Children in School Number of Persons in Community Centerville Elementary 25 1000 15,000 Centertown Suburban Elementary 25 1000 15,000 Centerville Junior High 35 1500 15,000 Two Oaks Elementary 5 200 5000 Two Oaks Junior High 10 300 5000 Totals: 100 4000 55,000 What is the rate of asthma in the school-age population? a. 5:1000 b. 25:1000 c. 100:20,000 d. 400:2000

ANS: B With 100 asthmatic children among 4000 total children, the rate is 100:4000, simplified to 25:1000. DIF: Cognitive Level: Application REF: p. 162

6. What is the rate of asthma in the school-age population? a. 5:1000 b. 25:1000 c. 100:20,000 d. 400:2000

ANS: B With 100 asthmatic children among 4000 total children, the rate is 100:4000, simplified to 25:1000. DIF: Cognitive Level: Application REF: p. 162

6. Which of the following contributed to several measles epidemics in the 1990s? a. People had stopped getting immunizations for measles and other diseases. b. The measles vaccine was no longer effective against the agent because the virus had mutated. c. The measles vaccine did not provide lifetime immunity. d. Thousands of ineffective contaminated vaccine doses had unknowingly been injected.

ANS: C Although it had been believed that measles immunity lasted for a lifetime, it clearly did not, and one to two booster doses are now recommended for continued protection against measles. DIF: Cognitive Level: Knowledge REF: p. 194

7. Which of the following is the reason for mumps outbreaks among young adults? a. People had stopped getting immunizations for mumps and other diseases. b. The mumps vaccine is no longer effective against the agent because the virus had mutated. c. The mumps vaccine does not provide lifetime immunity. d. Thousands of ineffective contaminated vaccine doses had unknowingly been injected.

ANS: C Although it had been believed that the mumps vaccine given in two doses conveyed lifetime immunity, it clearly did not, and a third dose is now recommended for persons at high risk for exposure to mumps. DIF: Cognitive Level: Comprehension REF: p. 194

5. Assuming that City A has a murder rate of 12 per 100,000 population and City B has a murder rate of 24 per 100,000 population, which city has the more worrisome problem? a. The answer cannot be determined from these data. b. City A has the more worrisome problem. c. City B has the more worrisome problem. d. Both cities have equally worrisome problems.

ANS: C Because City B has a murder rate of 24:100,000, whereas City A has a rate of 12:100,000, the murder rate in City B is twice as high as that in City A and hence has the more challenging problem. DIF: Cognitive Level: Application REF: p. 163

10. A school nurse decided to begin a "don't smoke, don't start" program. To determine whether the program has any effect, an experimental trial study was planned. Which of the following actions would the nurse take? a. Divide the students into two groups (smokers and nonsmokers), teach the course to both groups, and then observe for changes in beliefs. b. Divide the students into two randomly chosen groups, teach the program to all students, and then determine learning and smoking behaviors through a posttest. c. Use two randomly chosen groups, teach the program to one group, and then determine differences in knowledge and smoking behaviors between the two groups. d. Screen each student, and look for evidence of smoking behaviors.

ANS: C Because the nurse is planning an experimental trial study, the only option that demonstrates this type of approach with randomization and control is to randomly choose two groups, teach the program to one group, and then determine the differences between the two groups. DIF: Cognitive Level: Application REF: p. 164

9. A school nurse was concerned about the prevalence of obesity in the elementary school classes. On the basis of the literature, the nurse decided to ask each student whether he or she ate breakfast before coming to school in the morning. Which type of study is the nurse conducting? a. Experimental b. Case-control c. Correlational d. Clinical trial

ANS: C In a correlational study, investigators look for associations between two factors-in this case, between obesity and possible contributing factors. Experimental studies must involve two groups of people: a control group and an experimental group. Case-control studies are retrospective because the study begins after the health outcome has already occurred. In this case, a case-control study would be performed if only the obese children were asked the question. A clinical trial is similar to an experimental study. DIF: Cognitive Level: Application REF: p. 164

18. A community/public health nurse is beginning an investigation of a communicable disease. What is the first action that the nurse will take? a. Diagnose the disease, ask patients to name contacts, and then find those contacts. b. Diagnose the problem, treat it, and then interview the client. c. Identify the disease, isolate the causative agent, and determine the method of transmission. d. Use the media to share symptoms and causes and then have professionals available to answer telephone calls, being sure to obtain names of infected persons.

ANS: C In accordance with epidemiologic principles, communicable disease investigation involves five steps: identifying the disease, isolating the causative agent, determining the method of transmission, establishing the susceptibility of the populations at risk, and estimating the effect on the population. DIF: Cognitive Level: Application REF: p. 202

Which of the following statements is the most accurate description of a client who has received a diagnosis of hypersensitivity? a. "He or she gets his or her feelings hurt frequently." b. "His or her skin burns very easily from sunlight." c. "He or she reacts to much smaller doses of chemicals than do most people." d. "He or she experiences an allergic reaction."

