Community Quiz #3

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)"Lately I've had to double up on my dose just for it to be effective." Feedback Tolerance is the diminished physical and/or psychological response to effects of alcohol or illicit substances. A person develops tolerance when he or she needs to use higher doses of a substance to achieve the desired effect. Withdrawal is reduction in prolonged substance use that results in problematic behavioral, physiological, and cognitive changes. Feeling like one cannot function without a substance is a sign of substance dependence. Praising the medication and requesting another refill could be a sign of substance dependence.

Intimate partner violence is a pattern of assaultive and coercive behaviors. This definition includes: (Select all that apply.) A)Emotional injury B)Sexual assault C)Progressive social interaction D)Physical injury E)Deprivation

B)Sexual assault D)Physical injury E)Deprivation Feedback Intimate partner violence (IPV) is a pattern of assaultive and coercive behaviors that is perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation (not interaction), deprivation, intimidation, and threats. Emotional injury is not included in IPV.

A nurse working in the rural Southeast United States sees many young white adolescent girls in the clinic. The nurse should be aware that which type of substance use is highest among this demographic? A)Smoking cannabis B)Sniffing glue C)Injecting heroin D)Drinking alcohol

B)Sniffing glue Feedback For young adolescents, rates of inhalant use are highest for white females residing in the rural southeast (22.4%) and Mexican-American females (22.7%) living in rural parts of the western United States.

The nurse teaches about medication to a client who has just been diagnosed with schizophrenia. The psychiatrist has prescribed clozapine to the client. The primary adverse effect that the nurse should mention is: A)Hypoglycemia B)The metabolic syndrome C)Weight loss D)Dystonia

B)The metabolic syndrome Feedback Metabolic syndrome is an adverse effect of second-generation antipsychotics that develops as a result of pronounced weight gain, dyslipidemia, and hyperglycemia. Dystonia is common side effect of first-generation antipsychotic medications.

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exmplifies a primary prevention strategy for mental health problems? A)Educate families and community groups about mental health issues, symptoms of stress, and barriers to seeking help B)Screen for mental health disorders C)Promote support groups for people with mental health disorders D)Initiate health-promotion activities as a part of rehabilitation services

A)Educate families and community groups about mental health issues, symptoms of stress, and barriers to seeking help Feedback Primary prevention strategies include educating families and community groups about mental health issues, symptoms of stress, and barriers to seeking help. Secondary strategies include screening for mental health disorders. Tertiary strategies include promoting support groups for people with mental health disorders and initiating health-promotion activities as a part of rehabilitation services.

After examining a young woman, the nurse asks her questions about some bruises on her back. The client confides that her husband has started hitting her when they argue. The nurse makes recommendations about getting help; the client dismisses them and states, "It's just a few bruises. I think I can handle it." Which long-term consequences of exposure to violence, according to Healthy People 2020, should the nurse discuss with this client? (Select all that apply.) A)Premature death B)Breast cancer C)Disability D)Lost productivity E)Obesity

A)Premature death C)Disability D)Lost productivity Feedback Healthy People 2020 emphasizes a need to prevent violence and the sequelae known to result from exposure to violence recognizing that violence leads to the following: premature death, disability, poor mental health, high medical costs, and lost productivity. Breast cancer and obesity are not known as long-term consequences of exposure to violence.

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)"My boyfriend says that one day he'll put a bullet through my head if I don't stop nagging him." 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." 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.

Which instance would be considered child abuse and neglect according to the federal Child Abuse and Prevention and Treatment Act? A)A father leaving a child in the back seat of a car on a hot August day B)A mother not feeding a 5-year-old child all day C)A mother allowing her boyfriend to punch her daughter D)A caregiver smacking away a toddler's hand when she reaches for a hot stove E)A neighbor touching the private parts of a 12-year-old boy

A)A father leaving a child in the back seat of a car on a hot August day B)A mother not feeding a 5-year-old child all day C)A mother allowing her boyfriend to punch her daughter E)A neighbor touching the private parts of a 12-year-old boy Feedback The federal Child Abuse Prevention and Treatment Act (CAPTA) (42 U.S.C.A. §5106g), as amended by the Keeping Children and Families Safe Act of 2003 (U.S. Department of Health and Human Services, 2003), defines child abuse and neglect as the following: any recent act, or failure to act, on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act that presents an imminent risk of serious harm. A caregiver smacking away a toddler's hand would not result in serious physical or emotional harm. All of the other answers would.

Which accurately defines femicide? A)A homicide of a female that occurs in the context of intimate partner violence B)Violence that targets people or groups of people on the basis of their gender C)A pattern of assaultive and coercive behaviors D)A suicide by a female that occurs in the context of intimate partner violence

A)A homicide of a female that occurs in the context of intimate partner violence Feedback Femicide is a homicide (not a suicide) of a female that occurs in the context of intimate partner violence (IPV). Gender-based violence is violence that targets people or groups of people on the basis of their gender. IPV is a pattern of assaultive and coercive behaviors that is perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats.

