Community Nursing Exam #2

The ANA Standards of Home Health Nursing Practice is composed of two parts: Standards of Care, which follow the six steps of the nursing process, and Standards of Professional Performance, which include which of the following? (Select all that apply.) a. Quality of care b. Performance appraisal c. Collegiality d. Outcome identification e. Resource use

A: quality of care B: performance appraisal C: collegiality E: resource use The ANA scope and standards publications, including those for Home Health Nursing and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance. Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, critical thinking skills, education, collegiality, ethics, collaboration, research, and resource use.

What does the nurse understand when considering whether a geographic area is rural or urban? a. Rural and urban areas occur on a continuum. b. Rural regions have fewer than six persons per square mile. c. Rural residents feel isolated. d. Rural areas are recreational communities.

A: rural and urban areas occur on an continuum Rural and urban residencies are not opposing lifestyles. Rather, they occur on a rural-urban continuum ranging from living on a remote farm, to living in a village or small town, to residing in a larger town or city, to living in a large metropolitan area with a core inner city.

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

B: heart disease Heart disease is the leading cause of death for both men and women.

With use of the Intervention Wheel, identify the examples of community-level, systems-level, and individual-level practice within Sousa County.

Community-level practice occurred through Sousa County's social marketing campaign. Systems-level practice was applied in checking with local nursing homes that the vaccine was available and was being offered to residents. Individual-level practice was seen in individual health teaching that conveyed information about the risks of contracting influenza and stressed the importance of yearly vaccinations.

During an Individuals with Disabilities Education Act (IDEA) screening to detect mental or psychological conditions in young school-age children, a child is identified as having a cognitive disability. The school nurse should now consider this child to be at greatest risk for which potential problem? a. Abuse or neglect b. Age-inappropriate friendships c. Embarrassment d. Physical inactivity

A: abuse or neglect Individuals with disabilities are more likely to experience some form of abuse or neglect during their lifetime compared with individuals without disabilities. While all individuals with disabilities are at risk for abuse and neglect, children, the elderly, and women are at particular risk.

The National Association of School Nurses (NASN) and standards of practice for school nurses set forth which of the following principles? (Select all that apply.) a. School nurses should have a bachelor's degree in nursing and a specialty certification. b. School nursing uses the nursing process. c. Credentialing is recommended but not required. d. American Academy of Pediatrics governs the school nurse's practice. e. School nurses must ensure the safety of the children, including when delegating care.

A: school nurses should have a bachelor's degree in nursing and a speciality certification B: school nursing uses the nursing process E: school nurses must ensure the safety of the children, including when delegating care In reality, the educational preparation of school nurses ranges from associate to master's degrees. However, the NASN, the professional organization for school nurses, recommends that school nurses be registered nurses with a bachelor's degree in nursing and specialty certification as a school nurse. The NASN identifies eight criteria for schools nurses in providing care. One of these criteria is ensuring the safety of the children, including when delegating care.

From August through May, an inner city school district provides primary health care services, including mental health and dental care, to children and youth. This is a specific example of which of the following? a. Child health improvement program b. Primary care clinic c. School-based health center d. School health system

C: school-based health center Because many children may not receive health care services other than screening and first aid care from the school nurse, the federal government began funding school-based health centers. School-based health centers are family-centered, community-based clinics run within schools. These clinics provide expanded health services, including mental health and dental care, as well as the more traditional health care services like primary care. They can be small or large and may provide services during the school year, during certain hours throughout the year, or 24/7 all year.

Collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? a. Public health departments do not have the resources to accomplish these goals independently. b. The federal government is ultimately responsible for the health status of the nation. c. The public demands that the government protect the people. d. State health agencies must take a universal approach to achieving objectives.

C: the public demands that the government protect the people Partnerships and collaboration among groups are much more powerful in making change than the individual client and PHN working alone. Because public health departments do not have the resources to accomplish the Healthy People 2020 goals independently, collaboration is essential to quality public health nursing practice, and collaboration with existing groups at the local level is encouraged. New partnerships are formed related to specific goals. Communities develop coalitions to address selected objectives, based on community needs that include all of the local community stakeholders, such as social service; mental health; educational, recreational, and governmental agencies and institutions; as well as businesses.

After establishing trust with a homeless LGBTQ youth, what assessment by the nurse takes priority? a. Immunization status b. Nutrition c. STD screening d. Trauma screening

D: trauma screening Some 60% of homeless LGBQ youth and 75% of homeless transgender youth have experienced physical, sexual, or emotional abuse, and 10% of LGBQ and 25% of transgender youth reported intimate partner violence. While all options are important, the priority is trauma screening so that the nurse can use trauma-informed care with the client.

Provide a public health nursing diagnosis for the above scenario. What population is at risk? What prevention level is being applied?

Diagnosis: Persons older than age 65 years are at risk of illness because of the influenza season. Population at risk: Persons older than age 65 years constitute a vulnerable population for serious complications from influenza. Prevention level: The primary level is being applied, because the Health Department is giving vaccines to keep at-risk individuals from getting sick as the result of influenza.

Describe how the Sousa County Health Department nurses applied the following interventions: outreach, health teaching, and social marketing.

Outreach was practiced when the Health Department identified the at-risk populations and provided information about the flu and what can be done to prevent it. Health teaching was employed when the nurses communicated facts about the influenza vaccination through verbal and written advertisements, as well as through face-to-face contact with individuals. Social marketing was applied when information was shared over the radio, on billboards, and in newspaper articles to promote the social norm that at-risk populations need to receive the influenza vaccine each year.

Which of the following best represents the concept of homelessness as transitional? a. Man with chronic alcoholism and drug abuse living in a halfway house b. Recently unemployed man evicted from his apartment c. Teenager living on the streets and abusing drugs d. Woman with schizophrenia who is living in a shelter

B: recently unemployed man evicted from his apartment Transitional homelessness is typically caused by a catastrophic event, such as job loss or serious medical condition, which necessitates a short shelter stay, eventually transitioning to permanent housing.

