community exam 2 test bank

An older client is seeking a fourth refill on a prescription for benzodiazepines. The nurse is concerned that the client may be developing a tolerance for the drug. Which comment by the client would most confirm this concern? A) "Lately I've had to double up on my dose just for it to be effective." B) "I ran out of pills a week ago and have felt sweaty and agitated ever since." C) "I feel like I just can't function without the medicine." D) "The medicine has been wonderful. I think one more refill should do it for me."

A

Which exemplifies a nuclear family? A) First-degree relatives who live together B) First- and second-degree relatives who live together C) First- and second-degree relatives who live in the same neighborhood D) Individuals who are not blood relatives but share a common locale of origin or culture

A Feedback: Nuclear families consist of first-degree relatives—that is, two generations—who live together. Commonly, the two generations include parents and children. Extended families include both first- and second-degree relatives and can include grandparents, aunts, uncles, and cousins. Traditional definitions of extended family indicate that the family share a dwelling, but members can live in the same neighborhood or in relatively close proximity to one another. The time that an extended family spends together depends not only on geographic closeness to one another but also on family customs. Extended family can also include persons who are not blood relatives, but who share a common locale of origin or culture.

The physician approaches the client with a treatment plan for his cancer. The client states that his life is in God's hands and refuses conventional treatment. This is an example of: A) Fatalistic behavior B) Denial C) Anger D) Bargaining

A Feedback: One central facet of culture is religion, and this also directly affects health, illness, and treatment. Some religions attribute disease to divine forces, for instance. Some cultures are relatively fatalistic, which affects their health behaviors. Insha'Allah ("if God wills") is a common refrain for many Muslims, although they may mean it more or less literally. There is no evidence that the client is in denial, angry, or bargaining.

A client wants to know the best way to avoid sexually transmitted infections (STIs). The nurse should mention: A) Abstinence B) Monogamous relationship with an infected partner C) Washing the genitals after sex D) Use of latex condoms

A Feedback: Other than abstinence, a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected is the best way to avoid STIs. Sexual partners should talk to each other about their STIs so that preventive action can be taken. Prevention of STI transmission does not include washing the genitals, urinating, or douching after sex. Latex condoms can reduce the risk of transmission but only when used consistently (every time) and correctly.

Which factors place an individual at high risk for acquiring a sexually transmitted infection (STI)? (Select all that apply.) A) Having multiple sexual partners B) Using a condom during sex C) Having no other STIs D) Having a sexual partner who has had an STI E) Receiving a blood transfusion

A, D Feedback: Any person is in a high-risk group for STIs if they have multiple sexual partners, do not use a condom during sex, have other STIs, and/or have a sexual partner who has had an STD. Although once a risk for exposure to HIV, blood transfusions no longer place an individual at high risk for acquiring an STI.

A client arrives at the clinic shaky and requesting a refill on a prescription for alprazolam (Xanax). The nurse suspects that the client might be experiencing substance withdrawal. Which comment by the client would most tend to confirm your suspicion? A) "Lately I've had to double up on my dose just for it to be effective." B) "I ran out of pills a week ago and have felt sweaty and agitated ever since." C) "I feel like I just can't function without the medicine." D) "The medicine has been wonderful. I think one more refill should do it for me."

B

The nurse is caring for a client who is from a culture for which the nurse has a limited knowledge base. The nurse conducts the admission interview using cultural humility. Which should the nurse ask in the interview? (Select all that apply.) A) Yes or no questions B) About traditions C) Open-ended questions D) How the client has addressed the illness E) If the cause of the illness is spiritual

B, C, D Feedback: Cultural humility requires community health nurses to continually self-evaluate and critique their own cultural assumptions and advocate for their clients in a nonpaternalistic way. To do this, they should ask open-ended questions (not yes or no questions) about beliefs and practices of the client and family; ask about traditions; and ask what the client does think may have caused the illness and how the client has already tried to address it. Asking if the cause of the illness is spiritual is a yes or no question.

Which most accurately describes the purpose of force field analysis? A) Unfreezing the status quo B) Changing or moving to a new state C) Identifying the forces driving the change and those resisting it D) Refreezing to sustain the change or changes made

C Feedback: Force field analysis involves identifying factors within a community or organization that are driving or reinforcing change in the desired direction, as well as those that are restraining or resisting change. The change process in Lewin's model of change can be visualized as three steps of unfreezing the status quo, changing or moving to a new state, and refreezing to sustain the change or changes made.

The nurse conducts a well-child clinic in your community. The client population is culturally diverse, and, although the clinic is busy, it runs smoothly because it has an interpreter. In addition to the interpreter, it is important that the nurses treat each client that reflects his or her individual cultural needs. This is cultural: A) Bias B) Artwork C) Competence D) Beliefs

C Feedback: In nursing, cultural competence means considering cultural aspects of health, illness, and treatment for each client or community, as well as doing so at each stage of the nursing process. The nurse should not display cultural bias or favoritism to any specific culture. The nurse does not need to display the beliefs of other cultures, just a respect and understanding of them. The nurse does not need to display cultural artwork.

A 16-year-old client visits the community health clinic with concerns that she may have a sexually transmitted infection (STI). She asks whether STIs are treatable. STIs that are easily treated and curable include: (Select all that apply.) A) Human papillomavirus B) Herpes simplex C) Chlamydia D) Gonorrhea E) Syphilis

C, D, E Feedback: Infections caused by bacteria can be treated and usually cured with antibiotics, but those caused by viruses cannot be cured this way. Chlamydia, gonorrhea, syphilis—all bacterial—and trichomoniasis—parasitic are easily treated with antibiotics and cured if diagnosed early. Human papillomavirus and herpes simplex are viral infections that are not treatable.

A 50-year-old woman recently underwent a divorce and has two teenaged children. She has an associate's degree from her local community college and earns an annual salary of $22,000. Which risk factors place this woman at risk for intimate partner violence (IPV)? (Select all that apply.) A) Age of 50 years B) Education at associate's degree level C) Recent divorce D) Having two teenaged children E) Annual salary of $22,000

C, E Feedback: Risk factors include age less than 45 years, low income, lack of employment, recent separation or divorce, education at the high school (not associate's degree) level or less, and having young (not teenaged) children.