During an assessment, a teenager reveals a 2-year history of inhalant use. Using knowledge that fumes may be inhaled through the mouth, this will achieve a state of intoxication similar to: A)Alcohol B)Cannabis C)Cocaine D)Morphine

A)Alcohol Feedback Fumes may be inhaled through the mouth, referred to by adolescents as "huffing," or the nose ("sniffing"), to achieve a state of intoxication similar to that of alcohol, not cannabis, codeine, or morphine.

In researching the problem of homelessness in the city, the nurse discovers that the number of mentally ill homeless has steadily grown over the past couple of decades. The biggest reason for this trend is: A)Deinstitutionalization B)An increase in the prevalence of major mental illness C)Economic downturns D)Shortages of affordable housing

A)Deinstitutionalization Feedback The rising number of mentally ill clients who are homeless has steadily increased in the United States as state governments embarked on a systematic plan to "deinstitutionalize" the mentally ill. The goal of deinstitutionalization is to replace state hospitals with smaller group homes, half-way houses, or other supported living arrangements that integrate, rather than separate, the chronic mentally ill in the community. Tragically, the services available in the community seldom have kept pace with the demand for services. The gap in community-based services persists in all developed countries because of fiscal and political constraints. There is no evidence to support an increase in the prevalence of major mental illness. Economic downturns and shortages of affordable housing might contribute to homelessness overall, but are lesser causes than deinstitutionalization with regard to homelessness among the mentally ill.

The nurse cares for a woman who is in her 39th week of gestation and who recently revealed that she is being physically abused by her partner. Which conditions associated with intimate partner violence (IPV) should the nurse look for in this client and in her child now and in the coming weeks? (Select all that apply.) A)Depression in the mother B)Low-birth weight infant C)Down syndrome in the infant D)Gestational diabetes in the mother E)Cleft palate in the infant

A)Depression in the mother B)Low-birth weight infant Feedback Depression before, during, and after birth has been strongly correlated with IPV. Researchers have also found that pregnant women who are assaulted by an intimate partner are at increased risk of giving birth to infants of reduced weight. Down syndrome is a genetic disorder and is not associated with IPV. Gestational diabetes is an endocrine disorder and would not be caused by IPV. A cleft palate is a congenital birth defect not associated with IPV.

A nurse receives blood test results that indicate that a 14-year-old client has been using cannabis. Based on knowledge of factors that affect rate of cannabis use among youth, which would be the most effective strategy to discourage this behavior? A)Explain the risks associated with cannabis use B)Remind the client that it is still illegal in your state C)Refer the client for counseling D)Share about your own experience with drug use

A)Explain the risks associated with cannabis use Feedback Past-month cannabis use was 10 times higher in youth who perceived there was moderate, slight, or no risk, compared with their peers who perceived great risk. Thus, explaining the risks of use might dissuade future use. The client likely already knows that it is illegal in his state. Although referring the client to counseling might be appropriate, if he is unaware of the risks associated with cannabis use, he will likely not bother to pursue it. Sharing about your own experience with drug use would not be appropriate in the context of your role as a nurse.

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)First-degree relatives who live together 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.

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)Genetics B)Age D)Personal health habits and lifestyle E)Environment 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.

In assessing a 13-year-old Native American boy who lives on a reservation, the nurse finds that he regularly drinks alcohol and smokes cannabis. He says that most of his friends do so, as well. The nurse is aware that this rate of prevalence is far higher than that for 13-year-olds of all ethnicities nationwide. Which social conditions have researchers associated with this health disparity? (Select all that apply.) A)Greater availability of cannabis from local farms B)Higher socioeconomic status C)Lower academic attainment D)Proximity to Mexico and drug gangs E)College enrollment

A)Greater availability of cannabis from local farms C)Lower academic attainment D)Proximity to Mexico and drug gangs Feedback Substance misuse is a major public health concern for Native American youth on reservations, where more than half of eighth graders report alcohol and cannabis use, a pronounced increase from overall national prevalence rates for eighth graders of all ethnicities. While there is no causal model to explain the higher rates of substance use among youth on reservations, social factors including greater availability from local cannabis farms, proximity to Mexico and drug gangs, lower (not higher) socioeconomic status, and lower academic attainment (not college enrollment) are some of the social conditions that researchers have associated with this pronounced health disparity.

The nurse assesses a 33-year-old who abuses alcohol. To gauge how the client's substance use is impairing his ability to fulfill normal role functions, the nurse should use: (Select all that apply.) A)History of arrests for drunken driving B)Age at the time of first alcoholic drink C)Jobs lost due to intoxication at work and chronic absenteeism D)Failing grades in night classes at the local community college E)Blood alcohol level at time of last arrest for driving while intoxicated

A)History of arrests for drunken driving C)Jobs lost due to intoxication at work and chronic absenteeism D)Failing grades in night classes at the local community college Feedback Legal, employment, or academic difficulties that have resulted from misuse are an important gauge of how substance use is impairing the client's ability to fulfill normal role functions. Age at first use of a substance is a key indicator for risk of substance dependence but would not be a good gauge for how substance use is impairing the client's fulfillment of roles. Blood alcohol level is used to establish whether someone is intoxicated, but would not be a good gauge for how substance use is impairing the client's fulfillment of roles.