A nurse is planning a training session for a new group of disability determination workers regarding the leading causes of severe disabilities in U.S. adults. What topics will the training address? (Select all that apply.) a. Arthritis b. Back problems c. Obesity d. Heart disease e. Lung disease f. Occupational injury

A: arthritis B: back problems C: obesity D: heart disease Arthritis is the most common cause of disability in this country. Back problems are one of the top problems that lead to years lived with disability. Heart disease is another common cause and are the consequences of obesity.

Several faith communities are jointly operating and staffing a food pantry for community members in need that coordinates assistance with the local health department's Women, Infants, and Children program. The faith community nurse in one of the faith communities coordinates the overall partnership and the care teams to staff the project. This best demonstrates which role of the parish nurse? a. Coordinator b. Integrator of faith and health c. Health educator d. Personal Health counselor

A: coordinator Health care systems employ faith community nurse coordinators, who facilitate different arrangements with several faith communities of varying backgrounds. Practices in which several faith community nurses are supervised by a coordinator have built-in opportunities for networking, partnering, and mentoring.

To develop effective nursing interventions, the nurse should evaluate clients and populations in which context? a. Environment b. Improvement of status c. Human dignity d. Nursing theories

A: environment Nurses should evaluate clients and populations in the context of the environment to develop effective nursing interventions. Care must be multidimensional and should include consideration of biological, psychological, social, political, cultural, environmental, economic, and spiritual factors.

A nurse is designing a tertiary prevention intervention to address the leading cause of school absences related to chronic illness. Which illness does, the school nurse focus on? a. Asthma b. Attention-deficit hyperactivity disorder c. Diabetes mellitus d. Digestive system problems

A: asthma Asthma is the leading cause of children's absence from school as a result of a chronic illness. Children may be hospitalized with an asthma attack or have been recently discharged from the hospital to home. Asthma may be caused by allergic triggers with which the child comes into contact in the school, such as chalk dust, mold/mildew, or pet dander. There may also be concerns about the air quality in the school or specific classroom activities. The nurse can help students with asthma through medication administration, coaching in asthma management, and education of the student, teachers, other children, and parents.

A nurse practicing in a faith community engages in behaviors that support this practice mission. What activities does this nurse participate in? (Select all that apply.) a. Attend a weekend retreat focusing on developing one's faith. b. Be intentional about taking care of him- or herself. c. Find a faith community nurse to serve as a support system. d. Take time away to refresh and rejuvenate occasionally. e. Teach classes on self-help for overcoming spiritual distress.

A: attend a weekend retreat focusing on developing one's faith B: be intentional about taking care of him or herself C: find a faith community nurse to serve as a support system D: take time away to refresh and rejuvenate occasionally To sustain oneself as a faith community nurse who provides spiritual care to support individuals, families, and communities in the healing and wholeness process, the nurse must be intentional about self-care, spiritual formation, and renewal.

According to the Home Health Care Scope and Standards, which should be the minimum requirements for entry into home care practice? a. Baccalaureate in nursing b. Baccalaureate in nursing and clinical nurse specialist (CNS) certification c. Master's in nursing d. Master's in nursing and CNS certification

A: baccalaureate in nursing Nurses come to home care from a variety of educational and practice backgrounds. Home care nurses should be educated to function at a high level of competency so that they can be relied on not only by their professional colleagues but also by the community. According to the ANA's Home Health Care Scope and Standards, a baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting, including home care.

A nurse manager for a community health agency is teaching the staff ways to promote effective interprofessional collaboration. What strategies does the manager teach? (Select all that apply.) a. Be on time. b. Communicate in lay terms. c. Feel confident in your abilities. d. Know what other professionals do. e. Understand role theory.

A: be on time B: communicate in lay terms C: feel confident in your abilities D: know what other professionals do E: understand role theory All options are strategies to promote interprofessional collaboration.

Public health nurses (PHNs) understand what information about health disparities? (Select all that apply.) a. Access to health care is a driver of unequal outcomes. b. Data comes only from government agencies. c. Economics does not influence disparities. d. Having good insurance decreased disparities. e. Minorities have poorer outcomes overall.

A: access to health care is a driver of unequal outcomes E: minorities have power outcomes overall Health disparities such as lack of access to health care and lower quality care for certain populations drives unequal health outcomes for white people and people from ethnic and racial minorities, despite economic or insurance status.

According to Ziebarth (2016), what are the five essential attributes of faith community nursing? (Select all that apply.) a. Accessing health care b. Coordinating c. Disease managing and health promoting d. Empowering e. Faith integrating

A: accessing health care B: coordinating C: disease managing and health promoting D: empowering C: faith integrating Ziebarth in 2016 identified five essential attributes of faith community nursing to include: (1) faith integrating, (2) disease managing and health promoting, (3) coordinating, (4) empowering, and (5) accessing health care.

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

A: addressing the diabetic epidemic involves more than a focus on individual factors C: complications and mortality rates are highest among low-income and minority groups D: selection of healthy food options is both an availability issue and an eduction issue Diabetes is a serious public health problem and is epidemic in the United States. One in 12 adults in the United States has diabetes, and for every three people who have been diagnosed with diabetes, there is another who does not know he or she has it. Research supports the importance of also addressing social and economic factors related to health and well-being when treating diabetes. These social determinants of health include the characteristics of clients' communities, such as income distribution, educational level, and segregation. This broader perspective also includes attention to policies that affect the availability of healthy foods.

The school nurse is present during an assault by an active shooter. After the crisis is over, what actions by the nurse are most appropriate? (Select all that apply.) a. Arrange for grief counseling services in the school. b. Conduct regular assessments for anxiety and post-traumatic stress. c. Evaluate the school's response to this emergency. d. Prescribe medication for anxiety or depression. e. Provide open routes of communications with all involved.

A: arrange for grief counseling services in the school B: conduct their regular assessments for anxiety and post-traumatic stress E: provide open routes of communication with all involved After a disaster of any kind, the school nurse would provide or arrange for grief counseling, conduct regular assessment for anxiety, fear, depression, and post-traumatic stress disorder, and maintain open communication with students, staff, and parents.