C Hypersensitivity, or hypersusceptibility, means the person will have a sensitivity response to a much lower than expected dosage of a certain chemical

7. A community/public health nurse needs to conduct a descriptive study of the health needs of elderly persons attending a congregate meal at the local community center. Therefore, the nurse would a. Divide the elderly population into two groups (healthy and unhealthy), teach courses on healthy lifestyles, and then measure any changes. b. Use two randomly chosen groups, teach healthy lifestyles to all participants, and then determine learning through a posttest. c. Divide the elderly population into two randomly chosen groups, teach healthy lifestyles to one group, and then determine differences in knowledge between the two groups. d. Screen each elderly person and look for patterns in the findings related to health problems that necessitate attention.

ANS: D Descriptive studies focus on the amount and distribution of disease within a population; thus, screening would give the nurse information on the health needs of the elderly population as a whole. DIF: Cognitive Level: Application REF: p. 163

2. What scientific criteria were developed by Jacob Henle to link an organism to its specific disease? a. Give samples of the organism to three different researchers and see whether all three researchers can grow it successfully. b. Grow the organism on the diseased tissue and then see whether, when spread on normal tissue, the organism continues to grow. c. Identify microorganisms under a microscope and grow them on the tissue that the disease usually infects. d. Identify the organism, isolate the organism, and see if the organism produces disease.

ANS: D Henle's three criteria to link an organism to its specific disease were to identify the organism, isolate it, and use it to generate disease. DIF: Cognitive Level: Knowledge REF: p. 191

18. The community/public health nurse leads a support group for clients and their families who have been affected by cancer. Which of the following best describes this nursing intervention? a. Specific protection b. Primary prevention c. Secondary prevention d. Tertiary prevention

ANS: D Support groups are considered tertiary prevention. The clients and their families have already been affected by cancer, and the nurse is assisting them to prevent further problems. DIF: Cognitive Level: Application REF: p. 168

Which of the following activities is an ergonomist most likely to perform? a. Studying the prevention, detection, and treatment of work-related injuries b. Designing equipment for the interface of humans, their tools, and work activities c. Recognizing natural history of occupational disease and injuries in certain groups d. Describing the toxic properties of chemical agents used in the employment setting

B An ergonomist studies, designs, and promotes the healthy interface of humans, tools, and their work requirements. Physicians diagnose and treat disease, an epidemiologist studies and describes the natural history of diseases or injuries, and toxicologists examine toxic properties of chemicals.

The "Mr. Yuk" educational campaign and the practice of routinely dispensing medications in childproof containers are examples of a. Primary prevention programs that have had little effect on poisoning deaths. b. Primary prevention programs that have notably decreased deaths from poisoning. c. Secondary prevention programs that have had little effect on poisoning deaths. d. Secondary prevention programs that have notably decreased deaths from poisoning.

B Both campaigns were extremely effective, as seen in a dramatic decrease in poisoning deaths among children from birth to 4 years of age. Both interventions are examples of primary prevention.

Which of the following statements would be the most accurate description of symbolic interaction in a family? a. "Behaviors of one person are the cause of behaviors in another family member." b. "Behaviors of one person are the effect of behaviors in another family member." c. "Behaviors of one person are both the cause and the effect of behaviors in another family member." d. "Behavior within the family is consistent, patterned, and repetitious."

C Symbolic interaction is the way in which family members interact with each other. Behaviors of one person are both the cause and the effect of behaviors in another family member.

Which of the following is the best way for a nurse to determine a client's ethnicity? a. Analyzing the client's actions and communication patterns b. Closely observing behaviors and customs c. Discussing with anthropologists how to recognize the various ethnic groups d. Querying "How do you identify yourself?"

D Although it certainly would be useful to observe and analyze a client's beliefs, actions, behaviors, and communication patterns, the easiest and most efficient way to determine ethnicity is simply to ask the client.

Which of the following is a reason why each person is asked to report his or her race during the U.S. census? a. Race is a biologic reality defining persons with common biologic features. b. Race is a crucial variable, which explains the differences among different groups of people. c. Race is a historical tradition that must be upheld. d. Race is a way in which people identify themselves.

D The census has historically included this question, on the basis of the traditional concept of those who share common biologic features; however, there is no genetic difference among people, and many people have argued that the concept of race should not be used. At this point, race is primarily a concept reflecting how people identify themselves.

Which of the following actions demonstrates the occupational health nurse's need to balance conflict between what is legal and what is ethical? a. Ensuring the employer's profit and keeping the employees happy b. Fulfilling what the nurse's supervisor wants and what the employees want c. Encouraging primary prevention and first aid to the injured d. Reporting health problems to employers and keeping health records confidential

D The conflicts arise because the nurse has a responsibility to the employer and to the client. Thus the nurse needs to report health problems in the aggregate but also has to keep individual information confidential. The American Association of Occupational Health Nurses (AAOHN) has issued two useful advisories to help nurses manage confidentiality and record-keeping.

To what does the term environmental justice refer? a. Applying environmental laws equally throughout the country b. Being fair (or just) in relation to how the costs of environmental pollution cleanup are distributed c. Putting the most environmental pollution waste in the already polluted sites (known as Superfund sites) d. Recognizing that environmental risks are disproportionately high for low-income and minority populations who live in more highly polluted neighborhoods

D The effects of low income, discrimination, and limited choices in employment and housing are more exposure to pollution and are being recognized by use of the term environmental justice.