COMMUN QUIZ

Which approach to helping prevent foodborne disease would most likely be controversial? a. Farmworkers receiving education on safe use of pesticides b. Health exams of those employed in food processing facilities c. Irradiation of meat and poultry d. Unannounced inspections of food processing plants

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Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? A. Vulnerable populations B. Resilient populations C. Multiproblem families D. Disadvantaged families

A. Vulnerable populations

Which of the following children is most at risk for being abused? A. A 1-year-old B. A 6-year-old C. A 9-year-old D. A teenager

A. A 1-year-old Children under the age of 4 years and children with special needs are at highest risk for abuse.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent? A. Case management B. Client advocacy C. Holistic care D. Wrap-around services

A. Case management

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? A. Directly observing clients with active tuberculosis as they take their antitubercular medications B. Interpretation of tuberculosis skin test findings C. Assessing for signs and symptoms of active tuberculosis D. Administration of skin tests to identify persons who have been infected with tubercle bacilli

A. Directly observing clients with active tuberculosis as they take their antitubercular medications

A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? A. Establish lifestyle improvement programs through local youth organizations. B. Evaluate the food intake of a group of children for a 48-hour period. C. Provide education programs to overweight expectant parents. D. Evaluate the body mass index of children at regularly scheduled well-child exams.

A. Establish lifestyle improvement programs through local youth organizations. Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.

A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? A. Monitoring blood glucose levels closely and modifying diet accordingly B. Developing lifestyle improvement programs for women at risk for diabetes C. Presenting lifestyle management presentations at women's conferences D. Screening glucose levels of women at risk for development of diabetes

A. Monitoring blood glucose levels closely and modifying diet accordingly

Which of the following factors has the largest impact on health disparities among all populations? A. Poverty B. Lifestyle choices C. Education level D. Ethnicity

A. Poverty

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? A. Secondary prevention B. Primary prevention C. Tertiary prevention D. Secondary and tertiary prevention

A. Secondary prevention

Which of the following factors predisposes many migrant farmworkers to disenfranchisement? A. Short length of time in the community B. Previous experiences of physical abuse C. Inability to attend religious services because of work requirements D. Being a minority group member

A. Short length of time in the community

Which of the following behaviors results in men being less healthy than women? A. Concentration on sports, hunting, and other dangerous recreational choices B. Employment in stressful positions more so than women C. Preference to spend money on priorities other than health care D. Reluctance to visit physicians

D. Reluctance to visit physicians A major obstacle to improving men's health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of U.S. men see a doctor, nurse practitioner, or physician assistant compared with 74% of women

Some faculty at the College of Nursing decide to establish an innovative new program to help families with technology-dependent children. The program will include home care and respite care, among other services. When the group is applying for funding, what would such a service be called? a. Family professional respite care b. High tech-high care family comprehensive treatment c. Pediatric intensive care for homebound families d. Specialty "carve out"

Specialty "carve out" One approach used to manage care for high-risk populations is to contract their care to specialty organizations (referred to as "carve outs"). These specialty organizations often develop innovative approaches to caring for these high-risk populations.

Which nurse will probably be the most successful at creating improvement in family health? a. The nurse who is skilled at recognizing and strengthening the family's competencies b. The nurse who is expert at obtaining referrals and resources for the family c. The nurse who is superb at communication and interpersonal relationships d. The nurse who is very clear in assessing and naming the family's main problems

a. The nurse who is skilled at recognizing and strengthening the family's competencies The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits.

Which recommendation by the nurse would be aimed toward reducing a family member's health risk? a. "Be sure to take a 30 minute walk each day before you leave for work or when you get home." b. "Call our office if you have any questions or concerns at all." c. "Come back in 2 weeks for follow-up on your surgery." d. "Continue to take the drug until it is gone, even if you're feeling better earlier."

a. "Be sure to take a 30 minute walk each day before you leave for work or when you get home." The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

Which question reflects the nurse appraising health risks? a. "Does your 1-year-old have a booster seat in the car?" b. "Have you noticed any physical problems as you go about your daily routine?" c. "What concerns do you have today? d. "Why did you decide to come in for a checkup?"

a. "Does your 1-year-old have a booster seat in the car?" Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness

A school nurse asks a class about the ways HIV can be transmitted. Which comment by a student indicates a need for additional teaching? a. "I wouldn't sit next to someone with HIV." b. "Having unprotected sex with someone who is infected spreads HIV." c. "Sharing needles when shooting up drugs spreads HIV." d. "Transfusions of blood products that are contaminated can spread HIV."

a. "I wouldn't sit next to someone with HIV." HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. Worldwide, the largest number of HIV infections result from heterosexual transmission.

A nurse explained to a new mother that since she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. "Wait," said the new mother. "Why is my son getting two shots?" How should the nurse respond? a. "One injection protects your son, while the other encourages his body to build up immunity." b. "One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him." c. "Since you've already been infected with the virus, your son needs twice as much protection." d. "The second shot is just to make sure the first one works."

a. "One injection protects your son, while the other encourages his body to build up immunity." Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection.