A nurse is planning a women's screening program to detect the presence of the leading causes of disease burden for women in the United States. What items would the nurse include in the program? (Select all that apply.) a. Blood pressure b. Depression c. Usual diet d. Sexually transmitted diseases e. Smoking

A: blood pressure C: usual diet E: smoking Chronic disease has become a public health problem of great proportions with the most common and costly chronic diseases being heart disease, diabetes, stroke, cancer, and arthritis. Chronic disease is the leading cause of preventable deaths, disability, and decreased quality of life. Heart disease is the leading cause of death for both men and women. Uncontrolled hypertension leads to heart attack, stroke, kidney damage, and a host of other complications and only two thirds of people with hypertension are aware that have high blood pressure because there are no associated symptoms. Cancer is the second leading cause of death in the United States. Early screening and detection, promotion of healthy lifestyles, expanding access to services, and improving cancer treatments will help reduce the burden of cancer and disparities. Overweight and obesity are topics addressed numerous times in Healthy People 2020 because of their link to many chronic health diseases (risk factor for diabetes and heart disease). A dietary assessment, along with physical and psychological assessments, helps nurses to identify women at risk for appropriate referrals.

A nurse is the school district's single nurse overseeing 15 schools. Since the nurse cannot be at all schools on any given day, the district has asked for a cart with supplies for staff to use. What items does the nurse include in the cart? (Select all that apply.) a. Blunt scissors b. Casting material c. Disposable blankets d. Non-latex gloves e. Sharps container

A: blunt scissors C: disposable blankets D: non-latex gloves E: sharps container Recommended supplies for schools to have on hand if they do not have a nurse present include blunt scissors, disposable blankets, non-latex gloves, and sharps containers, among other items.

Community and public health nurses (PHNs) practicing in rural locales consistently note which of the following characteristic of their practice environments? a. Broad scope of practice b. Independence and autonomy c. Inter-generational practice d. Opportunity for community involvement e. Respect and visibility

A: broad scope of practice B: independence and autonomy C: inter-generational practice D: opportunity for community involvement E: respect and visibility Characteristics of nursing practice in rural environments include broad, diverse, and/or intergenerational scope of practice, greater independence, public status and autonomy, and a greater opportunity for community involvement than in many urban practice environments.

The role of the community-oriented nurse working with the special needs population is largely influenced by which of the following? a. Community awareness of and commitment to meeting the needs of people with disabilities b. Educational opportunities for nurses to learn about this population c. Number of people with disabilities in the community and the magnitude of their needs d. Nurse's attitude toward people with physical challenges

A: community awareness of and commitment to meeting the needs of people with disabilities Many factors influence the role of the community-oriented nurse in any given community. A major influence is the community's awareness of those who are disabled and its commitment to addressing their health needs. However, a nurse who becomes aware of and committed to meeting the needs of the physically compromised can use the principles of community-oriented practice to initiate long-term improvement of services in his or her community.

What is the rationale for the federal-state-local partnership teaming with other organizations to develop and implement responses to identified public health concerns? a. Community health is a shared responsibility. b. Health objectives are defined nationally. c. Population health is the responsibility of the government. d. Public health trends focus on bioterrorism.

A: community health is a shared responsibility PHNs partner with multidisciplinary teams of people within public health areas, in other human services and public safety agencies, and in community-based organizations. The health of communities is a shared responsibility that requires a variety of diverse and often nontraditional partnerships. Public health agency staffs include physicians, PHNs, nutritionists, environmental health professionals, health educators, various laboratory workers, epidemiologists, health planners, paraprofessionals who make home visits, and outreach workers. Community-based organizations include the American Red Cross (ARC), free clinics, advocacy groups, Head Start programs, daycare centers, community health centers, hospitals, senior centers, churches, academic institutions, and businesses. Other government agencies include fire/emergency services departments, law enforcement agencies, schools, parks/recreation departments, and elected officials.

The nurse case manager in a migrant farmworker clinic assesses this population for occupational and environmental risks related to which problems? (Select all that apply.) a. Contaminated water b. Fear of injury reporting c. Inadequate sewage d. Pesticide exposure e. Traffic accidents

A: contaminated water B: fear of injury reporting C: inadequate sewage D: pesticide exposure Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing with inadequate sewage and lack of heating or air conditioning. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.

The case manager role of the school nurse can best be described as which of the following? a. Coordinating health care for children with complex health problems b. Counseling students to choose workable solutions to their problems and conflicts c. Referring students to available resources d. Screening students for common health problems

A: coordinating health care for children with complex health problems The school nurse's case manager role is to help coordinate the health care of children with complex health problems to ensure that students' health care appointments and visits have the minimum possible negative impact on their educational experience.

Public health nurses working from the principles of this specialty would engage in which activities? (Select all that apply.) a. Create interventions for a healthy environment. b. Emphasize the health of individuals and families. c. Plan primary prevention activities as the priority. d. Research and use all available resources. e. Work with clients as equal partners.

A: create interventions for a healthy environment C: plan primary prevention activities as the priority D: research and use all available resources E: work with clients as equal partners The tenets (principles) of public health nursing were developed by the Quad Council of Public Health Nursing and integrated into the Scope and Standards of Public Health Nursing Practice of the American Nurses Association (ANA, 2005). These principles distinguish public health nursing from other nursing specialties. The eight principles include population-based unit of care; primary obligation to achieve the "greatest good for the greatest number"; engagement with clients as an equal partner; priority emphasis on primary prevention; focus on strategies that create healthy environmental, social, and economic conditions in which populations may thrive; obligation to reach out to all who might benefit; optimal use of available resources; and collaboration with other professionals, organizations, and entities.

Which statement is true regarding Holistic health care as an approach to nursing care? a. Critical to a successful faith community nursing health ministry b. Inconsistent with many congregations' theologies c. Provided in clinics staffed by complementary and alternative medicine providers d. Separate from but complementary to parish nursing

A: critical to a successful faith community nursing health ministry The interconnectedness of body, mind, and spirit is basic to holistic nursing and is embedded in the practice of faith community nurses. The emphasis on holism is carried across the life span.