The nurse helps a client who is a victim of intimate partner violence (IPV) with safety planning. The client worries about what to do if her partner becomes violent again. A safety suggestion for the when the client is at home is for her to go to the: A) Kitchen because it is well-lit B) Bathroom because it is a small space C) Basement because there are places to hide D) Living room because there are windows

D

The nurse works with a client who is struggling with heroin addiction. Which examination should the nurse perform to screen for a comorbidity that is highly associated with substance use disorders? A) Assessment of blood glucose level B) Bone marrow aspiration C) Magnetic resonance imaging of the brain D) Mental status examination

D

A community care nurse at a healthcare agency assists in coordinating a plan for providing health services in the most cost-effective way possible to a large number of members living in the region. This work is known as: A) Case management B) Home healthcare C) Interdisciplinary collaboration D) Care management

D Feedback: Care management is the coordination of a plan or process to bring health services together as a common whole in a cost-effective way. Case management is the development and coordination of care for a selected client and family. Home healthcare is a provision of healthcare that occurs in the setting clients consider their home. Interdisciplinary collaboration is the sharing of evidenced-based practice and skills as an integration strategy with clients and families in homes and other healthcare settings.

Who is in the best position to recognize both children being victimized and children perpetrating violence? A) Pediatric primary care provider B) Parent C) School nurse D) Next door neighbor

c

Which is the first step in developing a plan for evaluating a community-level intervention? A) Determine indicators or measures to answer evaluation questions B) Decide what method you will use to collect data C) Develop evaluation questions D) Decide how you will communicate your results

C Feedback: Steps in developing a plan for evaluating a community-level intervention include the following: (1) Develop evaluation questions "focused on what happened, how well it happened, why it happened the way it did, and what the results were"; (2) Determine indicators or measures you will use to answer your evaluation questions; (3) Identify where you will find the data you need to measure your indicators and answer your questions; (4) Decide what method you will use to collect data; (5) Specify the time frame for when you will collect data; (6) Plan how you will analyze your data on the basis of the type of data you are using; (7) Decide how you will communicate your results.

A client with tuberculosis sneezes in the waiting room and infects several other clients who are sitting on the other side of the room. Which mechanism of transmission is involved in this case? A) Airborne B) Droplet C) Direct contact D) Indirect contact

A Feedback: Airborne transmission occurs when microorganisms are carried in the air in small particles, called droplet nuclei, at distances that exceed a few feet. Droplet transmission theoretically is a form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission. Therefore, droplet transmission is considered a separate route of transmission. Droplets are generated from the source person primarily during coughing, sneezing, or talking and are propelled a short distance (<3 feet) through the air and deposited on the conjunctivae, nasal mucosa, or mouth of another person. Direct contact occurs through direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person (or animal). Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen.

The nurse discusses home care options with an 85-year-old client who recently fractured her humerus in a fall in her house. She is recovering well now but says the experience has made her see that it is time for her to change her living arrangements. The client can still bathe herself and cook meals on occasion but says she would like to live where nursing care is available onsite and where communal dining and recreation options are offered. Which of the following living arrangements could the nurse recommend? A) Assisted living facility B) Independent living in a senior living facility C) Nursing home D) Apartment located near a hospital

A Feedback: Assisted living is a type of community-based care that combines quasi-independent living with the availability of nursing care onsite and through home care visits. It is generally a level of care for people who cannot live on their own, but are not yet ready for a nursing home. This type of living arrangement is different from living independently in one's own apartment, such as living in a senior living facility, in that many activities are provided communally (e.g., eating, recreation) and there is an organized effort to create a "caring community" where residents' needs are supervised and met.

The community health nurse assesses the neighborhood in which the clients live. When observing the physical environment, the nurse notes that most of the homes in the neighborhood are well kept and the children playing in the yards are wearing clean clothing. The children appear well nourished. The nurse determines that the neighborhood has little need for a well-child clinic. This assessment is based on: A) Subjective data B) Objective data C) Cognitive analysis D) Valid data

A Feedback: Community health nurses often use informal assessments, such as windshield surveys, to learn about the neighborhoods in which their clients live. These surveys involve subjectively observing the physical community on foot or through the windshield of a car. In this way, the nurse can assess the level of economic development of the community on the basis of its physical environment, educational systems, safety and transportation, health and social services, communication, and recreation. This type of assessment is not based on objective or "valid" data, as the means of the assessment are purely subjective. It also does not involve cognitive analysis.

The nurse works with 68-year-old client who is having great difficulty managing his blood glucose level. The nurse finds that the client is not following the diet that he had agreed to follow and is eating portions that are far too large. He apologizes and explains that he is grieving the loss of his wife, who died 2 weeks ago. The nurse shares condolences with him on his loss and explain that it is perfectly understandable to have trouble following a new diet while grieving. In this scenario, the nurse is using which principal approach in motivational interviewing? A) Expressing empathy B) Supporting self-efficacy C) Rolling with resistance D) Finding a discrepancy

A Feedback: Empathy is an approach to clients that involves trying to see clients' lives through their own lens and trying to think about their experiences as they would think about them. Self-efficacy is the belief on the part of the client that change is possible. In motivational interviewing, the home care nurse does not fight client resistance but "rolls with it." Home care nurses also work to develop opportunities for clients to discover discrepancies between their current behavior and what they want to accomplish through changed behaviors.

The nurse is responsible for the construction of an isolation unit during an H5N1 outbreak. The unit is designated for only those clients with a confirmed diagnosis of H5N1. Which unit would be easily adapted to client needs? A) 12-room unit with negative air pressure units B) 15-room unit with a portable supply of PPEs C) 8-room unit with four code carts D) 12-room unit with four to six air changes per hour

A Feedback: For an outbreak of H5N1, place the client in an airborne isolation room (AIR). Such rooms should have monitored negative air pressure in relation to the corridor, with 6 to 12 air changes per hour (ACH), and exhaust air directly outside or have recirculated air filtered by a high-efficiency particulate air (HEPA) filter. If an AIR is unavailable, a portable HEPA filter should be used to augment the number of ACH. Use a fit-tested respirator, at least as protective as a National Institute of Occupational Safety and Health (NIOSH)-approved disposable N-95 filtering face piece respirator, when entering the room (DHHS, 2006). The Centers for Disease Control and Prevention (CDC) has recommended nonpharmaceutical community interventions that use social distancing strategies to reduce contact between people.

The client is admitted to the hospital for new-onset hypertension and chest pain. During the admission interview you ask the client if she takes over-the-counter medications, and she states no. She adds that she routinely visits a folk healer. The nurse's response should include: A) Obtaining a list of the herbs and folk medications that are taken and notifying the physician B) Requesting the client to stop the ingestion of the folk herbs C) Calling poison control with the list of herbs and folk medications D) Encouraging the client to continue to take the herbs and folk medications

A Feedback: Just as nurses ask about over-the-counter medication use, they should also inquire, respectfully, about what other preparations or nonpharmacologic strategies their clients may be using to maintain or regain health. The list is given to the physician. It would not be appropriate to either ask the client to stop taking the herbs or to encourage the client to continue taking the herbs, as this is beyond the scope of practice of the nurse. There is no need to call poison control regarding the herbs, as they are not likely to be poisonous or even harmful.