If an occupational nurse's goal is to address the most common preventable cause of death, what health program should the nurse emphasize? a. A "stop smoking" campaign with free vegetable nibbles for those on break b. An "exercise rather than eat" break program in the new workout room c. A "don't drink and drive" campaign d. An educational program on awareness of cancer and the importance of self-exams

a. A "stop smoking" campaign with free vegetable nibbles for those on break Tobacco is known as the single most preventable cause of death

Which infectious disease intervention represents primary prevention? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

a. A client receives a tetanus booster every 10 years. Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is tertiary prevention. Because the client has the condition, treatment is aimed at prevention of further injury.

What is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population

a. Activities or behavior of humans, including changes in the environment Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is.

In the United States, which demographic group has the highest risk for HIV infection? a. African American homosexual men b. Hispanic IV drug abusers c. Native American heterosexual males d. White lesbians

a. African American homosexual men The largest number of new HIV infections in 2009 (11,400) were in white men who had sex with other men (MSM), and this was followed by black MSM (10,800).

Which individuals should routinely be assessed for their risk for a STD? a. All sexually active adults b. Anyone who admits to using injectable drugs c. Men complaining of a sore on their penis d. Women attending a prenatal clinic

a. All sexually active adults

. What is the most rapidly growing group of homeless? a. Adolescents (runaways and "throw-aways") b. Families with children c. Persons in crisis d. Single men

b. Families with children

What is the most important principle to keep in mind when caring for the pregnant teen? a. All teen pregnancies are considered high-risk. b. Limited self-care knowledge can lead to pregnancy complications. c. Pregnant teens are likely to receive prenatal care late in the pregnancy. d. Pregnant teens may have limited financial resources to pay for care.

a. All teen pregnancies are considered high-risk. All of these statements are true; thus it is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy.

Which family would cause the nurse the most concern? a. An older couple have just retired and sold their house. During their routine annual physical exams, they talk about their new condo in a retirement community. b. Newlyweds have been saving their money, and they want to discuss birth control and family planning in preparation for future pregnancies. c. Parents come with their child for his pre-kindergarten physical exam and want to be sure all the child's immunizations are up to date. d. A woman is very pleased with her new position at the hospital and wants to have her preemployment exam and drug screen.

a. An older couple have just retired and sold their house. During their routine annual physical exams, they talk about their new condo in a retirement community. Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

. Which biological warfare agent would pose the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia

a. Anthrax Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat.

What action can a nurse take that will potentially increase accessibility to health care services for mentally ill homeless clients? a. Applying for a grant to fund a mobile clinic to take health care to the clients b. Distributing flyers to the homeless that detail the location of various types of health care services c. Referring homeless clients to areas that provide temporary housing d. Soliciting donations for food and clothing to be distributed to the homeless

a. Applying for a grant to fund a mobile clinic to take health care to the clients Accessibility refers to the ability of clients to obtain needed health care services. Although all of these options lead to opportunities for improvement in health, either directly or indirectly, only option 1 (applying for a grant for a mobile clinic) can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places.

VRSA and MRSA were formerly found primarily in hospitals, but where are outbreaks currently on the rise? a. Areas where people share dressing or bathing facilities b. Day care centers and schools c. Long-term care facilities d. Senior citizen centers

a. Areas where people share dressing or bathing facilities Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas.

A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. What action by the nurse would use secondary prevention to limit caregiver stress? a. Asking caregivers how they are doing and suggesting coping strategies b. Encouraging caregivers to periodically leave the house for a couple of hours c. Establishing support groups for caregivers of older parents d. Referring some activities to neighbors and friends

a. Asking caregivers how they are doing and suggesting coping strategies Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed. Also, option 2 could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" This information can help the nurse to: a. Assess the family's environment and social resources and risks b. Communicate with relevant others as needed c. Determine financial assets available to the family in case of serious need d. Understand the extended family relationships

a. Assess the family's environment and social resources and risks The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

What conclusion should the nurse draw when her Mantoux test is positive for exposure to tuberculosis? a. The nurse has been exposed to tuberculosis. b. The nurse has tuberculosis. c. The positive test result probably is due a problem in the testing process. d. The test is inaccurate and needs to be repeated.

a. The nurse has been exposed to tuberculosis. An individual who tests positive has been exposed and may be infected, but if that person shows no clinical signs, the person is not diseased. Infection refers to the entry, development, and multiplication of the infectious agent in the susceptible host. Disease is one of the possible outcomes of infection. People with latent TB have no symptoms, are not infectious, and can continue on with life. They may develop active TB. A nurse who interacts with clients may receive INH for a year as a precaution.

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a. At the city's homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner-city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs

a. At the city's homeless shelter, which is, by policy, vacant during the day Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. The most convenient place for the clients would be the homeless shelter where transportation and lack of comfort in an unfamiliar place would not be issues.

What should nurses be careful to do when using case management with vulnerable populations? a. Be willing to enter into a long-term relationship with families. b. Direct and control the client's care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency.

a. Be willing to enter into a long-term relationship with families. Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which nursing action is most appropriate? a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night b. Refer the man to a urologist to address the urinary bleeding c. Suggest that the family take him to an urgent care center immediately d. Treat the urinary infection and give the man medication to take to prevent the return of infection

a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups.