A nurse case manager working with a 1 year old with special needs living in an impoverished neighborhood identifies a potential health outcomes concern. What assessment by the nurse takes priority? a. Developmental milestones b. Frequent colds and infections c. Mental health d. Nutritional status

A: developmental milestones Homeless and impoverished children have higher health risks than other children. Inadequate nutrition can lead to delayed growth and development, failure to thrive, and conversely, obesity. Mental health is the greatest concern, but a 1 year old would not be assessed for mental illness and the child's special needs also contribute to possible developmental delays.

Which term would best describe a person who is limited in independent living skills, economic self-sufficiency, and self-help ability? a. Developmentally disabled b. Dual-diagnosed c. Impaired d. Physically disabled

A: developmentally disabled The Centers for Disease Control and Prevention (CDC)'s National Center on Birth Defects and Developmental Disabilities defines developmental disability as a long-term impairment that originates during development and up to age 22 years and lasts throughout the person's lifetime. The disability must limit the person in at least three of the following areas: self-help, language, learning, mobility, self-direction, independent living, and economic self-sufficiency.

A nurse will be starting a new job serving a rural, Native American reservation. What supplies or equipment does the nurse anticipate having the highest need for? a. Diabetic testing supplies b. Oximeter and sensors c. Suicide prevention pamphlets d. Water purifiers

A: diabetic testing supplies While all supplies are needed, Native Americans have a high rate of diabetes so diabetic testing supplies would be most needed. This aggregate has less need for oximeters and sensors, thermometer covers, and water purifiers than other aggregates. For instance the oximeter would be the priority in coal mining towns.

The Omaha System was initially designed to address the concerns of nurses practicing in the community in the following areas: (Select all that apply.) a. Documentation b. Information management c. Nursing practice d. Telehealth e. Specialty certification

A: documentation B: information management C: nursing practice The Omaha System was initially developed to operationalize the nursing process and provide a practical, easily understood, computer-compatible guide for daily use in community settings and is the only American Nurses Association (ANA)-recognized terminology developed inductively by and for nurses who practice in the community.

Some major public health challenges for public health nursing include which of the following? (Select all that apply.) a. Drug-resistant organisms b. Emerging infections c. Health reform legislation d. Substance abuse e. Violence in society

A: drug-resistant organisms B: emerging infections C: health reform legislation D: substance abuse E: violence in society All options are examples of current challenges to public health and public health nursing.

A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. What evidence-based action by the nurse would be best? a. Educating migrant lay health workers b. Establishing a farmworker advocacy group c. Fundraising for a mobile health unit d. Lobbying local politicians for more funding

A: educating migrant lay health workers The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.

Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression? (Select all that apply.) a. Elevated levels of poverty b. Geographic isolation c. Insufficient mental health services d. Lack of awareness e. Tolerance for destructive coping mechanisms

A: elected levels of poverty B: geographic isolation C: insufficient mental health services There appears to be persistent, endemic depression among rural residents. Factors that relate to this level of depression are the high rate of poverty, geographic isolation, and insufficient mental health services.

A nurse is planning an activity for older congregants. After reading Healthy People 2020 goals for older adults, which activity does the nurse design? a. Exercise program integrating movements from a sitting or standing position b. Classes to promote a healthy self-image c. Cooking classes highlighting various cuisines d. Monthly onsite access to biotouch and massage therapists

A: exercise program integrating movements from a sitting or standing position Recognizing that older adults are one of the fastest growing age groups in the community, including baby boomers (adults born between 1946 and 1964), a new goal was added to Healthy People 2020—improve the health, function, and quality of life of older adults. A specific objective is: increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities. The adaptive exercise program would accomplish this.

Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) a. Higher incidence of acute and chronic disease b. Higher risk of physical trauma c. Crisis-oriented health care, usually in emergency departments d. Reduced eligibility for entitlement/assistance programs e. Lack of awareness of care options

A: higher incidence of acute and chronic disease B: higher risk of physical trauma C: crisis-oriented health care, usually in emergency departments E: lack of awareness of care options Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis-oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.

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

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

A middle school student approaches the school nurse and says, "Can I talk to you about something important?" The school nurse responds affirmatively but should clarify which topic? a. "Anything you tell me will be kept private and confidential." b. "If anything you tell me indicates that you or someone else is in danger, I must tell the parents and school officials." c. "It may be best for me to set up an appointment with the school counselor." d. "You can always speak to me if you are in trouble or when you need someone to talk to."

B: "if anything you tell me indicates that you or someone else is in danger, I must tell the parents and school officials" The school nurse may be the person whom children trust to be told important secrets about health. It is important that, as a counselor, the school nurse have a reputation as a trustworthy person to whom children can go when they are in trouble or when they need someone to talk to. Nurses in this situation should tell children that if anything they reveal indicates that they are in danger, the parents, and school officials must be told. However, privacy and confidentiality, as in all health care, are important.

The nurse counseling women regarding hormone replacement therapy (HRT) would include which information? a. HRT is beneficial for vasomotor symptoms for a brief time. b. HRT should be considered for prevention of osteoporosis in all women. c. Menopause is a result of hormone deficiency and HRT is appropriate for all women. d. Research concludes that HRT does prevent heart disease in menopausal women.

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

A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are natives of which country? a. Guatemala b. Haiti c. Mexico d. Panama

B: Haiti Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel).

A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach? a. Assessment b. Case management c. Geriatrics d. Tertiary prevention

B: case management Case management is a client-professional partnership that can be used to arrange a continuum of care for rural clients, with the case manager tailoring and blending formal and informal resources. Collaborative efforts between a client and the case manager allow clients to participate in their plan of care in an acceptable and appropriate way, especially when local resources are few and far between.

A PHN in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of which tertiary prevention public health nursing function? a. Case finding b. Case management c. Collaboration d. Provision of direct services

B: case management Case management is a major tertiary prevention function for PHNs at the community level of practice. Case managers assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying services that will improve the overall community health status.

The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps

B: collecting necessary data on migrant workers' lifestyle and health status C: educating communities about the migrant workers in their areas D: educating policymakers about successful programs for migrant workers Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policy makers at local, state, and national levels are necessary actions that nurses are prepared to undertake.