The nurse assesses a 7-year-old girl who has had problems at school lately with her behavior and mood. On the basis of the description provided by the child's mother, the nurse suspects either attention-deficit/hyperactivity disorder (ADHD) or bipolar disorder may be involved. Which behaviors—when occurring in all spheres of the child's life—would most strongly suggest ADHD rather than bipolar disorder in this client? A)Hyperactivity and impulsivity B)Mood and anxiety symptoms C)Irritability and impulsivity D)Anxiety and hyperactivity

A)Hyperactivity and impulsivity Feedback In children with ADHD, hyperactivity and impulsivity are evident in all spheres of the child's life. Unlike bipolar disorder, mood and anxiety symptoms are not predominant in ADHD; generally, teachers and parents do not characterize the child with ADHD as angry, irritable, and moody.

The nurse assesses a 12-year-old boy who has been diagnosed with bipolar disorder. Which behaviors should the nurse most expect to observe in this child? (Select all that apply.) A)Irritability B)Distractibility C)Screaming D)Rage episodes E)Sleep disturbances

A)Irritability C)Screaming D)Rage episodes E)Sleep disturbances Feedback In contrast to attention-deficit/hyperactivity disorder (ADHD), which is characterized by impulsivity and distractibility, almost 75% of the children diagnosed with bipolar disorder have a predominance of mood symptoms such as irritability, sleep disturbances, and anxiety. For a child with bipolar disorder, the slightest frustration can set off a flood of crying, screaming, or anxiety symptoms. Unlike toddlers who have temper tantrums that are time limited, children with bipolar disorder can have rage episodes that can last from 2 to 3 hours.

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)Is there a gun in your house? 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? 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?

The nurse performs motivational interviewing with a college student in the university health center regarding the student's history of binge drinking. The nurse hopes to ascertain the student's readiness to change her behavior and encourage her to make better choices related to alcohol use. The interview should begin with: A)Listening empathetically to establish trust B)Eliciting feelings about how the drinking behavior is affecting the student's life C)Noting discrepancies between attitudes toward alcohol and alcohol-associated harms D)Being supportive of the student's life goals

A)Listening empathetically to establish trust Feedback Nurses in university health services are ideally positioned to identify at-risk students and use motivational interviewing to ascertain the students' readiness to change their behavior. Motivational interviewing begins by establishing trust, being an empathic listener, and instilling hope and positive regard—communication skills familiar to nurses, which are the foundation of the nurse-client relationship. Once the nurse establishes rapport, brief motivational interviewing consists of specific cognitive strategies such as eliciting feelings about how the drinking behavior is affecting the student's life, noting discrepancies between attitudes toward alcohol and alcohol-associated harms, emphasizing strengths, supporting life goals, and empathically supporting the student on ways to implement change or remaining neutral when met with ambivalence.

Which risk factors are associated with committing gun-related homicide? (Select all that apply.) A)Low income B)Lack of education C)Female gender D)Being a victim of discrimination E)Lack of employment opportunities

A)Low income B)Lack of education D)Being a victim of discrimination E)Lack of employment opportunities Feedback Factors that associated with committing gun-related homicides are as follows: low income, being a victim of discrimination, lack of education, and lack of employment opportunities. Most often, males are the victims as well as the perpetrators of homicides.

A woman mentions that her 6-month-old son has demonstrated some odd behavior. She thinks it might be related to autism. She asks what age would be best to have screening done on the child. The nurse should respond: A)Now, as an infant B)When the child begins to walk C)When the child is preschool-aged D)When the child starts school

A)Now, as an infant Feedback In the past, diagnosis of autism was often delayed until preschool because clinicians would look for evidence of language impairments before making a definitive diagnosis. More recently, the emphasis is on screening for prodromal symptoms in infancy with the hope that some of the more debilitating features of the disorder might be mitigated with early intervention and treatment.

Which exemplifies cultural diversity? A)People from South Korea, Brazil, and Nigeria all living in the same apartment complex B)A town in which everyone speaks Spanish, is originally from the same region in Mexico, and prepares similar types of food C)A university where all of the professors share the same political views D)A workplace in which accountants, lawyers, marketing executives, information technologists, and maintenance workers are all employed

A)People from South Korea, Brazil, and Nigeria all living in the same apartment complex Feedback A culture is a social group that shares ethnic origins, language, and characteristic features of everyday life, such as the town in which everyone speaks Spanish. Culture also refers to a group of people who share attitudes, values, goals, and practices, such as the university with professors who all share the same political views. Diversity is a range or variety of differences, such as the workplace that employs people of various occupations. More recently, the term cultural diversity has come into use to describe people of different racial or ethnic backgrounds in society, such as the apartment complex with residents from several different countries.