Which represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

a. Being bitten by an infected mosquito Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance. Vectors include mosquitoes, which can transmit the infectious agent by biting the host.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which type of service do these actions represent? a. Case management b. Client advocacy c. Holistic care d. Wrap-around services

a. Case management

A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which secondary prevention action could the nurse take? a. Conducting a sexual behavior survey with the adolescents b. Establishing in-school education related to transmission of sexual infections c. Providing free condoms at schools and universities d. Providing follow-up educational programs for those diagnosed with an STI

a. Conducting a sexual behavior survey with the adolescents Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. What would the nurse call this intervention? a. Contracting b. Crisis intervention c. Empowerment d. Strategic planning

a. Contracting Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

. What is the most helpful intervention a nurse in community health can initiate to increase lasting resilience among new immigrants? a. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

a. Direct clients to English-as-second-language courses. Vulnerability can be reversed by obtaining resources to increase resilience. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status.

In what way is HSV-2 infection more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

a. HSV-2 is a viral infection that is both chronic and incurable. Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

A woman and man who have come to the health clinic begin to argue loudly. "You gave me an STD!" the man yells. The woman screams back, "Not me. I don't have an STD!" Which of the following would be appropriate for the nurse to say to them? Select all that apply. a. "Actually, you're very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done." b. "Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary." c. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." d. "You may be able to get treatment from your pharmacist so you won't have to be embarrassed like this again." e. "You clearly have slept with someone else, so why blame this person?" f. "You have to list ALL your sex partners when you go in for treatment"

a. "Actually, you're very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done." b. "Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary." c. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STD test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person.

Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? Select all that apply. a. "I always address the problem that the client believes is the most important." b. "I avoid asking clients for income or financial information, because this is an invasion of privacy." c. "I sometimes bend the rules a bit to adapt my care to the needs of my clients." d. "I make sure to do a complete assessment, since we often don't know when the person will return to the clinic." e. "I try to observe the client's cultural traditions as I probe for signs of abuse." f. "When a client needs to see a financial advisor but can't afford one, I give the best advice I can."

a. "I always address the problem that the client believes is the most important." e. "I try to observe the client's cultural traditions as I probe for signs of abuse." Because poverty is a primary cause of vulnerability, the nurse should include questions about the client's financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used. Focus on what data are needed to help the client that day with the problem the client believes is most important.

Nursing students are offering health screenings at the local homeless shelter. Which persons or groups will the students most likely see? Select all that apply. a. A group of men who smell strongly of body odor and alcohol b. A man some of the students have previously met at the mental health clinic c. A woman who has bruises peeking out from her sweater and skirt d. Persons who just want to come in from the cold weather outside e. A man who is distributing religious tracts and inviting clients to attend services f. A woman and her two children who have been living in their car until it got so cold

a. A group of men who smell strongly of body odor and alcohol b. A man some of the students have previously met at the mental health clinic c. A woman who has bruises peeking out from her sweater and skirt f. A woman and her two children who have been living in their car until it got so cold Groups commonly found among the homeless include persons living in poverty, victims of domestic abuse, people who abuse alcohol or other substances, persons who are mentally ill, and veterans

What factor(s) may help determine how many home visits are made to a particular family? Select all that apply. a. Agency's policies regarding eligibility for services b. Family's feelings about the home visit and willingness to continue c. Nurse's perception of the amount of time needed to complete required tasks d. Reimbursement policies of third-party payers e. Time needed to meet the family's health goals f. None of the above, since it is rare to make more than one home visit

a. Agency's policies regarding eligibility for services b. Family's feelings about the home visit and willingness to continue d. Reimbursement policies of third-party payers

What advice would you give a new nurse on how to care for very poor families? Select all that apply. a. Be supportive in any way possible. b. Educate the family on how to maximize their health using free resources. c. Offer the family free medication samples whenever possible, keeping in mind the cost of many prescription drugs. d. Recognize the family's poverty and refrain from asking whether they want to make a payment toward their bill. e. Remember to allow the family their pride by not suggesting sources of help that they may not need. f. Try to keep the family separate from your paying clients.

a. Be supportive in any way possible. b. Educate the family on how to maximize their health using free resources. c. Offer the family free medication samples whenever possible, keeping in mind the cost of many prescription drugs. The textbook suggests that the poor be treated like anyone else. Don't prejudge by assuming a poor family cannot pay anything, don't be condescending, and don't call attention to a family's poverty by treating the family differently or separately. Always be supportive. Suggest all programs that might help, such as food banks, churches, and clothing centers. Remember that families are not always able to pay for medications, so free samples are often appreciated. Many families need help to learn how to promote their own health, given their lack of resources.

A family asks the nurse to please meet at their home rather than at the clinic. Why might the family prefer to meet in their home? Select all that apply. a. The family won't have to travel. b. It is cheaper for the family due to reimbursement requirements. c. Meeting at home is much more convenient for the family. d. The nurse won't be distracted by other clients or responsibilities. e. It would save money for the nurse and the clinic. f. The family members may feel more in control.

a. The family won't have to travel. c. Meeting at home is much more convenient for the family. f. The family members may feel more in control.

A mother felt very guilty that her baby was born HIV-positive. When the nurse suggested the usual PDT and MMR immunizations, the mother was extremely upset. "Don't you know HIV children are immunosuppressed?" she exclaimed. What would be the nurse's best response? a. "All children have to have these immunizations before they can attend school." b. "Being HIV-positive, your child is more likely to catch an infection and be very ill if not immunized." c. "I'm so sorry; I forgot for a moment your child was HIV-positive." d. "The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them."

b. "Being HIV-positive, your child is more likely to catch an infection and be very ill if not immunized." Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Many states do have a "no shots, no school" law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

. A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, what comment by a parent would cause concern? a. "I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." b. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c. "My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d. "I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

b. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around." Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy.