The nurse is reviewing the sources of funding for the local community health intervention program on smoking cessation. In the federal grant proposal, the nurse elaborates on all the various local organizations and private foundations that have pledged to support the program after initial funding from the grant ends. The nurse also explains the plan for ongoing fundraising efforts for the program for years to come. With these comments, the nurse is attempting to establish which essential component of funding? A) Sustainability B) Program replication C) Clinical expertise D) Accountability

A Feedback: Sustainability is an important consideration in program planning and a key factor in grant making. Most funding agencies expect programs to give a clear and convincing plan outlining how efforts started with grant funding will be continued after the grant ends. Accountability includes regular communication about how funds were used, details of program activities, and progress toward achieving program goals. The ability to replicate or reproduce a successful program within a different community or with a new population aggregate is a test of the strength of the design of an intervention. The explanation provided in the grant request does not mention the nurse's clinical expertise.

As an advocate for leukemia research, the nurse along with many others succeeded in urging the U.S. Congress to debate and vote on a bill that significantly increases federal funding for this research. Which system level would such an intervention address? A) Upstream B) Mainstream C) Sidestream D) Downstream

A Feedback: Upstream interventions effect change at the societal, environmental, or policy level; such is the case in this scenario. Mainstream interventions effect change at the population or community level. Downstream interventions effect change at the individual level. There is no "sidestream" system level.

The nurse has recently been appointed to a community-based advisory board of an agency that is interested in providing fiscally sound, high-quality care for clients they decide will be their service population. Any profit margin that is acquired is reinvested in the operations of the home healthcare service. Which type of agency is this? A) Private/voluntary B) Hospital based C) Proprietary D) Official

A Feedback: Voluntary agencies are generally established as not-for-profit entities, although they operate with the same fiscal objectives as "for-profit agencies." A hospital-based agency is a home health agency that is not freestanding in the community but is one of many specialty services offered at a hospital setting. A proprietary agency is a home health agency that is motivated by a for-profit philosophy. Official agencies are supported by public monies that often come from taxes. The public monies can come from local, state, or federal governments.

A client arrives on the unit, diagnosed with norovirus infection from eating shellfish. The client has been vomiting repeatedly and is now severely dehydrated. Which interventions are likely to be performed for this client? (Select all that apply.) A) Starting an intravenous line for fluid and electrolyte replacement B) Encouraging the client and the client's family to practice good handwashing C) Immediate disinfecting all potentially contaminated objects and surfaces D) Isolating the client until 12 hours after the client has been symptom free E) Administering a vaccination

A, B, C Feedback: Oral hydrating solutions should be given for attacks of norovirus, and in severe cases intravenous fluid and electrolyte replacement may be necessary. At the first signs of this acute gastroenteritis outbreak, good handwashing, thorough and immediate disinfection with appropriate solutions, and isolation of sick people until 72 hours, not 12 hours, after they are symptom free are critical. There is no vaccine currently for noroviruses.

The community health nurse is reviewing guidelines for the 15-minute assessment to keep the interview focused and family centered. Which questions and considerations for the family assessment can be asked for the question "Who is part of the family?" (Select all that apply.) A) What is the nature of individuals' connections to one another? B) Does the individual live alone or have no living family members? C) What influences from the family of origin are present in daily life? D) Do members speak independently or is an interpreter present? E) What observations can be made about the interpersonal dynamics between members?

A, B, C Feedback: Questions to consider for "Who is part of the family?" include the following: What is the nature of individuals' connections to one another? Does the individual live alone or have no living family members? What influences from the family of origin are present in daily life? Questions to consider for "Who is the informant?" are as follows: Do members speak independently or is an interpreter present? and What observations can be made about the interpersonal dynamics between members?

As the occupational health nurse in a factory finds that five employees out of 30 have positive tuberculin skin test results. One employee on the 3-to-11 shift has been diagnosed with active tuberculosis (TB). She asks if this means that the whole factory has been exposed. The nurse replies that the probability of infection depends upon: (Select all that apply.) A) Concentration of infectious droplet nuclei in the air B) Duration of exposure to the infected person C) Proximity to the infected person D) The use of safety gloves by employees E) Physical exertion required in the job

A, B, C Feedback: The probability that a person who is exposed to Mycobacterium tuberculosis will become infected depends primarily on the concentration of infectious droplet nuclei in the air and the duration of exposure to a person with infectious TB disease. The closer the proximity and the longer the duration of exposure, the higher the risk of becoming infected. Close contacts are people who share the same air space in a household or other enclosed environment for a prolonged period (days or weeks, not minutes or hours) with a person with pulmonary TB disease. A suspected TB client is a person in whom a diagnosis of TB disease is being considered, whether anti-TB treatment has been started. People generally should not continue to be suspected of having TB for more than 3 months. The use of safety gloves and physical exertion on the job do not affect the probability of infection.

Which aspects of Lewin's change theory will help people visualize and create needed change? (Select all that apply.) A) Unfreezing the status quo B) Changing or moving to a new state C) Enforcing the status quo D) Refreezing to sustain the change or changes made E) Increasing restraining forces

A, B, D Feedback: In Lewin's model of change, the change process can be visualized as three steps: unfreezing the status quo, changing or moving to a new state, and refreezing to sustain the change or changes made. Force field analysis is a tool used to identify forces that enforce the status quo, not to actually enforce the status quo. The purpose of using levers of change is to increase driving forces and/or to decrease restraining forces—leverage points identified in the force field analysis.

Which are included in the five types of health risk factors that affect families? (Select all that apply.) A) Genetics B) Age C) Intelligence D) Personal health habits and lifestyle E) Environment

A, B, D, E Feedback: The five types of risk relate to: (1) genetics; (2) age; (3) biological factors; (4) personal health habits/lifestyle; and (5) environment. Intelligence is not a health risk factor.

Which are recommendations made by the World Health Organization's Commission on Social Determinants of Health (CSDH)? (Select all that apply.) A) Improve conditions under which all people are born, grow, live, work, and age B) Provide increased funding for research of genetic disorders C) Ensure more equitable distribution of power, money, and resources D) Instill a sense of personal responsibility for one's health in each person E) Expand knowledge of the social determinants of health

A, C, E Feedback: The three overall recommendations of the CSDH are to: (1) improve the conditions under which all people are born, grow, live, work, and age to minimum standards; (2) ensure more equitable distribution of power, money, and resources; and (3) expand knowledge of the social determinants of health and establish a system to measure and monitor health inequity. Recommendations did not include providing increased funding for research of genetic disorders or instilling a sense of personal responsibility for one's health in each person.