A nurse conducting a home visit for a child with cerebral palsy observes the child gazing out of the window into the neighborhood. The nurse prepares to provide guidance to the parents regarding their child. What topics does the nurse include? (Select all that apply.) a. Adjusting the school schedule to keep the child occupied with studies b. Community attitudes about interacting with children with disabilities c. Opportunities and places for organized and spontaneous play d. Legislation regarding access rights for people with disabilities d. Physical activity needs to avoid obesity and its consequences

B: community attitudes about interacting with children with disabilities C: opportunities and places for organized and spontaneous play D: legislation regarding access rights for people with disabilities E: physical activity needs to avoid obesity and its consequences Greater emphasis has been placed on increasing children's physical activity to avoid childhood obesity, but children with any type of a disability continue to be less physically active and at greater risk of obesity than their healthy peers. This is a result of the relative lack of available opportunities for disabled children to participate in organized and spontaneous play. Additionally, nondisabled children and their parents may have negative attitudes about interacting or playing with disabled children. Parents should be aware of what legislation exists to provide equal opportunities.

A nurse working in a clinic in an inner city with high poverty and unemployment rates recognizes the need for programs for women because impoverished women are at higher risk for: a. decreased access to social services. b. poorer health status. c. exposure to environmental toxins. d. poorer academic success.

B: poorer health status The relationship between poverty and health is significant. Poverty presents a formidable obstacle to positive health across the life span. Those in lower income groups have poorer health status, and those with poor health have decreased ability to work and improve their socioeconomic status.

A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. Which strategy would the nurse consider most effective when working with these clients? a. Form a community partnership to establish a clinic for homeless persons. b. Create a trusting environment and establish a therapeutic relationship. c. Collaborate with the local united way to obtain funding for primary care services. d. Dialogue with local clergy to address the unmet primary care need for homeless persons.

B: create a trusting environment and establish a therapeutic relationship In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

In designing a substance abuse primary prevention education program for the secondary schools in the community, it would be most important for the school nurse to include content related to the latest trend in the use of which drug? a. Cocaine b. Ecstasy c. Heroin d. Marijuana

B: ecstacy There has been an increase in the use of "club drugs" such as lysergic acid (LSD), ketamine, gamma hydroxybutyrate (GHB), Rohypnol, and ecstasy (MDMA). The school nurse can teach students about the serious side effects of ecstasy, especially that it causes a very high body temperature, which can lead to death. Teaching students about the dangers of using all drugs is the responsibility of the school nurse. The school nurse can also teach parents and other members of the community about the latest drug use trends, increasing everyone's awareness of these dangerous trends.

Children with chronic health problems face challenges in school because of which of the following issues? a. Difficulty gaining access to public school education b. Embarrassment and self-imposed social isolation c. Increased special education costs in public schools d. Psychological distress related to the severity of their disability

B: embarrassment and self-imposed social isolation Children with chronic health problems often experience embarrassment regarding the demands of their disability and the regimens required to manage it. Having to explain why they must attend to special needs could call unwanted attention to them and their condition. School-age classmates may be reluctant to be close friends with children with chronic illnesses because they may fear that any chronic disease or disability is contagious.

The PHN serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on public health programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

B: ensure that all populations have access to affordable, quality health care Public health's shift from being the primary care provider of last resort to the developing partnerships to meet the health promotion and disease prevention needs of populations has raised concerns about available health care for the uninsured and underinsured. The role of the PHN given this ongoing shift in health care delivery is still being developed in many agencies. PHNs retain responsibility for ensuring that all populations have access to affordable, quality health care services. They accomplish this by advocating for legislation that promotes universal health care, such as increased funding for community health centers and expansion of Medicaid eligibility criteria, and by forming partnerships with hospitals, free clinics, and other organizations to ensure the availability of health care for all populations in the community.

A nurse is working at a school that participates in the federal school meal program. What activity does the nurse engage in related to this program? a. Assists in creating a school-based health clinic. b. Ensures the school wellness policy is current and reflects best practice. c. Provides meal accommodations for special needs children. d. Writes policies to ensure equal access to education for all students.

B: ensures the school wellness policy is current and reflects best practice The Child Nutrition and WIC Reauthorization Act of 2004 requires that each local education agency (LEA) participating in federal school meal programs, such as the National School Lunch or Breakfast Program, must establish a local school wellness policy.

Conditions that may lead to disability typically are the focus of primary prevention activities. However, all three levels of prevention apply to physically compromised clients, primarily because the focus should be on which of the following? (Select all that apply.) a. Addressing the client's perception of himself or herself in terms of the disability b. Establishing lifelong, health-promoting behaviors c. Integrating appropriate complementary and alternative medicine treatments d. Overcoming barriers to disease prevention activities e. Preventing complications from the effects of immobility and the disease process

B: establishing lifelong, health-promoting behaviors D: overcoming barriers to disease prevention activities E: preventing complications form the effects of immobility and the disease process Many health-promotion and disease-prevention needs are similar across the life span. However, the specific problems encountered and interventions required to deal with the needs of persons with disabilities vary depending on age, the specific disabling condition, and developmental status. Health promotion is a multidimensional concept that applies to all individuals regardless of disability. Both health-promotion and disease-prevention programs for persons with disabilities should focus on preventing the complications from the effects of immobility and the disease process. The complications of immobility and the disease process must be prevented to ensure optimal independent and healthy living, so that the individual with disabilities has the opportunity to lead a productive and happy life.

The congregational wellness committee expresses the desire to establish a seasonal shelter for homeless women and children in the community as part of its health ministry. The faith community nurse prepares a resource assessment for the next committee meeting. This intervention reflects the parish nurse's responsibility for which type of practice issues? a. Ethical b. Financial c. Legal d. Professional

B: financial The faith community nurse is challenged to be creative in identifying sustainable financial support for programs as well as in finding low cost or free resources.

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

B: implementing secondary prevention of aging C: maximizing functional status D: meeting social needs E: providing appropriate recreation Senior centers were developed in the 1940s to provide social and recreational activities. Now many centers are multipurpose, offering recreation, education, counseling, therapies, hot meals, and case management, as well as health screening and education. Nurses caring for elder populations strive to help maximize functional status and minimize functional decline. Senior centers are effective platforms for nurses to provide interventions related to primary, secondary, and tertiary prevention, health promotion and maintenance, and disease prevention. Senior centers are multipurpose and provide safe, stimulating recreational opportunities. Many of the changes traditionally associated with aging can be delayed or prevented by positive health practices and proactive intervention.