A client with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. How should the nurse respond? a. "Clients with TB are often noncompliant, so if I directly observe , you will be sure to take the drugs that have been ordered." b. "This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs." c. "This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember." d. "Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs."

b. "This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs." It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment.

A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big day care center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to day care soon." What advice should the nurse give? a. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b. "Your daughter may have pinworms; let me teach you how to check for this." c. "Perhaps your child is not developmentally ready for group play." d. "Try to arrange more one-on-one time with your 3-year-old."

b. "Your daughter may have pinworms; let me teach you how to check for this." Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver.

According to the Federal Register, what is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a. $21,200 b. $23,000 c. $25,200 d. $27,000

b. $23,000

Which bill would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a. A bill that establishes policies requiring all persons to pay the same cost for services regardless of income b. A bill that promotes universal health insurance coverage c. A bill that requires all health care providers to give care to uninsured persons without charge d. A bill that requires health care workers to report undocumented immigrants who present for treatment

b. A bill that promotes universal health insurance coverage Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care.

. The nurse was making a postpartum visit to a teenage mother and her month-old infant. What assessment would be most important? a. Assessing for mother's ability to fulfill her own growth and development tasks b. Assessing for mother's knowledge about normal infant growth and development c. Assessing how much the teenager mother's own mother is helping her cope with child care d. Assessing whether the baby's father is being helpful to the mother

b. Assessing for mother's knowledge about normal infant growth and development Although the nurse might assess for any and all of these options, the primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse.

Why is chlamydia a major focus of public health efforts? a. Because, when not treated, it has more serious long-term outcomes than other STDs b. Because it can cause problems in infants born to infected mothers c. Because it is not frequently seen in the United States d. Because it is so difficult and expensive to treat

b. Because it can cause problems in infants born to infected mothers Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers, although it is rather easily treated with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. If you were the nurse, how would you respond? a. Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs. b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. c. The presence of an STD in women with cervical cancer may lead to congenital defects in offspring. d. The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.

b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information

What is the main reason some health clinics allow clients to be tested for HIV anonymously with no record of the client's name, address, or contact information? a. Client doesn't actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test and collection agencies will not be able to harass them. d. Client wants to be sure care providers don't share results with their family.

b. Client may be engaged in illegal activities (drug use). An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination.

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. What might lead the nurse to talk to the teacher about the child? a. Concern that other children are mistreating the child b. Concern over developmental delays c. Concern that the child is given adequate food during lunch d. Concern that the child may need to sit in the front in order to be able to see well

b. Concern over developmental delays Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Poverty-stricken children may be hungry and fatigued and have dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children also experience higher rates of school absenteeism, academic failure, and emotional and behavioral maladjustments. The stress of homelessness can be seen in withdrawal, depression, anxiety, aggression, regression, and self-mutilation. Homeless children may have delayed communication, more mental health problems, and histories of abuse

. What action by the nurse can best ensure long-term positive health outcomes of poor pregnant teens and their children? a. Assisting teen mothers to learn about their body changes during pregnancy b. Developing programs that allow teen mothers to complete their education c. Offering courses in proper care of babies and how to be a parent d. Monitoring pregnant teens to detect early problems with pregnancy

b. Developing programs that allow teen mothers to complete their education Single motherhood is increasing. A direct correlation exists between lack of education and poverty. Similarly, a direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth.

What is the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a "cauliflower" appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

b. Elevated growths with a "cauliflower" appearance HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter.

Which component of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

b. Environment

What should the nurse and family do together before beginning to implement the family's health care plan? a. Determine the family's willingness for a home visit. b. Establish the purpose of the visit. c. Review important points of teaching discussed during the visit. d. Review the family record and reason for referral.

b. Establish the purpose of the visit.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. What should the clinic's policy be regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Re-administer the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest x-rays.

b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working. Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results.

A student nurse was seriously shocked when late one night the she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. What is a likely explanation for a healthy young adult engaging in such behavior? a. He ate his meal but wanted more and had no more money. b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c. A friend had thrown his meal away, and he thought he could find his friend's untouched food. d. He was doing this to fulfill obligation of fraternity initiation at the college.

b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.

Worldwide, what is the number-one cause of death? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

b. Infectious diseases In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Infectious diseases, however, are still the number-one cause of death worldwide.

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. What should the college health nurse do? a. Inform all students, staff, and faculty of a possible rubella epidemic. b. Inform all students, staff, and faculty of a possible measles epidemic. c. Reassure the student that it is just a bad cold and will soon pass. d. Tell the student to take two aspirin, acetaminophen, or ibuprofen and drink lots of fluids while resting.

b. Inform all students, staff, and faculty of a possible measles epidemic. Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the United States in adolescents and young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), and a red, blotchy rash beginning several days after the respiratory signs. Measles is serious. Around 10% of measles cases require hospital admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who may have been exposed should be informed that anyone under 18 who has not received both immunization doses should receive measles vaccine.