A nurse, new to the community health agency, works in a culturally diverse area of the community. The nurse is responsible for providing holistic care to clients and to be culturally competent. The health agency requires the nurse to demonstrate which competency to exhibit cultural competence? (Select all that apply.) A) Value diversity B) Adopt the client's cultural values C) Acquire cultural knowledge D) Adapt to diversity E) Speak the language of the client

A, C, D Feedback: For community and public health agencies to be culturally competent, they must do the following: have a defined set of values and principles and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally; have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of the communities they serve; and incorporate this capacity in all aspects of policy making, administration, practice, and service delivery, as well as systematically involve consumers, key stakeholders, and communities.

Which statements by a caregiver would indicate the presence of risk factors for violence and should cause the nurse to have significant concern for the safety of children? (Select all that apply.) A) "My boyfriend says that one day he'll put a bullet through my head if I don't stop nagging him." B) "My 3-year-old daughter cries when my partner and I argue." C) "My husband sometimes makes our son come into our bedroom and watch as he hits me." D) "The last time we fought, he threatened to go pull out his shotgun." E) "My husband got upset with how much our daughter was texting and took her phone away from her for a month."

A, C, D Feedback: Risk factors that indicate significant concern for the safety of the children are as follows: (1) threats to kill the caretaker, children, and/or self or fears on the part of the caretaker for the children's safety; (2) a child was physically injured in an incident in which the caretaker was the target; (3) a child was coerced to participate in or witness the abuse of the caretaker; (4) a weapon was used or threats to use a weapon were made, and the caretaker believed that there was intention and ability to cause harm. A toddler crying because of an argument and a father taking away a daughter's phone for a month are not causes for significant concern regarding the safety of the children.

The nurse is completing a lethality assessment with a female client. Which are appropriate lethality risk questions? (Select all that apply.) A) Is there a gun in your house? B) Are you using drugs or drinking excessively? C) Has your partner ever been arrested? D) What is the worst thing your partner has ever done to you? E) Do you feel that the partner is capable of hurting you?

A, C, D, E Feedback: Appropriate questions to ask a client to assess for lethality risks associated with intimate partner violence include the following: (1) Is there a gun in the house? (2) Is the woman's partner unemployed? (3) What is the worst thing the partner has ever done to the victim? (4) Does the victim feel that the partner is capable of hurting her, of carrying out his threats? (5) Has the woman's partner ever been arrested? (6) Is the woman's partner (not the woman herself) using drugs or drinking excessively?

A client is admitted to the hospital. On admission, it is noted that the client does not speak English. It will take 20 minutes for the hospital interpreter to arrive. The nurse decides to wait for the interpreter rather than relying on the client's husband. Appropriate rationales for this decision include that the interpreter is: (Select all that apply.) A) More likely to be fluent in both languages B) More likely to be familiar with the client's symptoms C) Trained in ethics and will be better at explaining cultural differences D) More likely to understand the client's needs E) More likely familiar with technical healthcare terms

A, C, E Feedback: Interpretation should never be conducted by family or friends of a client, except in emergencies. Use of family or friends as interpreters subverts privacy and confidentiality. Furthermore, professional interpreters are not only fluent in both languages and technical healthcare terms but also trained in issues of ethics and cultural brokerage. "Cultural brokerage" means mediating an interaction between people of different cultures. A broker may point out and/or explain cultural differences to the participants, in order for the parties to understand each other better. An interpreter is not more likely to be familiar with the client's symptoms or needs.

The nurse investigates a family's health routines and rituals as part of the overall family assessment. Which exemplify family health routines? (Select all that apply.) A) Siblings all brushing their teeth together before bed every night B) Parents taking their 9-month-old child to the health clinic when he has a fever C) Entering a 5K run/walk charity event each year as a family D) Taking a walk together around the neighborhood after dinner each evening E) The mother having a mammogram performed every year

A, D Feedback: Routines are observable, repetitive patterns that involve two or more family members. These patterns are repetitive and predictable. Rituals, on the other hand, are more formal, repetitive patterns that strengthen family self-image or identity. Six categories of family health routines are as follows: self-care; safety and precaution; mental health behaviors; family care; illness care; and member care giving. Siblings brushing their teeth together before going to bed every night and the family taking a walk together each evening are examples of family health routines. Taking a child in for a sick visit is not a routine because it is not repetitive or predictable. Entering a 5K as a family each year is more of a ritual than a routine. The mother having a mammogram every year is not a family routine because she does it by herself.

The case manager works with a client who has type 2 diabetes and heart disease. In this role, which actions should the nurse take in managing the client's diseases? (Select all that apply.) A) Provide weekly coaching sessions by telephone for blood glucose management. B) Supervise cardiac stress tests in the exercise room of the local hospital. C) Administer emergency insulin when the client arrives at the hospital in a diabetic coma. D) Demonstrate use of a glucose meter to the client. E) Review heart-healthy and diabetic-friendly food options with the client and his family.

A, D, E Feedback: Disease management often focuses on chronic illness such as heart disease, heart failure, diabetes, pulmonary disease, urinary incontinence, and asthma. In disease management programs, in addition to medications, there is strong emphasis on the use of telephone coaching, Internet resources, and intensive client and family teaching to advance self-care and adherence to wellness care. Recently, to help clients and families manage their health problems in an effective and efficient manner, there has been an effort to bundle disease states together in light of many comorbidity patterns. Supervising a cardiac stress test and administering emergency glucose are clinical interventions that go beyond basic disease management.

Which best illustrates systems theory? A) School systems in two different counties each setting up their own independent afterschool exercise programs B) Father being challenged to stop smoking because his daughter learned of the hazards of smoking from a smoke cessation program at her middle school C) Hospital requiring all of its nurses to wear an identification badge while on duty D) Physician in one state deciding to stop accepting Medicaid clients, while another physician in another state begins accepting Medicaid clients

B Feedback: A community is a complex system of human activity conducted within the context of the social and ecological environment. Every family, neighborhood, workplace, school, and recreational facility is itself a system with its own boundaries, rules, and purpose. These systems overlap to the extent that individual people in each family system participate in the activities or are affected by the decisions made within other systems. Social systems engage in reciprocal exchange or flows of information, energy, resources, and goods or services. Systems within the community are interdependent and interconnected. Change in one system leads to reciprocal changes in interconnected systems. The only example given above that reveals this reciprocal relationship between systems is the one in which the father, who is a member of a family system, is influenced by information learned by his daughter from an overlapping system, her middle school. The other answers reflect systems operating independently.

Which type of agency can be either profit or nonprofit? A) Private/voluntary B) Hospital based C) Proprietary D) Official

B Feedback: A hospital-based agency is a home health agency that is not freestanding in the community but is one of many specialty services offered at a hospital setting. It can be for profit or nonprofit depending on the philosophy of the hospital. Voluntary agencies are generally established as not-for-profit entities, although they operate with the same fiscal objectives as "for-profit agencies." A proprietary agency is a home health agency that is motivated by a for-profit philosophy. Official agencies are supported by public monies that often come from taxes. The public monies can come from local, state, or federal governments.