Reasons blended families are becoming more widespread include an increase in the number of: (Select all that apply.) A)People who remarry following a divorce B)People who remain single after being widowed C)Recognized gay and lesbian relationships D)Married couples having children E)Couples cohabiting with children from prior relationships

A)People who remarry following a divorce C)Recognized gay and lesbian relationships E)Couples cohabiting with children from prior relationships Feedback Blended families form when two partners cohabit or marry and live with children from a previous relationship or relationships. This type of family has become widespread as more divorced or widowed people marry and more gay and lesbian relationships become recognized.

Which are among the key categories of indicators of health presented in Healthy People 2020? (Select all that apply.) A)Physical activity B)Exposure to allergens C)Responsible sexual behavior D)Tobacco use E)Occupation

A)Physical activity C)Responsible sexual behavior D)Tobacco use Feedback Healthy People 2020 include lists of determinants or indicators of health that can help families direct priorities to address their own health risks. These leading indicators of health relate to physical activity, obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to healthcare. Exposure to allergens and occupation are not key categories of leading indicators of health.

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)Siblings all brushing their teeth together before bed every night D)Taking a walk together around the neighborhood after dinner each evening 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 nurse is selecting a health appraisal related to alcoholism to assess health risk in a client. Which are examples of information that should be included in the appraisal? (Select all that apply.) A)Signs and symptoms of alcoholism B)Recommended daily limit of alcoholic drinks consumed per day C)Examples, such as frequently drinking an alcoholic beverage in the morning D)Incidence rates of alcoholism in the United States E)Information on local substance abuse programs

A)Signs and symptoms of alcoholism B)Recommended daily limit of alcoholic drinks consumed per day C)Examples, such as frequently drinking an alcoholic beverage in the morning E)Information on local substance abuse programs Feedback Appraisals often include information that identifies a common problem, specific criteria that confirm that the problem exists, tangible examples of the problem, and treatment recommendations. Incidence rates are often included in databases but would not be presented in a health appraisal.

The nurse suspect a 16-year-old client is being physically abused by her boyfriend. Compared with adolescent girls with no abuse history, this client is at significantly increased risk for: (Select all that apply.) A)Smoking cigarettes B)Anorexia C)Becoming pregnant D)Assaulting her siblings E)Theft

A)Smoking cigarettes B)Anorexia C)Becoming pregnant Feedback Adolescent girls who reported experiencing sexual or physical assault were significantly more likely to report smoking, attempt suicide, use cocaine, become pregnant, and engage in unhealthy eating habits, compared with adolescents with no abuse history. There is no evidence of an association of assaulting one's siblings or theft with exposure to violence.

The nurse examines a client who is taking haloperidol for schizophrenia and notices that she habitually twists her tongue and arms. This side effect of her medication is known as: A)Tardive dyskinesia B)Akathisia C)Dystonia D)Neuroleptic malignant syndrome

A)Tardive dyskinesia Feedback Of particular concern with the first-generation antipsychotics is the risk of developing tardive dyskinesia. This condition, which is irreversible, is characterized by twisting movements of the tongue, limbs, and torso. Some of the other debilitating side effects of the first-generation antipsychotics include akathisia (extreme restlessness in the limbs), dystonia (severe stiffness in muscles, most prominently the neck), blurred vision, urinary retention, and neuroleptic malignant syndrome.

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)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? 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?

The nurse assesses a family in which the wife and mother has recently been diagnosed with breast cancer. Which factors will likely affect the family's response to the health risk that this diagnosis presents? (Select all that apply.) A)What the husband and wife learned about dealing with serious illness in their families of origin B)Whether the family is covered by health insurance C)How the children tend to cope with stressful situations D)The response of fellow members of the family's mosque E)The incidence rate of breast cancer in the family's community

A)What the husband and wife learned about dealing with serious illness in their families of origin B)Whether the family is covered by health insurance C)How the children tend to cope with stressful situations D)The response of fellow members of the family's mosque Feedback Families approach the idea of health risk in many different ways depending on (1) what they have learned from their past experiences in their family of origin; (2) economic circumstances, especially healthcare insurance coverage; (3) stress and coping styles; and (4) internal and external culture. The incidence rate of breast cancer in the family's community is not as likely to affect their response.

At what age are prodromal assessment symptoms of bipolar disorder typically evident? A)Younger than 3 years of age B)Younger than 6 years of age C)Younger than 9 years of age D)Younger than 12 years of age

A)Younger than 3 years of age Feedback In most cases, the prodromal symptoms of bipolar disorder are evident when the child is younger than 3 years of age.

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)"I ran out of pills a week ago and have felt sweaty and agitated ever since." Feedback Withdrawal is reduction in prolonged substance use that results in problematic behavioral, physiological, and cognitive changes. Tolerance is the diminished physical and/or psychological response to effects of alcohol or illicit substances. A person develops tolerance when he or she needs to use higher doses of alcohol or illicit substances to achieve the desired euphoric effect. Feeling like one cannot function without a substance is a sign of substance dependence. Praising the medication and requesting another refill could be a sign of substance dependence.