For the nurse concerned about the prevalence of tuberculosis among migrant farmworkers, what tertiary prevention would best be used? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

b. Initiate directly observed therapy (DOT) for tuberculosis treatment. Tertiary prevention is carried out among persons already infected with the disease. In this instance DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems.

What is the most common vector-borne disease worldwide? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever

b. Malaria Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. More than 1 million children die of malaria each year. Dengue is the second most common vector-borne disease.

Which group is most at risk for suicide? a. Adolescents under age 20 b. Men over age 85 c. Females 25 to 45 years of age d. Women over age 65

b. Men over age 85

. The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. What would be the best action to take to improve client outcomes? a. Providing antibiotics to all homeless persons with chronic, nonhealing wounds b. Offering daily access to a room with soap, water, and bandages c. Handing out free bandaging supplies following each clinic visit d. Performing regular monitoring of the client's wound condition

b. Offering daily access to a room with soap, water, and bandages Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits.

What is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation

b. Poverty

Which level of prevention is represented by a nurse who offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

b. Secondary prevention Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease.

What is the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases

b. To exterminate specific infectious agents one by one

A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. What comments from the husband would suggest an energized family? Select all that apply. a. "I make most of the decisions so the kids don't notice much difference." b. "My daughter is pretty independent; she's active in both sports and theater." c. "My son is old enough to get a job and help pay all these medical bills." d. "My wife taught our daughter how to cook simple meals." e. "My wife and I both travel for work a lot, so the kids have learned how to be flexible." f. "Our church has dropped off several meals; so has my son's Boy Scout troop."

b. "My daughter is pretty independent; she's active in both sports and theater." e. "My wife and I both travel for work a lot, so the kids have learned how to be flexible." f. "Our church has dropped off several meals; so has my son's Boy Scout troop." Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

A nurse enters a family's home for the first time. What goals should the nurse have? Select all that apply. a. Assessing each family member in detail both physically and psychologically b. Collaborating with the family to establish goals and a plan for meeting them c. Determining the exact relationship between each member of the family d. Exploring the family's perception of their problems and needs e. Negotiating who will implement the nursing care plan and how it will be implemented f. Stating the nurse's conclusions of the family's problems and needs

b. Collaborating with the family to establish goals and a plan for meeting them d. Exploring the family's perception of their problems and needs

A nurse is concerned about a young teenage mother who does not seem to know how to play with an infant. What behaviors might the nurse want to role-model as good parenting behaviors? Select all that apply. a. Allowing the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe b. Cuddling and holding the baby while smiling and gazing into the baby's eyes c. Teaching the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face d. Singing to baby with different melodies until baby seems to listen and shows a preference for certain tunes e. Using "baby talk" (goo-goo, gaga) to help the infant recognize verbal sounds f. Walking with the baby while pointing to bright colors and listening to sounds

b. Cuddling and holding the baby while smiling and gazing into the baby's eyes d. Singing to baby with different melodies until baby seems to listen and shows a preference for certain tunes f. Walking with the baby while pointing to bright colors and listening to sounds Suggestions for promoting interaction between an adult and a baby include the following: maintaining a distance of 8 to 10 inches from the baby, smiling, and making eye contact. Talk to the baby, but avoid "baby talk." Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). Babies love to play and enjoy "taking walks" and looking at brightly colored objects or toys that make noises.

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? Select all that apply. a. The child develops allergies with sneezing. b. The child persists in biting behavior or is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. The school system requires all students to receive routine immunizations in order to attend. e. Parents of well children at the school strongly object to the HIV-positive child attending. f. There is an outbreak of chickenpox in the school.

b. The child persists in biting behavior or is unable to control body secretions. f. There is an outbreak of chickenpox in the school. Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Strong disapproval by parents of well children is an opportunity to teach these persons how HIV is transmitted.

Six students order meals at the local mom-and-pop restaurant. Which students are at high risk for illness? Select all that apply. a. The first student asks for a salad with chicken strips and dressing on the side. b. The second student asks for a hamburger, very rare. c. The third student orders a tuna salad sandwich with extra mayonnaise. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast. e. The fifth student asks for the recipe of the week, Carpaccio (raw beef tenderloin). f. The sixth student orders two tomato-and-cheese pizza slices.

b. The second student asks for a hamburger, very rare. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast. e. The fifth student asks for the recipe of the week, Carpaccio (raw beef tenderloin).

What would be appropriate reasons for the nurse to visit a family in their home rather than have them come to the clinic? Select all that apply. a. To decrease use of clinical resources in giving care b. To encourage active family involvement in the health plan c. To have uninterrupted time to discuss health concerns d. To identify barriers to, and supports for, the family's health goals e. To increase the family's comfort and sense of control f. To maximize the nurse's efficiency and personal comfort

b. To encourage active family involvement in the health plan d. To identify barriers to, and supports for, the family's health goals e. To increase the family's comfort and sense of control

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. What sort of immunity will follow? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

d. Passive immunity Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a nonimmunized individual, such as the transfer of antibody by administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination.

What public health action has been particularly instrumental in reducing childhood infectious diseases in the United States? a. Answering parents' questions about the safety and importance of vaccines today b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. "No shots, no school" legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge

c. "No shots, no school" legislation, which legally requires children be immunized before school Vaccines are one of the most effective methods of preventing and controlling communicable diseases. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. One of the most effective programs has been the "no shots, no school" legislation, which has resulted in the immunization of most children by the time they enter school

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" What might be your response? a. "Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b. "It's just the right thing to do." c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d. "We're a religious God-fearing community, and we take care of each other."

c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease.