The case manager works with a 10-year-old girl who has asthma. Because the client's family has trouble affording inhalers, the case manager researches client assistance programs through which they could receive free medications. This aspect of case management is known as: A) Care management B) Advocacy C) Disease management D) Interdisciplinary collaboration

B Feedback: Advocacy is always moving the needs of clients, families, and communities to a point of awareness that will advance change and increase quality of a life and experience. Care management is the coordination of a plan or process to bring health services together as a common whole in a cost-effective way. Disease management is a system of coordinated healthcare interventions and communications for groups of people with conditions in which client self-care efforts are significant. Disease management emphasizes prevention at the secondary and tertiary level using evidence-based practice guidelines. Interdisciplinary collaboration is sharing of evidence-based practice and skills by several disciplines as an integration strategy with clients and families in homes and other healthcare settings.

The nurse is approached by the health department to investigate and assess the rise in developmental disabilities in an isolated section in the community. To begin the assessment, the nurse should gather objective data from which source? A) Client interview—aggregate data B) Internet—aggregate data C) Internet—Wikipedia D) Direct observation of the area

B Feedback: By exploring data available on the Internet, community health nurses can not only describe trends but also identify resources that address the trends and determine where gaps may exist. The aggregate data from these resources include local demographics, such as death rates, causes of death, marital status, gender, age, ethnicity, and density of the population. Depending on the purpose of the community assessment, records in health facilities may be examined. Client interviews and direct observation of the area would render subjective data, not objective. Wikipedia is not an authoritative source.

The nurse is caring for a client who refuses the food as served. He states that the food is foreign to him and will make him ill. All food must be blessed. The personal care attendant is upset by this behavior and states that the client should eat the food anyway. The client's behavior is most likely a result of: A) Psychosocial deficit B) Cultural belief C) Allergies D) Hygiene

B Feedback: Culture is how people approach the world. Culture includes language, religion, occupation, economics, art, politics, and philosophy, along with diet. The fact that the client says that the food must be "blessed" indicates a religious belief that is part of his culture. There is no evidence of a psychosocial deficit in this client, or of allergies or hygiene concerns.

During a conference after rounds, a nurse states, "They are in the United States now; you would think that they would act like us." This nurse is exhibiting: A) Cultural humility B) Ethnocentrism C) Cultural competence D) Cross-cultural nursing

B Feedback: Ethnocentrism refers to the tendency of people to view their way of doing things and their culture as superior to the cultures and ways of others. Cultural humility requires community health nurses to continually self-evaluate and critique their own cultural assumptions and advocate for their clients in a nonpaternalistic way. In nursing, cultural competence means considering cultural aspects of health, illness, and treatment for each client or community, as well as doing so at each stage of the nursing process. Cross-cultural nursing is any nursing work in which the nurse and client have different cultures.

The school nurse notifies the community nurse that there have been five confirmed cases of pertussis in the sixth-grade classes. In addition to responding to the cluster of cases, the community nurse should immediately: A) Recommend that the school be closed B) Research the vaccine compliance in the school C) Recommend that notes be sent home to the parents regarding a pertussis epidemic D) Consult with the infection control physician at the local hospital

B Feedback: Existing (secondary) data can often be used to identify the community's strengths and weaknesses, to determine assets and liabilities, and to describe, along with available community resources, the amount of disease/disability or health in a population. The data that identify the "who, what, where, and when" related to disease, disability, and exemplars of health must then be systematically organized and analyzed. In this case, the nurse should gather further data regarding the vaccination history of students in the school before initiating an intervention. If the pertussis is only affecting children who have not been vaccinated and 98% of the children in the school are vaccinated, then the nurse may focus efforts on getting those few children vaccinated who are not already. If, however, the disease is affecting children already vaccinated or if a significant number of children are not vaccinated, then the nurse might consider recommending that the school be closed, recommending that notes be sent home to the parents regarding an epidemic, or consulting with the infection control physician at the local hospital.

The nurse researches whether the community would benefit from monthly blood pressure clinics. Which system level would such an intervention address? A) Upstream B) Mainstream C) Sidestream D) Downstream

B Feedback: Mainstream interventions effect change at the population or community level, as in this scenario. Upstream interventions effect change at the societal, environmental, or policy level. Downstream interventions effect change at the individual level. There is no "sidestream" system level.

Each employee in a small community hospital is informed that he or she needs a tuberculin skin test and of the date that the test is due. The kitchen employees tell the nurse that they don't need the test and never had to have it before. The nurse should respond with: A) The test does not need to be given if you do not have client contact. B) Tuberculosis guidelines require testing of an entire healthcare setting. C) The test will not hurt; we won't fire you if you test positive. D) The tuberculosis guidelines state kitchen workers are at risk.

B Feedback: The 2005 tuberculosis (TB) infection control guidelines emphasize actions to maintain momentum and expertise needed to avert another TB resurgence and to eliminate the lingering threat to healthcare personnel, which is mainly from clients or others with unsuspected and undiagnosed infectious TB disease. A sample recommendation is that the term "tuberculin skin tests" be used rather than purified protein derivative. The scope of settings in which the guidelines apply has been broadened to include laboratories and additional outclient and nontraditional healthcare settings. These recommendations also apply to an entire healthcare setting rather than to areas within a setting.

There are several approaches to family assessment that use particular concepts that nurses typically encounter in practice. These models provide an organized framework with which to conduct a family assessment. Which is the aim of the family assessment in the Life Span Development approach? A) To identify family routines and rituals that could influence family health B) To identify family health practices within a social and historical context C) To assess health patterns in 11 areas of family health D) To engage the family as a way to identify its strengths, with attention to family dynamics and concerns related to health and illness

B Feedback: The aim of family assessment in the Life Span Development approach is to identify family health practices within a social and historical context. The aim of family assessment in the Rituals and Routines approach is to identify family routines and rituals that could influence family health. The aim of family assessment in the Functional Health Patterns approach is to assess health patterns in 11 areas of family health. The aim of family assessment in the Family Systems approach is to engage the family as a way to identify its strengths, with attention to family dynamics and concerns related to health and illness.

Ten documented cases of West Nile virus (WNV) have occurred recently in the community. To reduce the transmission of the virus, the nurse should educate the members of the community to: (Select all that apply.) A) Avoid contact with birds B) Avoid contact with mosquitoes C) Avoid those with a confirmed diagnosis D) Eliminate standing water E) Avoid exposure to the environment during the daylight hours

B, D Feedback: WNV virus is not transmitted from person to person but from mosquito to person. No isolation precautions are indicated other than standard precautions. The Centers for Disease Control and Prevention (CDC) guidelines emphasize avian, animal, mosquito, and human WNV surveillance, along with control and elimination of mosquito breeding sites such as standing water in flowerpots, buckets, and old tires. The CDC recommends using an insect repellent such as DEET (N, N-diethyl-m-toluamide) or picaridin when outdoors, following the directions on the package. Because mosquitoes are most active at dusk and dawn, in addition to an insect repellent, people should wear long sleeves and pants when outdoors during these hours. Screens on windows and doors will keep mosquitoes out.