The nurse assesses a new client and performs a standard screening for intimate partner violence. Which is the most appropriate question to ask first? A)"Are you in danger now?" B)"It's normal for couples to disagree about things. What happens when you and your partner disagree?" C)"Do you ever think about hurting yourself, cutting, stopping eating, or purging food?" D)"Have you ever thought about or been granted a restraining order?"

B)"It's normal for couples to disagree about things. What happens when you and your partner disagree?" Feedback The most appropriate question to ask first is, "It's normal for couples to disagree about things. What happens when you and your partner disagree?" This question is open-ended and allows the client to share information about behavior that she may not even recognize as abuse. The other questions listed are more appropriate to ask as follow-up questions, once the woman has stated that she is being abused.

The identification of parental age as a potential risk factor in autism raises the issue that lifetime exposure to environmental toxins might damage the sperm and the ovum. Research findings suggest that the risk of autism in relation to age of the parent at the time of the child's birth is increased by: A)30% if the father is older than 40 years B)30% if the mother is older than 35 years C)40% if the father is older than 35 years D)40% if the mother is older than 40 years

B)30% if the mother is older than 35 years Feedback Researchers found that the risk of autism increased by 30% if the mother was older than 35 years and 40% if the father was older than 40 years at the time of the child's birth.

The nurse assesses a 15-year-old client who shows some signs of possible drug addiction. The nurse reviews the client's health and family history, looking for key indicators for risk of substance dependence, such as: (Select all that apply.) A)Obesity B)Age at first use of illicit substance C)Family history of alcoholism D)Presence of a learning disability E)Early onset of diabetes

B)Age at first use of illicit substance C)Family history of alcoholism Feedback In conducting a complete biopsychosocial history, two of the key indicators for risk of substance dependence are age at first use and a family history of substance use disorder. Obesity, presence of a learning disability, and early onset of diabetes are not key indicators for risk of substance dependence.

A politically active community health nurse assists in drafting state legislation for alcohol use laws. Which principles of the World Health Organization should be integrated into the draft legislation? (Select all that apply.) A)Legislation should be guided and formulated by the interests of local business owners. B)Alcohol policies should be equitable for all in the state. C)Alcohol policies should be sensitive to cultural contexts. D)Legislation should protect those with substance use disorders from serving extended prison sentences. E)Legislation should protect those exposed to the harmful effects of drinking by others.

B)Alcohol policies should be equitable for all in the state. C)Alcohol policies should be sensitive to cultural contexts. E)Legislation should protect those exposed to the harmful effects of drinking by others. Feedback Public policies and interventions to prevent and reduce alcohol-related harm should be guided and formulated by public health interests, not the interests of local business owners, and based on clear public health goals and best available evidence. Alcohol policies should be equitable and sensitive to national, religious, and cultural contexts. Protection of populations at high risk for alcohol-related harm and those exposed to the harmful effects of drinking by others should be an integral part of public health policies. Populations affected by the harmful use of alcohol should have access to affordable and effective prevention and care services. Legislation should not protect those with substance use disorders from serving extended prison sentences.

In comparison with other generations, members of generation X: A)Respect authority, but want recognition for their individual contributions B)Are likely to multitask and have more than one career in their lifetimes C)Prefer authoritarian leadership and direct personal interaction with superiors and others D)Are goal oriented and focused people who desire guidance

B)Are likely to multitask and have more than one career in their lifetimes Feedback People of the war generation were used to authoritarian leadership and direct personal interaction with superiors and others. "Baby boomers" respected authority, but wanted recognition for their individual contributions. People who were born between 1965 and 1983 are known as generation X (Gen X) and are likely to want more flexibility in their lifestyles. Whereas their parents were goal-oriented and focused, people in Gen X are more likely to multitask and have more than one career in their lifetimes. People born between 1984 and 2002 are known as generation Y and also want flexibility in life like their Gen X counterparts, but with guidance.

Which best describes the function of the grand nursing theory in nursing practice? A)Presents a systematic view of related statements to describe, explain, predict, or prescribe a phenomenon of interest B)Relates human experience to nursing practice and nursing care C)Assesses health patterns in 11 areas of family health D)Engages the family as a way to identify its strengths with attention to family dynamics and concerns related to health and illness

B)Relates human experience to nursing practice and nursing care Feedback In nursing practice, grand nursing theory relates human experience to nursing practice and nursing care. Theory presents a systematic view of related statements to describe, explain, predict, or prescribe a phenomenon of interest. Functional Health Patterns is an approach to family assessment that has as its goal to assess health patterns in 11 areas of family health. Family Systems is an approach to family assessment that has as its goal to engage the family as a way to identify its strengths with attention to family dynamics and concerns related to health and illness.