An instructor is reviewing Salmonella infections with her class. Which comment indicates that the student needs further review on how Salmonella is spread? a. "Certain pets and farm animals may be Salmonella carriers." b. "It is possible to transmit Salmonella by person-to-person contact." c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d. "Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings. Anthrax (not Salmonella) forms spores when infected blood is exposed to air.

Using the Neuman Systems Model, what might the nurse ask a client to assess physiological health? a. "What helps you to cope with situations involving your wife's cancer?" b. "How has your child's illness affected the behavior of your other children?" c. "Tell me about any illnesses your other family members have." d. "Who do you turn to for support outside your immediate family?"

c. "Tell me about any illnesses your other family members have." Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health.

Which question reflects a nurse's concern regarding risk reduction? a. "Did any of the hunters in your family kill a deer this year?" b. "How do you keep your rifles safe from curious children?" c. "Where do you shoot with your handguns?" d. "Where do you keep your rifles locked when it is not hunting season?"

c. "Where do you shoot with your handguns?" Risk reduction is a complex process that requires knowledge of risks and families' perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the family's perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which statement indicates a need for additional staff education? a. "If a client who does not speak English comes in, you must obtain an interpreter right away." b. "We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns." c. "You will like working with Hispanic immigrants because they have close-knit family structures." d. "You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

c. "You will like working with Hispanic immigrants because they have close-knit family structures." Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence.

Which family is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b. A man knows that his grandfather, father, and older brother all died of cardiac disease. c. A man is currently unemployed and despairs about finding a position. d. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two-thirds of his original salary.

c. A man is currently unemployed and despairs about finding a position. A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

When drawing a genogram, how does the nurse demonstrate a marriage relationship between two individuals? a. A broken line b. A dashed line c. A solid line d. Two parallel lines

c. A solid line

Which represents a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

c. A woman is pregnant with her first child. Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.

Which comment should cause the nurse to probe further to determine whether the family was in crisis? a. A man says, "I can't visit my wife in the hospital when I'm at work all day. How can I be sure she's all right?" b. A man says, "My wife always handled our finances. Now that she's gone, I'll have to learn how to do this." c. A woman says, "I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children." d. A woman says, "What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?"

c. A woman says, "I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children." A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.

Which is an example of tertiary prevention by a nurse? a. Administration of skin tests to identify persons who have been infected with tubercle bacilli b. Assessing for signs and symptoms of active tuberculosis c. Directly observing clients with active tuberculosis as they take their antitubercular medications d. Interpretation of tuberculosis skin test findings

c. Directly observing clients with active tuberculosis as they take their antitubercular medications Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB.

Which action should the nurse focus on first during an initial home visit? a. Assessing the family and the home setting for both strengths and problems b. Determining the family's expectations of a home visit c. Establishing rapport between the nurse and the family d. Engaging in extended social interaction as would be expected from any guest

c. Establishing rapport between the nurse and the family With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurse's self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client's expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

Which sexually transmitted disease can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Herpes

c. Hepatitis B

What is the most frequent reason that liver transplants are needed? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Liver cancer

c. Hepatitis C Hepatitis C- Primary reason for liver transplants and is caused by sharing syringes and other drug-related paraphernalia, unsterilized tattoo needles and piercing equipment or sexual contact. Does not show symptoms until it is too late. Cannot do more than rest and get adequate nutrition and liquids. HCV infection sometimes results in an acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer. You can get Hepatitis C when you have contact with the blood of an infected person, primarily through sharing contaminated needles to inject drugs.

A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, "My mom said she couldn't see you and you should go away." What should the nurse do? a. Demand the child let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch if the mother changes her mind or if the nurse can be helpful in any way. d. Point out that legally once an appointment has been made, the nurse must see the client to be sure the client is all right.

c. Leave a card with information on how to get in touch if the mother changes her mind or if the nurse can be helpful in any way. The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present

What is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever

c. Lyme disease All four are diseases borne by ticks as the vectors. Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States.

Excluding war, what is the leading cause of disability for Americans 15 to 44 years of age? a. Accidents b. Arthritis c. Major depressive disorder d. Workplace injuries

c. Major depressive disorder

Where should the nurse look to determine whether other communities are also having an epidemic of measles? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Morbidity and Mortality Weekly Report d. Weekly National Report of Communicable Diseases

c. Morbidity and Mortality Weekly Report Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The National Notifiable Diseases Surveillance System (NNDSS) data are collated and published weekly in the Morbidity and Mortality Weekly Report (MMWR).

. What can the nurse do to decrease the risk for depression in older adults? a. Encourage moving to a nursing home where others of the same age reside. b. Monitor for signs and symptoms of depression. c. Organize an exercise and health promotion program at the local senior citizen center. d. Teach older clients to focus on their strengths rather than their weaknesses.

c. Organize an exercise and health promotion program at the local senior citizen center. The depression rate among older adults is half that of younger people, but the presence of a physical or chronic illness increases rates of depression. Depression rates for older adults in nursing homes range from 15% to 25%; thus encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underuse the mental health system and are more likely to be seen in primary care or to be recipients of care in institutions. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

Which intervention by community mental health nurses is most likely to help prevent youth violence? a. Distributing literature that associates violence with a lack of intelligence b. Explaining to youth why youth violence is detrimental to society c. Partnering with associations to provide alternative activities that improve social skills d. Recommending increased funding to prosecute and jail teens associated with violent activity

c. Partnering with associations to provide alternative activities that improve social skills Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act.