What does a community-oriented nurse newly assigned to a rural community learn about the characteristics of rural and small town life? a. Fractured family and social systems b. Informal social and professional relationships c. Openness to people new to the community d. Role of churches as socialization centers e. Work of many residents in high-risk occupations

B: informal social and professional relationships D: role of churches as socialization centers E: work of many residents in high-risk occupations The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for "insiders" and mistrust of newcomers ("outsiders").

Women with disabilities may be at higher risk for abuse because women with disabilities are: a. less exposed to multiple caretakers. b. less likely to have access to resources. c. more independent. d. socially unattractive.

B: less likely to have access to resources Women and girls with disabilities face many challenges and often have to face "double discrimination." There is worldwide gender discrimination in such areas as access to housing, education, training, employment, and salary equity. Being female also places one at risk for sexual exploitation, abuse, neglect, and violence. Women with disabilities are at increased risk of this type of abuse because of the powerlessness of women in many parts of the world, the lack of resources, and women being undervalued.

The impact of poverty on the onset of disability can best be expressed by which of the following statements? a. Being underinsured through the workplace limits options for health care services. b. Low income can increase the risk of preventable disability. c. Successful insurance settlements for injury claims limit the financial impact of disability. d. Transportation for persons with limited mobility affects access to health care services.

B: low income can increase the risk of preventable disability Persons with low income have less access to health care throughout their lives and are less likely to participate in all levels of prevention. Therefore, they are at greater risk for the onset of disabling conditions and for more rapid progression of disease processes. Those living in poverty could also be at greater risk for disabling conditions resulting from lifestyle choices, such as accidental injuries; tobacco, alcohol and drug use; and inadequate nutrition.

The nurse knows that which individual would be considered correctly defined? a. Agricultural day laborer: A migrant or seasonal farmworker with a second part time job b. Migrant farmworker: Travels to do farm work unable to return to a permanent home in the same day. c. MSFW: A foreign worker employed seasonally in agriculture who is also a migrant d. Seasonal worker: Individual who travels around the country working crops in season

B: migrant farmworker - travels to do farm work unable to return to a permanent home in the same day According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day.

A faith community nurse is planning a strategy to carrying out the health education role. What activity would be most appropriate? a. Conducting prayer circles b. Organizing health fairs c. Planning congregational meals d. Providing volunteer training

B: organizing health fairs Faith community nurses provide opportunities to learn about health, focus on the teaching role of the nurse, select resources, utilize strategies, and lead activities to promote health. They use a variety of formats including seminars, conferences, classes, workshops, individual or group sessions, newsletters, printed materials, bulletin inserts, and bulletin boards to empower others to be active partners in managing health. Health fairs are used as a means to encourage positive health choices.

The PHN ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. Which principle is the PHN is adhering to? a. Collaboration b. Partnership c. Public health care d. Public health nursing

B: partnership Changes can be accomplished more easily and effectively by partnerships and collaboration among groups than by the individual client and PHN working alone. The Community Campus Partnerships for Health involved its members and partners in developing nine principles of good practice for community partnerships in 1998. These include agreeing on a mission; values, goals, and measurable outcomes; establishing a relationship characterized by mutual trust, respect, genuineness, and commitment; building on identified strengths and assets but also determining areas for improvement; balancing power and enabling resources to be shared; ensuring clear, open, and accessible communication with ongoing listening and a common validated language; mutually establishing roles, norms, and processes; ensuring feedback to, among, and from all stakeholders; sharing the credit for accomplishments; and taking time for the partnership to develop and evolve.

The incentives and pressures for cost control and improved health outcomes have promoted the development of technologies that are simpler, more reliable, and more: a. acceptable to the patient. b. complex. c. efficient. d. expensive.

C: efficient The increased availability of telehealth coincides with trends described in this and other chapters in this book: an aging population, increased chronic illness and costs, and changes in health care reimbursement. Home health, palliative, and hospice providers face the challenge of managing increasingly complex clients in a highly constrained fiscal environment where patterns of care and reimbursement are based on client need and agency efficiency. Telehealth has emerged as a viable and acceptable way to supplement the delivery of health care economically.

To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses must first: a. apply epidemiologic principles for prevention. b. develop resource expertise in the community. c. examine their personal beliefs, values, and experiences. d. understand the federal criteria and guidelines for poverty.

C: examine their personal beliefs, values, and experiences To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses need to understand poverty as a concept with historical, social, political, economic, biological, psychological, and spiritual dimensions. Understanding the concepts of poverty and homelessness begins with an examination of one's own beliefs, values, and personal experience.

An undocumented migrant farmworker has been diagnosed with TB. The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.

C: fragmented services Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.

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

C: heart disease, stroke, and homicide African American men have higher lifetime rates of prostate cancer compared to all other races.

A community-oriented nurse wants to develop strategies to reduce the effects of toxic stress on children. What activity would the nurse make a priority? a. Creating a space for therapeutic play b. Employing a child psychologist c. Hiring a full-time lactation consultant d. Offering stress-reduction counseling

C: hiring a full-time lactation consultant Breastfeeding has been suggested as a toxic stress mitigator, beginning with the skin-to-skin contact immediately following birth. This mother/infant contact stimulates a rise in maternal oxytocin and prolactin and decreases cortisol, reducing infant allostatic load and inducing calm. Breastfeeding has been proven to aid in the establishment of maternal-infant attachment and lower the stress response in mothers and infants. A full-time lactation consultant would be most beneficial.

In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle and which of the following as the priority? a. Communicable diseases b. Educational level c. Housing arrangements d. Pesticide exposure

C: housing arrangements Migrant farmworkers and their families often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.

The local hospital emergency department has recently noted an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of the rise in cases and schedules an assessment of which of the following? a. Bars frequented by migrant workers b. Farm fields employing migrant workers c. Housing for migrant workers d. Restaurants frequented by migrant workers

C: housing for migrant workers Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.