Select the examples of social marketing. (Select all that apply.) A) Ad campaign for a new brand of toothpaste B) Brochure placed in obstetricians' offices promoting the benefits of breastfeeding C) Infomercial on television presenting the advantages of a piece of exercise equipment D) Billboard illustrating the dangers of texting while driving E) Posters placed in college dormitories encouraging condom use

B, D, E Feedback: Social marketing is the use of marketing principles and practices to change health behaviors or beliefs, social or cultural norms, or community standards to improve health or benefit society. Examples include the use of social marketing to promote health behavior change related to eating fruits and vegetables (5 a day), breastfeeding, active play by children, and following guidelines for cancer screenings. It has also been used to change social and cultural norms related to smoking, texting while driving, condom use, and consumption of trans fats. An ad campaign for a new brand of toothpaste and an infomercial on a piece of exercise equipment are examples of commercial marketing, as they are for profit and intended to help sell a particular product.

Many in the community have developed cancer. The EPA has discovered a leak of biohazardous waste from a local factory that has leached into the water table. The area is decontaminated and cleaned. The community identifies the need for a local hospice for those with cancer who are dying. Area communities participate in the fund drive. This type of community effort may best be described as: A) Geopolitical community B) Epidemiologic model C) Community of solution D) Developmental model

C Feedback: A community of solution is formed by an aggregate specifically to address health concerns within a particular area. Communities of solution are composed of persons not only from the area of need but also members of neighboring communities who have a vested interest in a challenge the community faces. These communities can form in response to a health threat, such as contaminated water or industrial air pollution. A geopolitical community is a group of people who live within identified boundaries and governing systems. An epidemiologic model is a process used to assess a community using data collected from descriptions and statistical relationships to evaluate the level of health and well-being within a community to address identified healthcare needs. A developmental model is a retrospective, historical analysis of system parameters such as the physical environment, education, safety and transportation, politics and government, health and social services, communication, economics, and recreation in a community.

The nurse recently took a position in a national chain of home healthcare agencies directed at caring for clients who are on home hemodialysis. The services provided are often paid for privately by families, and any profit margin is used to benefit the owner of the agency. Which type of agency is this? A) Private/voluntary B) Hospital based C) Proprietary D) Official

C Feedback: A proprietary agency is a private agency that plans to and wants to make a profit. It can be part of a local, national, or international chain of home healthcare agencies directed toward any group of clients with particular healthcare problems or challenges. A voluntary agency is generally established as a not-for-profit entity, although it operates with the same fiscal objectives as "for-profit agencies." A hospital-based agency is a home health agency that is not freestanding in the community but is one of many specialty services offered at a hospital setting. Official agencies are supported by public monies that often come from taxes. The public monies can come from local, state, or federal governments.

The community health nurse has limited time for family assessments because of demanding caseloads or staffing shortages. Using your knowledge that focused family interviews of 15 minutes or less can yield a wealth of information, which is an example of an activity that will acknowledge the family's strengths? A) Ask family members if they see an area that could be changed B) Allow everyone present to voice observations, insights, or concerns before offering how they could change the situation C) Share any genograms and ecomaps that illustrate relationships with family members D) Collaborate with the family to set priorities, plan care, and evaluate goals

C Feedback: Acknowledge the family's strengths by sharing any genograms and ecomaps that illustrate relationships with family members. Avoid offering advice prematurely by allowing everyone present to voice observations, insights, or concerns before offering how they could change the situation and asking family members if they see an area that could be changed. Plan goals and outcomes with the family by collaborating with the family to set priorities, plan care, and evaluate goals.

The nurse assesses a client in the local neighborhood clinic. He exhibits signs and symptoms of tuberculosis (TB) yet has a negative tuberculin skin test result. The nurse suspects that the physician may further test the client because he: A) Visited Central America recently B) Is recovering from jet lag C) Is HIV positive D) Works in a factory setting

C Feedback: Active TB infection is characterized by a chronic productive cough, low-grade fever, night sweats, and weight loss, along with a positive purified protein derivative (PPD) tuberculin skin test result. People with active TB are contagious. However, certain people who are anergic (lack an immune response to an antigen) may not have a positive PPD (e.g., persons with HIV). Having visited Central America recently, recovering from jet lag, and working in a factory setting would not produce a false negative result on the tuberculin skin test.

A man who lives in a homeless shelter is diagnosed with active tuberculosis (TB). The shelter keeps a list of those who are assigned beds, and the majority of those sleeping there are regulars. Which finding would indicate a positive tuberculin skin test result using a two-step process? A) 4-mm induration B) 2-mm induration C) 6-mm induration D) 3-mm induration

C Feedback: All high- and medium-priority contacts who do not have a documented previous positive tuberculin skin test result or previous TB disease should receive a baseline purified protein derivative (PPD) tuberculin skin test. The reaction to the intracutaneously injected PPD tuberculin skin test is the classic example of a delayed (cellular) hypersensitivity reaction, which induces induration. Induration of ≥ 5 mm is considered a positive result in people who have an initial induration of 0 mm.

The community health nurse is assessing stressful life events in a family. Which exemplifies a life event related to illness and family care strains? A) A history of police reports of a 23-year-old man's hitting his girlfriend B) A couple in their 40s divorcing C) A 63-year-old woman's sense of responsibility as the oldest among her siblings for taking care of her chronically ill parents D) A 35-year-old woman not speaking to her sister for 5 years after not being invited to her wedding

C Feedback: An example of illness and family care strains is the responsibility an oldest sibling feels to care for chronically ill parents. An example of family legal violations is domestic violence or child abuse. An example of marital strain is divorce or decreased sexual intimacy. An example of intrafamily strains is a family feud in which two sisters refuse to speak to each other.

The nurse prepares community program objectives that are specific, measurable, achievable, relevant, and time bound (SMART) to help in planning interventions and establishing measurement systems to evaluate programs and outcomes. Which is a measurable objective? A) Program will reduce teenage obesity. B) Fewer teens will start smoking. C) Blood pressure for children aged 12 to 18 years in Marks School will be reduced by 5% after petting the dog for 1 day in March 2019. D) Number of older minority residents in Legacy Independent facility receiving a flu shot will triple.