Which finding in a young single pregnant woman would cause you the most concern? a. Elevated blood pressure b. First prenatal visit at 5 months' gestation c. Persistent homelessness d. Positive STD test

c. Persistent homelessness All these assessment findings are of concern and need attention. However, pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus being homeless is the most dangerous sign of those listed.

A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. What are the most typical reasons that a teenage girl might wait so long to come in for prenatal care? Select all that apply. a. Her friends were suggesting ways to make the problem go away. b. She knew she could not be pregnant because her boyfriend said he used a condom. c. She was afraid her parents would pressure her to terminate the pregnancy. d. She kept hoping the pregnancy would just go away. e. She was scared about the examination and what health care providers do to you. f. She was trying to keep her pregnancy a secret

c. She was afraid her parents would pressure her to terminate the pregnancy. d. She kept hoping the pregnancy would just go away. e. She was scared about the examination and what health care providers do to you. f. She was trying to keep her pregnancy a secret Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, since they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Being told that a condom was used doesn't make it so. The girl should know whether a condom was used or not without relying on verbal statements.

. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, what might the nurse suspect? a. The child is accident-prone and clumsy. b. The child is being bullied and pushed around by other children. c. The child may be a member of the 5H club. d. The child tripped, so perhaps she needs vision screening.

c. The child may be a member of the 5H club. Many American children are members of the "5H" club—they are hungry, homeless, hugless, hopeless, and without health care.

Which client would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

c. The client who is employed and often works 12 hours a day without moving from the computer desk Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.

What is the most common reason that people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear results will be positive. b. They avoid the problem (maybe it will go away). c. They don't recognize their symptoms as possibly being due to HIV. d. It is too expensive to get HIV test.

c. They don't recognize their symptoms as possibly being due to HIV. When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, "I'm sorry to bother you when you're not feeling well, but I need to ask you a few questions." What should the nurse ask? Select all that apply. a. "Do you know how you got this infection?" b. "Is the treatment working? Are you starting to feel better now?" c. "Where are you employed?" d. "Where do you usually eat?" e. "Who lives with you?" f. "With whom have you had sexual relations?"

c. "Where are you employed?" e. "Who lives with you?" f. "With whom have you had sexual relations?" The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the client's place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others.

Experts are concerned that smallpox could be used in a bioterrorist attack. What symptom might suggest smallpox as opposed to the more common and much less dangerous chickenpox? Select all that apply. a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever. e. Rash is macular and then vesicular but does not become pustular in smallpox. f. Vesicles are deep seated instead of superficial.

c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever. f. Vesicles are deep seated instead of superficial.

A student asks the college nurse how AIDS is diagnosed. The nurse's best response would be, "A diagnosis of AIDS is made when: a. "A screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test." b. "Antibodies to HIV are detected about 6 weeks to 3 months following possible exposure." c. "Antibodies to HIV reach peak levels of 1000/ml of blood." d. "CD4 T lymphocytes drop to less than 200/ml."

d. "CD4 T lymphocytes drop to less than 200/ml." AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

A client who is very upset says to the nurse, "But we always used a condom! How could I have genital warts?" How could the nurse best respond? a. "Are you positive you always used a condom?" b. "Condoms don't always work." c. "The condom might have had a tear in the latex." d. "Skin to skin contact to a wart may have occurred outside the area that the condom covers."

d. "Skin to skin contact to a wart may have occurred outside the area that the condom covers." The challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur.

During which phase of the home visit does the nurse document what was accomplished? a. Previsit phase b. In-home phase c. Termination phase d. Postvisit phase

d. Postvisit phase A major task of the post-visit phase is documenting the visit and services provided.

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do what? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions

d. Produce very severe physical reactions Virulence is the ability to produce a severe pathological reaction

A high school student is planning to volunteer at the hospital after school, so she needs to have a Mantoux test before beginning. What should the nurse tell the new volunteer? a. "I will be using tiny tines to administer the TB antigen to the skin on your arm." b. "Notify the clinic immediately if you experience any redness or itching at the test site." c. "The areas should be kept dry until you return; cover it with plastic wrap when bathing." d. "You will need to return in 2 to 3 days to have any reaction interpreted."

d. "You will need to return in 2 to 3 days to have any reaction interpreted." The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters.

. A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mom asks, "Do you think my son is crazy?" Which is the most appropriate response? a. "Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b. "Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c. "Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." d. "Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

d. "Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way." Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. With more time the nurse can help the mother deal with feelings of having a "crazy" family member and the effects of such behavior on the whole family.

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which finding on an arm would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility Erythema alone does not indicate a positive finding. For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10 mm induration would be a positive finding in an immigrant from a region with high TB infection. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

There is great concern in the nurse's community over three local cases of West Nile virus. How can the nurse best use this concern to help the community to become involved? a. Ask the state department of health for assistance b. Demand that everyone over age 65 become immunized immediately c. Encourage immunization of all children under 12 d. Have an educational campaign to remove any containers of standing water

d. Have an educational campaign to remove any containers of standing water Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather—especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites.