The shift of home care away from its charitable and public health-oriented roots toward current models in use can be attributed to which event? a. Consolidation of voluntary and official home health agencies b. Expansion of home care to include community health needs c. Integration of home care into benefit programs d. Passage of the Medicare prospective payment system

C: integration of home care into benefit programs Medicare included home care as a benefit for enrollees in 1965. Inclusion of home care benefits began to change the nature of the services provided. Services were focused on individuals with specific functional and health problems who could not be cared for elsewhere, and the care provided became more technical, opening the door for population-focused home care, transitional care, home-based primary care, traditional home health care, and hospice care.

Because of the need for various knowledge, skills, and perspectives, successful functioning in the provision of services in home care requires which of the following? a. Certified advance practice home health nurses b. Integration of home health aide and homemaker roles c. Interprofessional teams d. Physician certification of the medical problem and plan of care

C: interprofessional teams The responsibilities and functions of health professionals in home care are determined by Medicare regulations, professional organizations, and state licensing boards. Many specialized services can be provided in home care, such as enterostomal therapy, podiatric care, pharmaceutical therapy, nutritional counseling, intravenous therapy, respiratory therapy, and psychiatric or mental health services. Many of these services can be provided on a consulting basis, either through staff education or through direct provision of services. This requires the use of an interprofessional team model, so that the specialized knowledge, skills, and perspectives of each team member can be integrated and will be implemented and reinforced by those in all involved disciplines to achieve successful patient outcomes.

Which man would have the highest risk for prostate cancer? a. Has erectile dysfunction. b. Has multiple sex partners. c. Is African American. d. Refuses to be screened.

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

State public health agency responsibilities include which of the following activities? a. Conducting community health assessments b. Enforcing public health codes c. Monitoring health status d. Providing expertise that facilitates evidence-based practice

C: monitoring health status Federal public health agencies develop regulations that implement policies formulated by Congress, provide funding to state and territorial health agencies for public health activities, survey the nation's health status and health needs, set practices and standards, provide expertise that facilitates evidence-based practice, coordinate public health activities across state lines, and support health service research. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. They receive funding from federal agencies to implement public health initiatives. Local public health agencies are responsible for implementing and enforcing local public health codes and ordinances and providing essential public health services to the community.

The school nurse wishes to provide community outreach. What activity does the nurse plan? a. Arrange transportation for appointments. b. Conduct research on immunization reluctance. c. Organize a multi-disciplinary health fair. d. Provide service opportunities for students.

C: organize a multi-disciplinary health fair When performing community outreach, school nurses can participate in community health fairs in the schools, influenza immunization programs, and blood pressure screenings for school staff, among other things. The nurse can include other disciplines in the fairs, such as dentists to provide free dental cleaning. The school nurse can also serve as the liaison for coordinating educational programs in the schools provided by local health charities.

Hospice care would be an appropriate option to discuss with which of the following patients? a. Patient with stage II lung cancer who is undergoing chemotherapy. b. Patient with early Alzheimer's disease whose caregiver needs respite care. c. Patient with metastatic breast cancer who has discontinued chemotherapy. d. Patient with severe debilitating osteoporosis.

C: patient with metastatic breast cancer who has discontinued chemotherapy The criteria for entry into hospice care are that the disease process or condition has progressed to the point that further treatment cannot cure and death within 6 months would not be unexpected. This does not mean that the patient will die within the next 6 months, only that if death occurred, it would not have been unexpected. Patients must select care measures to keep them comfortable.

A rural health nurse who is planning programs to address the population's needs should recognize that, in general, rural populations: a. engage in physical activity during leisure time. b. engage in preventive health behaviors. c. perceive their overall health as less favorable. d. use seat belts.

C: perceive their overall health as less favorable In general, people in rural areas have a poorer perception of their overall health and functional status than those in urban areas.

At the request of a local senior women's group, a nurse is developing an osteoporosis primary prevention program. Which of the following is an appropriate strategy the nurse would incorporate in the program? a. Design a nurse-directed program instead of a peer-directed program. b. Encourage exercise and consideration of HRT. c. Promote diets rich in calcium and vitamin D and daily weight-bearing exercise. d. Promote swimming and supplementation with calcium and vitamin D.

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

A nurse designing a program to improve the health of frail elderly. What does the nurse need to address in this program? a. Culture, religion, and race b. Media and marketing initiatives c. Racial/ethnic and sociological disparities d. Vital statistics on mortality causes

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

The nurse assesses a client with paraplegia and cataracts. The client holds a full-time job and engages in several hobbies. What does the nurse document about this client? a. Dual diagnoses b. Functional limitations and wheelchair bound c. Visual and physical limitations d. Visual impairment and physical disability

C: visual and physical limitations Functional limitations occur when individuals experience difficulty performing basic activities of daily living because of their disability. Examples of functional limitations include difficulty standing, walking, climbing, grasping, and reading. Emphasis is placed on the level of function rather than on the purpose of the activity, so that functional limitation can be associated with the disability.

A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, non-metropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding? a. Apple grower who lives in a 100-square-mile county with a population of 19,900. b. Client who lives next to a ranch in a town of 1200 people. c. Soybean grower and spouse who live in a 400-square-mile county with a population of 39,200. d. 70-year-old client residing in an assisted living facility in a rural area.

D: 70-year-old client residing in an assisted living facility in a rural area Farm residency denotes living outside "city limits" and involvement in agriculture. Frontier regions have fewer than six persons per square mile; rural communities have fewer than 20,000 residents or fewer than 99 persons per square mile. "Non-metropolitan" statistical areas are regions without a central city of 50,000 or more citizens. The soybean grower and spouse make their living in agriculture (farm resident), and the county where they live has fewer than 99 persons per square mile (rural).

The parish nurse works with a congregant with early stage Alzheimer's disease and with the individual's family to design a progressive quality-of-life plan that addresses the need for legal, financial, health care, and end-of-life decision-making strategies as the disease progresses. This approach to well-being for the individual can best be characterized as an example of the philosophy of faith community nursing that: a. considers the ongoing, dynamic nature of health, spiritual health, and healing. b. emphasizes strengths of individuals, families, and communities. c. emphasizes the spiritual dimension found in every person. d. focuses on the faith community and its ministry.