A nurse is preparing to make a mandatory report of intimate partner violence (IPV) with regard to the caregiver of a pediatric client. Which actions are appropriate? (Select all that apply.) A)Tell the child about the possibility of filing a mandatory report B)Determine whether it will be safe to inform the child about the report C)Ask about the child's incidence of using drugs D)Ask the victim whether she has a plan to keep herself and the child safe E)Ask the victim if she would like to file a report at the same time as you file yours

B)Determine whether it will be safe to inform the child about the report D)Ask the victim whether she has a plan to keep herself and the child safe E)Ask the victim if she would like to file a report at the same time as you file yours Feedback The nurse should take the following actions when making a mandatory report of IPV: (1) Talk with the adult victim (not the child) about the possibility of filing a mandatory report. (2) Consider the safety concerns of filing. (3) Determine whether it will be safe to inform the children about the report. (4) Share concerns of safety with the Child Protective Agency. (5) Ask about the perpetrator's behaviors with questions such as the following: What is the worst thing he or she has done? Does he or she own a gun? Has he or she been arrested? Does he or she use drugs (not does the child use drugs)? Do you think he or she is capable of hurting you or your children? (6) Address safety planning with the nonoffending victim. (7) Consider filing in concert with the adult victim.

During a home visit of a client with high blood pressure with whom the nurse has developed a strong therapeutic relationship, the nurse learn that the client keeps a large salt shaker near the stove and heavily salts whatever he is cooking. He also keeps a salt shaker on the dinner table and adds more salt when eating. The nurse suggests removing the salt shaker near the stove and only lightly salting food when eating as a way to help reduce the client's sodium intake. This intervention would most likely achieve the goals for assessment associated with which nursing theory? A)Science of Unitary Beings B)Health as Expanding Consciousness C)Roy Adaptation Model D)Self-care Agency

B)Health as Expanding Consciousness Feedback The nursing goals for assessment for the theory of Health as Expanding Consciousness are to develop a therapeutic relationship with the family that helps them identify areas for change and to build a story with the family as a means to change a pattern. The nursing goals for assessment for the theory of Science of Unitary Beings are to identify family patterns, which enable nurses to gain understanding and appreciation for the family, and to partner with families to make changes and define outcomes. The nursing goals for assessment for the theory of Roy Adaptation Model are to identify basic health needs and the key roles and relationships within the family and to determine how different stimuli affect the family's ability to adapt to change. The nursing goals for assessment for the theory of Self-care Agency are to identify roles and relationships within the family and to determine the family's ability to respond to critical situations and support each other.

The nurse is conducting a 15-minute interview with a family. On the basis of the five leading principles for interviewing, appropriate actions for the nurse to take include: (Select all that apply.) A)Having family members share their family history with you, going back several generations B)Listening actively as the family members speak C)Constructing an ecomap of the family D)Asking family members to prioritize their needs and to express their expectations regarding nursing care E)Pointing out the strong relationships they enjoy in their family and explaining how they will help them cope with the health issue of concern

B)Listening actively as the family members speak C)Constructing an ecomap of the family D)Asking family members to prioritize their needs and to express their expectations regarding nursing care E)Pointing out the strong relationships they enjoy in their family and explaining how they will help them cope with the health issue of concern Feedback Five leading principles that maximize information gleaned in a 15-minute family interview include the following: use of manners (introducing yourself), use of therapeutic conversation (using active listening), use of ecomaps and genograms, use of therapeutic questions (asking members to discuss their needs and expectations), and acknowledgment of family strengths. Having family members share their family history in detail would not be appropriate, as you do not have the time for that.

The nurse assesses a client who recently attempted suicide by prescription drug overdose. Based on knowledge of a recent study of the findings of the Third National Health and Nutrition Survey, what is the most important risk factor to assess for in this client? A)Substance abuse B)Major depressive disorder C)Social isolation D)Chronic pain

B)Major depressive disorder Feedback A recent study of the findings of the Third National Health and Nutrition Survey found that, after adjustment for other risk factors, a history of major depressive disorder was the strongest risk factor associated with attempted suicide for both men and women. Other risk factors include a history of substance abuse, suicide or self-mutilating behaviors, chronic pain, social isolation, stress, unemployment, and poverty.

The nurse performs an assessment of a client with schizophrenia. Which comorbid health conditions should the nurse most expect to find in this client? (Select all that apply.) A)Osteoarthritis B)Obesity C)Hypertension D)Breast cancer E)Cardiac complications

B)Obesity C)Hypertension E)Cardiac complications Feedback Clients with schizophrenia often have a myriad of comorbid chronic health conditions. Obesity, hypertension, and severe cardiac and metabolic complications all are much more prevalent in people with schizophrenia due to higher rates of smoking, poor nutrition, and lack of exercise. Osteoarthritis and breast cancer are not comorbidities associated with schizophrenia.