C Feedback: Blood pressure for children aged 12 to 18 years in Marks School will be reduced by 5% after petting the dog for 1 day in March 2019 is an example of a measurable objective. The other objectives listed are not SMART objectives because the results are not measurable. The objective on teenage obesity should specify by what percentage or in how many teenagers obesity will be reduced and the minimum acceptable amount it will be reduced to, as well as from which population. The objective on teen smoking should specify how many fewer teens will start smoking and from which population. The objective on flu shots should define "older" and "minority" so that the exact population intended can be accurately identified and thus it can be determined at what point the number has "tripled."

The nurse is scheduling a follow-up appointment for a client who recently immigrated from Nicaragua. The client agrees to a 9:00-AM appointment on the following Wednesday. The nurse should anticipate that on the following Wednesday, this client will: A) Show up half an hour before the scheduled time B) Not return at all for the follow-up appointment C) Arrive late for the appointment, after completing whatever tasks the client feels need to be accomplished first D) Arrive exactly on time

C Feedback: Differences in how people view time can create a clash of expectations in clinical encounters. For Anglo-American culture, for instance, time is thought of as linear and perishable. This is especially true in the healthcare world, in which time is considered a scarce commodity. In contrast, a Hispanic immigrant may view 10:00 AM as a suggested time for a clinic appointment and will arrive when other responsibilities are accomplished.

A client presents with several ulcerative sores on his penis that are firm, round, and painless. He also has rough, reddish brown spots on his palms and the bottoms of his feet. He acknowledges that he is sexually active with multiple partners and is inconsistent in his use of a condom. Which sexually transmitted infection should the nurse most suspect in this client? A) Gonorrhea B) Chlamydia C) Syphilis D) Human papillomavirus

C Feedback: Syphilis is primarily indicated by ulcerative sores occurring mainly on the external genitals, vagina, anus, or in the rectum, although they can occur on the lips or in the mouth. The sore is usually firm, round, and painless. Rashes associated with secondary syphilis appear as rough, red, or reddish brown spots both on the palms of the hands and/or the bottoms of the feet. Infections with Neisseria gonorrhoeae, like those resulting from Chlamydia trachomatis, cause several clinical syndromes including urogenital, pharyngeal, and rectal infections in males and females, and conjunctivitis in adults and neonates. Chlamydia is known as a "silent" infection because most infected people are asymptomatic and lack abnormal physical examination findings. Men who are symptomatic typically have urethritis, with a mucoid or watery urethral discharge and dysuria. A minority of infected men develop epididymitis (with or without symptomatic urethritis), presenting with unilateral testicular pain, tenderness, and swelling. Human papillomavirus infections, if manifest, are primarily indicated by genital warts.

The nurse works with a female client who recently developed an infection of Staphylococcus aureus while in the hospital. In this case, S. aureus is which component in the chain of infection? A) Host B) Environmental reservoir C) Agent D) Portal

C Feedback: The agent, or the microbe that causes the disease, is the "what" of the epidemiologic triangle. The host, or the organism that is harboring the infectious agent, is the "who" of the triangle. The environment, which includes those external factors that cause or allow disease transmission, is the "where" of the triangle. Other necessary elements include a portal of exit from the host, environmental reservoirs, transmission, and a portal of entry to a new host.

A client, diagnosed with hypertension, is prescribed a no-added-salt, low-fat diet. He agrees and repeats the teaching principles. At the next visit, the nurse notices salted meat on the counter and the client shows the nurse his food diary. The diet in the past week does not reflect the physician's orders. What cultural component may have contributed to the noncompliance with the diet order? A) Diet may be too lean B) Wife cooks according to the husband's preferences C) Diet may not meet the cultural criteria for food choices D) Food tastes bland and unappetizing

C Feedback: What and how people eat varies tremendously among cultures, the understanding of which is crucial to good nursing care. A nurse educating a client who is newly diagnosed with diabetes or hyperlipidemia about dietary restrictions will be much more effective if he or she chooses examples that resonate with that particular client. Although the diet could be too lean or bland and unappetizing or the wife might cook according to the husband's preferences, these are not cultural components.

Which type of assessment considers a configuration of behaviors that occur sequentially over time? A) Asset-based assessment B) Epidemiologic model C) Collaborative model D) Functional health pattern

D Feedback: Functional health pattern (FHP) assessment may be used for individual, family, or community assessment. It involves a systematic and deliberate format and considers a configuration of behaviors that occur sequentially over time. Understanding community patterns provides insight into how groups respond to problems and take action. A key factor of the asset-based assessment model is building coalitions and active partnerships with the community during the assessment phase. Collaboration with community members shifts the focus from dependency on experts to empowerment of all, working together toward a goal. An epidemiologic model is a process used to assess a community using data collected from descriptions and statistical relationships to evaluate the level of health and well-being within a community and to address identified healthcare needs. A collaborative model of assessment involves nurses, social workers, and other public health experts working with each other and with community residents to assess the community in an interdisciplinary manner.

The community health nurse is using a genogram to aid in the family assessment. What aspect of family connections and relationships is included in the genogram? A) Influence of other systems on families B) Influence of groups on families C) Family relationships and their vital connections D) Relationships across two or more generations

D Feedback: Genograms are diagrams that show relationships across two or more generations. Ecomaps outline the influence that other systems or groups have on families. They illustrate family relationships and show vital connections, which can include religious, work, cultural, or social groups.

Four employees at a local restaurant have positive purified protein derivative (PPD) tuberculin skin tests and have been diagnosed with latent tuberculosis (TB) infection. Which employee would be at the greatest risk for contracting active TB disease? A) Works two jobs B) Vacations in South America C) Cooks the food D) Takes immunosuppressants

D Feedback: In many people who have latent TB infection, the Mycobacterium tuberculosis bacteria remain inactive for a lifetime without causing active TB disease. But in other people, especially those who have weak immune systems, the bacteria become active and cause TB disease. Working two jobs, vacationing in South America, and cooking food would not put one with a latent TB infection at greater risk for contracting active TB disease.

The student-nurse discusses transmission that involves contact of a susceptible host with a vehicle. Based on the chain of infection links, which exemplifies a vehicle? A) Animals B) Insects C) Reptiles D) Water

D Feedback: Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen. Vehicles also include food, water, and contaminated hands that are not washed. Indirect contact also includes vector transmission. Vectors are animal or insect carriers of infectious agents.

Which is a relationship risk factor for intimate partner violence? A) Emotional dependence and insecurity B) Belief in strict gender roles C) Desire for power and control D) Unhealthy family interactions

D Feedback: Individual risk factors for intimate partner violence include emotional dependence and insecurity, belief in strict gender roles, and desire for power and control. Relationship risk factors include unhealthy family relationships and interactions.