D: focuses on the faith community and its ministry In faith community nursing, health, spiritual health, and healing are considered an ongoing dynamic process. Because spiritual health is central to well-being, influences are evident in the total individual and are noted in a healthy congregation. Well-being and illness may occur simultaneously. Spiritual healing or well-being can exist in the absence of a cure for physical illness.

A faith community nurse has entered into a written contract to provide spiritual care at two local nursing homes and the community hospital. This best represents the implementation of which model of faith community nursing? a. Congregational model b. Health ministry model c. Holistic care model d. Institutional model

D: institutional model A paid institutional model is supported by a health care institution (e.g., hospital, health department, or long-term care facility) where nurses are paid (salary or hourly) either by the institution, or shared salary with the congregation over time.

The nurse working with migrant farmworkers and their families understands that which of the following are true statements regarding the health and well-being of the migrant children? (Select all that apply.) a. Are not eligible for Medicaid or state health insurance. b. Generally attend school despite moving frequently. c. Have a federal safety net of limited overtime until age 18. d. May be exposed to "take home" chemicals. e. Often suffer from anxiety-related problems.

D: may be exposed to 'take home' chemicals E: often suffer from anxiety-related problems Children of migrant farmworkers can be exposed to chemicals when the parent comes home from work or picks them up to hold or carry them. Children of migrant farmworkers suffer frequently from anxiety-related problems.

A community health nurse is prioritizing health-promotion activities with the local rural community. An understanding of the health status and health risks of the rural community would lead the nurse to give priority to which activity? a. Aerobic exercise classes b. English as a second language program c. Mentoring program to increase adult literacy d. Motor vehicle and farm accident prevention

D: motor vehicle and farm accident prevention All of the health-promotion activities mentioned would be helpful for a rural community. However, health-promotion activities should be prioritized according to the most common causes of morbidity and mortality for the population served. Rural residents are at increased risk of injury and death secondary to motor vehicle crashes and farm-related occupational injuries.

Which of the following best describes faith community nurses? a. Advanced practice nurses working in churches to provide holistic nursing care and spiritual healing b. Baccalaureate-prepared nurses volunteering in faith communities to assist in their health ministries c. Nurses coordinating congregational health outreach programs within geographically delineated faith communities d. Professional nurses partnering with faith communities focusing on spiritual and holistic care, and illness prevention

D: professional nurses partnering with faith communities focusing on spiritual and holistic care, and illness prevention Faith community nursing is defined by the American Nurses Association (ANA) as a specialized practice of professional nursing that focuses on the intentional care of the spirit as well as the promotion of whole person health and the prevention or minimization of illness within the context of a faith community and the wider community.

The home care nurse assesses clients and services regularly for fiscally responsible use. What is a key driver of this activity? a. Increasing rate of insurance fraud b. Merit-based pay incentivization c. Need to maintain current funding d. Reduction of service time to 30 days

D: reduction of service time to 30 days New CMS legislation has decreased an episode of home care from 60 days to 30 days, so nurses must be vigilant about ensuring that their clients are not receiving more care than needed.

What causes nurses practicing in rural communities to often observe that protecting client confidentiality is a unique challenge? a. Close-knit atmosphere among residents b. Difficulty keeping one's business private c. "Everyone knows everything already" d. Social informality and respect

D: social informality and respect Nurses practicing in rural areas are obligated to maintain client confidentiality just as they would in an urban setting. However, nurses are often asked for health information and advice in nonclinical settings. This social informality is part rural characteristic and partly due to respect for the nurses. Nurses must be especially sensitive and exercise creativity to maintain client confidentiality when approached in public settings.

Rapid changes in public health resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice that established which of the following? a. Core public health functions as the competency framework b. Minnesota Department of Health's Intervention Wheel as the practice competencies c. Quad Council principles as the primary framework for practice d. Standards for baccalaureate- and master's-prepared PHNs

D: standards for baccalaureate and master's-prepared PHNs Historically, many of the core public health competencies were provided by PHNs who had learned these skills in the workplace while gaining knowledge through years of practice. Because of rapid changes in public health and limited resources, this approach to competency development can no longer be sustained. In 2007 and again in 2013, the ANA revised the 1999 Scope and Standards of Public Health Practice to reflect the increasing complexity and rapid changes faced by PHNs. The revised standards include standards that must be met by all nurses with baccalaureate degrees, the entry level into public health nursing, as well as standards that must be fulfilled by advanced practice PHNs prepared at the master's level.

What connection does the nurse make between the older adult and poverty? a. Medical expenses often lead to bankruptcy. b. Older men have a higher poverty rate than women. c. Poverty for elders has risen overall since the 1960s. d. Staying out of poverty is a near-daily challenge.

D: staying out of poverty is a near-daily challenge The demarcation between poverty and near poverty among those aged 65 and older is fluid and precarious. A serious illness, injury, or other sudden disruption can force a senior to choose between paying for medication, heating, and food.

A home health nurse is charged with identifying opportunities for health promotion and illness primary prevention. Which activity would the nurse do? a. Collaborate with the chaplain to address the spiritual needs of a hospice patient. b. Educate a school nurse on the care regime of a student newly diagnosed with asthma. c. Refer a newly diagnosed diabetic patient to the nutritionist for dietary teaching. d. Track the immunization status of the clients in his or her workload.

D: track the immunization status of the clients in his or her workload Immunizations prevent disease, a function of primary prevention. Patients requiring home health care may be more at risk of complications of diseases like influenza and pneumonia. Keeping immunizations current is a critical aspect of health promotion and illness primary prevention for these patients.

A nurse wishes to become involved in outreach to migrant farmworkers. What activity by the nurse would be consistent with this service? a. Assisting migrant farmworkers to understand their rights b. Developing policies and assuring funding for services c. Reaching migrant communities for primary prevention d. Training lay health workers for health education

D: training lay health workers for health education Migrant health programs have recruited current or former migrant workers to serve as outreach workers or community health workers (often referred to as promotores or promotoras) to assist in outreach and health education of the workers. Nurses can be part of the planning and training of health workers for outreach and educational programs. Evaluation to determine successful outreach educational methods can be undertaken by nurses.