The nurse works with a client who has just been diagnosed with schizophrenia. While discussing the various medication options for this disorder, the nurse explains that some have been associated with the development of type 2 diabetes. The client explains that she is already at risk for developing diabetes and would like to avoid any medications that might promote the disease. On the basis of this information, which medication should this client most avoid? A)Haloperidol B)Olanzapine C)Fluphenazine D)Ziprasidone

B)Olanzapine Feedback Evidence is mounting that the second-generation antipsychotics, in particular clozapine and olanzapine, may increase the risk of developing new-onset type 2 diabetes. Haloperidol and fluphenazine are first-generation antipsychotics. Ziprasidone is a second-generation antipsychotic but less associated with development of type 2 diabetes than is olanzapine.

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)To identify family health practices within a social and historical context 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.

In a 15-minute family interview, after asking a question, the nurse pauses and remains silent while the grandmother, whose English is limited, replies to the question. The nurse makes eye contact with her and nods while she talks. When she is finished, the nurse asks a few follow-up questions. Which principle to maximize information during an interview is demonstrated in this behavior? A)Manners B)Use of therapeutic conversation C)Use of therapeutic questions D)Acknowledgment of family strengths

B)Use of therapeutic conversation Feedback When time is limited, purposeful and focused conversation, known as therapeutic conversation, can help build a relationship. Nurses validate family concerns with their active listening. Use of manners and common courtesies such as the nurse introducing himself or herself to the family indicates a desire to connect with the family and to instill trust in family members. Asking family members therapeutic questions helps them not only to identify their expectations about nursing care but also to assign priorities to their needs. Acknowledgment of family strengths leads the family to view their situation differently and makes them more likely to move toward more effective problem solving.

Which most accurately defines gender-based violence? A)A homicide of a female that occurs in the context of intimate partner violence B)Violence that targets people or groups of people on the basis of their gender C)A pattern of assaultive and coercive behaviors perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with the victim D)A type of violence typically committed by one gender but not the other

B)Violence that targets people or groups of people on the basis of their gender Feedback Gender-based violence is violence that targets people or groups of people on the basis of their gender. Femicide is the homicide of a female that occurs in the context of intimate partner violence (IPV). IPV is a pattern of assaultive and coercive behaviors perpetrated against an individual by one who is, was, or wishes to be in an intimate relationship with that individual and that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, deprivation, intimidation, and threats. Gender-based violence is based on the gender of the victim, not that of the perpetrator.

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)A 63-year-old woman's sense of responsibility as the oldest among her siblings for taking care of her chronically ill parents 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.

Pediatric providers face special issues in screening for intimate partner violence (IPV) in a caregiver who is accompanying a child. Which are appropriate strategies for addressing this screening issue? (Select all that apply.) A)Asking the mother directly, with the child present B)Asking the child directly, while the mother is out of the room C)Asking the mother indirectly, with a written questionnaire or computer survey D)Screening for the safety and dangerousness of the situation before deciding whether to ask the mother E)Informing parents about mandatory reporting law after asking questions

C)Asking the mother indirectly, with a written questionnaire or computer survey D)Screening for the safety and dangerousness of the situation before deciding whether to ask the mother Feedback Appropriate strategies include the following: asking mothers indirectly (written questionnaire, computer survey), asking mothers directly, without (not with) the child present; informing parents about mandatory reporting laws before (not after) asking questions; screening for safety and dangerousness of the situation; and being aware of resources and referrals. It would not be appropriate to ask the child about IPV that the mother may have experienced.

The nurse assesses a client who recently immigrated to the United States from Haiti. The client reports upset stomach and diarrhea. He explains that a witch doctor put a curse on him and that he sometimes sees evil spirits around him. The most accurate way to describe this type of illness would be as a: A)Mental illness B)Gastrointestinal disorder C)Culture-bound syndrome D)Hypochondria

C)Culture-bound syndrome Feedback Mental health and, conversely, mental illness are concepts bound by culture. Understanding of what connotes mental health is shaped by social norms that evolve from generation to generation. In Western cultures, medical science interprets any deviation from normative function of the five senses as indicative of a psychotic disorder. Hearing a voice, claiming to see an object, or having certain tactile sensations is viewed as a pathological state to be treated by psychiatric professionals. In some parts of the world, spiritual possession and belief in healers with special powers are culture-bound syndromes. Although gastrointestinal symptoms are involved in this client's condition, he suffers from more than just a gastrointestinal disorder. Hypochondria, or a condition in which one imagines that he or she has an illness but really does not, would not be applicable because the client has real symptoms and comes from a culture in which his illness is acknowledged as such.

The nurse works with a recovering heroin addict who is currently receiving opioid substitution treatment. Besides reducing his use of heroin, what additional benefits are offered by this treatment? (Select all that apply.) A)Reduction in alcohol use B)Weight loss C)Decrease in transmission of HIV D)Improving the client's overall health E)Decrease in depression

C)Decrease in transmission of HIV D)Improving the client's overall health Feedback Opioid substitution programs are effective in decreasing the transmission of HIV infection, reducing injecting drug use, and improving the health of people addicted to opioids. They are not associated with a reduction in alcohol use, weight loss, or a decrease in depression.