Which infectious disease intervention represents secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual partners. b. Clients with HIV infection are given medications to improve immunological response. c. Health care workers are encouraged to receive annual vaccinations for influenza. d. Health care workers are required to have a tuberculosis skin test or chest x-ray.

d. Health care workers are required to have a tuberculosis skin test or chest x-ray. Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest x-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection.

A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. What should the nurse do? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurse's commitment to the family and enter the home quickly. d. If personal safety is a concern, drive away and notify the family from a safer location.

d. If personal safety is a concern, drive away and notify the family from a safer location. Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

Why is health care of the homeless so expensive to the community? a. Health conditions of the homeless require increased preventive services. b. Homeless clients typically make more clinic visits for multiple health problems. c. Homeless people spread contagious diseases to those they pass on the street. d. Most care to homeless people takes place in hospital emergency departments.

d. Most care to homeless people takes place in hospital emergency departments. Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics.

What factor predisposes many migrant farmworkers to disenfranchisement? a. Being a minority group member b. Inability to attend religious services due to work requirements c. Previous experiences of physical abuse d. Short length of time in the community

d. Short length of time in the community Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds.

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. What would you expect the local medical centers to do? a. Agree to collaboratively apply for the funds in a cooperative proposal b. Individually compete eagerly for the additional funds now available c. Reach out enthusiastically to this previously underserved population group d. Strongly consider not applying, since vulnerable populations have multiple cumulative risks and will be expensive to treat

d. Strongly consider not applying, since vulnerable populations have multiple cumulative risks and will be expensive to treat Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat, since they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care).

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV-positive. Besides follow-up tests to confirm or correct that diagnosis, what other test should the nurse do immediately? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. TB Mantoux

d. TB Mantoux HIV-infected persons who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB.

What action would be helpful if the nurse wanted to empower the family of a mother with newly diagnosed breast cancer? a. Applying for emergency financial assistance on the family's behalf b. Arranging for community members to assist with child care c. Arranging for the mother to join a cancer support group d. Teaching the family how to navigate the health care system

d. Teaching the family how to navigate the health care system Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

A student engages in unprotected sex under the influence of alcohol. Having an HIV test immediately afterward seems like the rational thing to do. Based on known statistics, what will the student's HIV test probably show? a. The results will probably be negative for HIV. b. The results will probably be positive for HIV. c. The probability of disease is so low, there is no reason to be tested. d. The test results won't be reliable so soon after exposure.

d. The test results won't be reliable so soon after exposure.

A client was clearly very relieved when an HIV test came back negative. "Thank goodness. I've had sex several times without a condom, and when one of my friends said he was sick, I think I panicked." What is important to emphasize immediately before the client draws too many conclusions? a. Abstinence is the only way to be certain you are HIV-free. b. Sex should be restricted to one partner. c. The test could be wrong, and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

Why are many health care providers more afraid of getting hepatitis B than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

d. There is no treatment for HBV, which can be a very serious illness. Both HBV and HIV are blood-borne pathogens. Health care workers may be exposed to either from needle stick injuries and mucous membrane splashes. However, HBV remains alive outside the body for a longer time than does HIV and thus has greater infectivity. The virus can survive for at least 1 week dried at room temperature on environmental surfaces, and therefore infection control measures are crucial in preventing transmission. There is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease.

For what is the nurse assessing when conducting a health risk appraisal? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities

d. Unhealthy activities Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

Aggregates at high risk for having poor health outcomes because of limited resources are called: a. Disadvantaged families b. Multi-problem families c. Resilient populations d. Vulnerable populations

d. Vulnerable populations

When a nurse calls the family to set up the first home visit, what information should the nurse share? Select all that apply. a. A bit of personal information about the nurse b. Everything the nurse knows about the family c. How many visits will be planned d. The cost of the visit and how this may be paid e. The reason for the visit f. Exactly how long the visit will last

d. The cost of the visit and how this may be paid e. The reason for the visit

Some clients are reluctant to tell their primary care provider that they have tested positive for HIV. What are some legitimate reasons for this reluctance? Select all that apply. a. They are afraid the caregiver will refuse to continue providing care for them. b. They know that the care provider will be required to tell other family members. c. They know that the care provider will be required to tell other clients who use the same clinic. d. They don't trust the government's ability to keep information confidential. e. They are afraid of discrimination (jobs, housing, insurance, etc.). f. Because there are no effective treatments for HIV, there is no reason to tell.

d. They don't trust the government's ability to keep information confidential. e. They are afraid of discrimination (jobs, housing, insurance, etc.).

The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Why won't the nurse just prescribe some antibiotics as the client repeatedly requests? Select all that apply. a. Antibiotics are expensive, whereas the support measures would be almost free of cost. b. Clients cannot suggest treatments to care providers. c. Clinics cannot afford to continually give antibiotics to anyone who asks for them. d. In the midst of a flu epidemic, the supply of antibiotics is dangerously low. e. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs. f. Viral diseases are not affected by antibiotics.

e. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs. f. Viral diseases are not affected by antibiotics.