A client is fearful of being infected with the Ebola virus. To which reliable source of family risk reduction information should this client turn? A) A report from the client's neighbor whose daughter was recently infected with the Ebola virus B) Information the client's wife reported from a newspaper article about the Ebola virus that she read C) Data from an Internet site that the client's daughter conveyed D) A conversation the client has with his healthcare provider

D Feedback: Information the client gains from a conversation with his healthcare provider would be the most reliable, as the other sources are informal and secondhand. In informal settings, family members may receive inaccurate information about risk reduction, primarily because people interpret risk reports at their level of understanding (i.e., their own level of education or the level of information given). In fact, family members often hear ambiguous reports or interpretations about how someone became disabled or ill or died.

The case manager for a 12-year-old boy who is obese and prediabetic. To help the client develop a diet that will promote weight loss and control of his glucose level, the case manager decides to consult with a dietician, who provides several current journal articles that present findings on various diets. This aspect of case management is known as: A) Care management B) Advocacy C) Disease management D) Interdisciplinary collaboration

D Feedback: Interdisciplinary collaboration is sharing of evidence-based practice and skills by several disciplines as an integration strategy with clients and families in homes and other healthcare settings. Advocacy is always moving the needs of clients, families, and communities to a point of awareness that will advance change and increase quality of a life and experience. Care management is the coordination of a plan or process to bring health services together as a common whole in a cost-effective way. Disease management is a system of coordinated healthcare interventions and communications for groups of people with conditions in which client self-care efforts are significant. Disease management emphasizes prevention at the secondary and tertiary level using evidence-based practice guidelines.

Preventing intimate partner violence (IPV) and recurrence of violence requires targeting efforts at all three levels of prevention: primary, secondary, and tertiary. Which is a tertiary prevention strategy? A) Adding a question to the standard health history form that asks whether the client is currently experiencing abuse B) Putting up posters around the health provider's office that give tips on what to do if one is in an abusive relationship C) Screening a woman for evidence of abuse who has several risk factors for IPV D) Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him

D Feedback: Primary prevention includes screening and prevention efforts that target the general population. Secondary prevention occurs through generalized screening and inquiry with high-risk populations. Tertiary prevention involves caring for victims affected by or currently experiencing violence. Adding a question to the standard health history form and putting up posters are examples of primary prevention, as they are aimed at the general public. Screening a woman for evidence of abuse who has several risk factors for IPV is an example of secondary prevention. Providing help to a woman who is being abused is an example of tertiary prevention.

The nurse admits a client to the hospital with the diagnosis of Escherichia coli O157:H7. The client is dehydrated and febrile. During the history phase of the admission, the client states that he doesn't know how he could have gotten sick at the local county fair—the hamburger he bought was well done. Upon further discussion, the nurse suspects the transmission may have occurred because of: A) Use of a gas barbecue B) Improper cleaning of the cooking tools C) Use of wood instead of charcoal to cook the meat D) Animals roaming in the fair grounds

D Feedback: Recent cases of hemolytic-uremic syndrome (HUS) have been associated with outbreaks of E. coli O157:H7 infections, which were apparently caused by contact with animals in public settings, including fairs, farm tours, and petting zoos. Experience from these and previous outbreaks underscores the necessity for adequate control measures to reduce zoonotic transmission. The Centers for Disease Control and Prevention has developed standardized recommendations for public health officials, veterinarians, animal exhibitors, and visitors to animal exhibits; it established that hand washing is the single most important prevention step for reducing the risk for disease transmission. Other critical recommendations for venues with animals are the inclusion of transition areas between animal and nonanimal areas (e.g., where food is sold) and proper care and management of animals in public settings. Use of a gas barbecue, use of wood instead of charcoal to cook meat, and improperly cleaned cooking tools are not associated with E. coli infection.

International health experts indicate that the avian flu is the virus most likely to cause the next pandemic. What may improve its transmissibility to the public? A) Increase in consumption of chicken B) Increase in autoimmune disease incidence C) Shift to zoonotic transmission D) Antigenic shift

D Feedback: The H5N1 virus can improve its transmissibility among humans by two mechanisms. The first is antigenic shift, a "reassortment" event, in which genetic material is exchanged between human and avian viruses during coinfection of a human or an animal such as a pig. Reassortment could result in a fully transmissible pandemic virus, which could rapidly spread throughout the world. The second mechanism is a more gradual process of antigenic drift, an adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Nearly all of the human infections with H5N1, which are the largest documented since its emergence in humans in 1997, were a result of people having direct or close contact with infected poultry or contaminated surfaces, but not a result of consuming chicken. An increase in incidence of autoimmune diseases, which involve one's own immune system attacking the body, is not related to the spread of avian influenza and would not lead to a pandemic. The avian flu is already transmitted primarily in a zoonotic manner, so any shift in transmission would be to human-to-human transmission, which would be more likely to cause a pandemic than zoonotic transmission.

The home health nurse has to ensure that a safety plan is in place to address falls. Using knowledge that 55% of fall-related injuries occur with falls inside the home, a total of more than 60% of these falls occur in which two rooms? A) Living room and hallway B) Kitchen and bathroom C) Hallway and bedroom D) Living room and bedroom

D Feedback: The most common rooms where people fall include the living room (31%), bedroom (30%), kitchen (19%), bathroom (13%), and hallway (10%).

Which is a societal risk factor for intimate partner violence? A) Experiencing poor parenting B) Marital instability C) Unwillingness of neighbors to intervene when violence is witnessed D) Traditional gender roles

D Feedback: Traditional gender roles is a societal risk factor, as it is primarily determined by the society one lives in, rather than by individual characteristics, relationship dynamics, or even local community factors. Experiencing poor parenting is an individual risk factor. Marital instability is a relationship factor. Unwillingness of neighbors to intervene when violence is witnessed is a community factor.

The nurse assesses a 77-year-old woman who has been caring for her husband who has Alzheimer disease in their home for the past 8 years. The client complains of exhaustion and depression. Which stressors should the nurse most suspect as the cause of this client's symptoms? A) Marital strain B) Caregiver burden C) Spillover D) Interfamily strain

D Feedback: Whether caring for an elder who is homebound or a child with a disability, caregiver burden has been well documented in the literature as a significant stressor on the family member who assumes primary responsibility for care. In most cultures, women (mothers, wives, sisters, daughters, or female in-laws) have assumed this role, usually by default. Caregiver burden is a significant issue for families because it can cause the development of physical or emotional illness in the caregiver over time. Marital strain is a term that describes how couples manage tensions and promote intimacy as opposed to create negativity (strain) in conflict resolution (Gottman, 1994). Defensiveness, criticism, contempt, and withdrawal erode trust in many relationships. Spillover describes the relationship between work and family—that is, requirements in different roles are similar, or fulfillment is sought in one role because of lack of gratification in others. Caregiver burden is considered intrafamily strain, which is the effect of stressors on families that make members less sensitive and loving to each other (not "interfamily strain").