An injury prevention objective of Healthy People 2020 is: A)Prevention of drug-related deaths B)Identification of improper chemical storage in homes C)Decreased incidents of homicide, child maltreatment, and physical assaults D)Elimination of alcohol possession by adolescents on school property

C)Decreased incidents of homicide, child maltreatment, and physical assaults Feedback The injury prevention objectives of Healthy People 2020 include the following: (a) prevention and reduction of firearm-related (not drug-related) deaths; (b) identification of improper firearm (not chemical) storage in homes; (c) surveillance of external causes of injury in emergency departments; (d) decreased incidents of homicide, child maltreatment, and physical assaults; (e) prevention and reduction of sexual assaults; and (f) elimination of weapon (not alcohol) possession by adolescents on school property.

The nurse teaches a client about pharmacologic treatments for alcohol-dependent disorders. The client correctly understands the teaching when she tells the nurse that a medication that induces aversive effects if alcohol is consumed is: A)Naltrexone B)Acamprosate C)Disulfiram D)Buprenorphine

C)Disulfiram Feedback Naltrexone and acamprosate have pharmacologic properties that diminish craving for alcohol, whereas disulfiram induces aversive effects if alcohol is consumed. Opioid substitution treatment consists of administering methadone or buprenorphine in prescribed doses to injection drug users in programs administered by governments.

A woman who is at high risk for alcohol abuse has just found out that she is pregnant. The nurse counsels her about the long-term effects of alcohol on the child. The nurse should include mention of: (Select all that apply.) A)Down syndrome B)Type 1 diabetes C)Low IQ D)Facial anomalies E)Short attention span

C)Low IQ D)Facial anomalies E)Short attention span Feedback Alcohol use during pregnancy is a serious public health concern because of the multiple deleterious, lifelong effects of alcohol on the child. These lifelong effects include low IQ, hyperactivity, short attention span, distinctive facial anomalies, and structural brain defects. Down syndrome is the result of a genetic defect and is not associated with alcohol use in the mother. Type 1 diabetes is also not associated with alcohol use in the mother.

The nurse works with a 16-year-old client who has an alcohol use disorder. Which mental disorder, highly correlated to substance use disorder, should the nurse also assess for in this client? A)Obsessive compulsive disorder B)Anxiety disorder C)Major depression D)Bipolar disorder

C)Major depression Feedback In the United States, substance use is highly correlated with a range of mental disorders and serious psychological distress. Three times as many youth 12 to 17 years of age who were diagnosed with major depression in the past year met criteria for substance use disorder (18.2%), as compared with youth who did not have a history of mental illness (5.8%).

The community health nurse is concerned with the prevalence of new HIV infections in the community and understands the strong correlation between substance use disorders and HIV. Which interventions should the nurse promote in the community health clinic to best address this problem? (Select all that apply.) A)12-step self-help groups B)Family and couples therapy C)Opioid substitution treatment D)Syringe exchange programs E)Motivational interviewing

C)Opioid substitution treatment D)Syringe exchange programs Feedback Opioid substitution treatment and syringe exchange programs have been effective in lowering the rates of HIV infection among injection drug users in both developed and developing countries. Self-help groups such as Alcoholics Anonymous are effective in assisting people in countries with high rates of alcohol abuse but would not help decrease the rate of HIV infection. Family and couples therapy also would not address the underlying problems among injection drug users that promote the spread of HIV.

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)Recent divorce E)Annual salary of $22,000 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.

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)School nurse Feedback School nurses play a pivotal role in recognizing both children who are being victimized and those who are perpetrating violence, as they are in daily contact with the children. The parents of the children might know whether their own child is a victim or a perpetrator, but they likely would know the other children involved. The child's primary care provider and next door neighbor are not as likely to know of violence experienced or perpetrated by children as the school nurse is, due to the nurse's more frequent contact with the children and location in the school setting.

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 secondary prevention strategy? A)Creating and broadcasting a public service announcement that raises awareness about IPV 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

C)Screening a woman for evidence of abuse who has several risk factors for IPV 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. Creating and broadcasting a public service announcement 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 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)Share any genograms and ecomaps that illustrate relationships with family members 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 is speaking with a 14-year-old client who has attempted suicide by cutting his wrists in the past. How would the nurse implement a means-restriction approach to suicide prevention in this case? A)Teach the client to block out all thoughts of self-harm as soon as they arise B)Encourage the client to seek out counseling C)Suggest to the client's parents that they lock up all sharp knives in the house D)Recommend to the client's parents that the client be under constant surveillance

C)Suggest to the client's parents that they lock up all sharp knives in the house Feedback Community health nurses can promote "means restriction," especially in families where there is a member at risk for suicide. Families who own firearms should be encouraged to secure firearms using trigger locks and locking bullets in a separate location from the firearm. If a client informs the nurse that he or she is having thoughts of taking an overdose, then prescription or over-the-counter medications that may be fatal in overdose should be removed or secured in a safe location. Although families might presume that removing the instrumental means of harm is an ineffective gesture, the community health nurse must reassure the family that their actions are sending a strong, unambiguous message to the potential victim that people care about them and will take any necessary steps to ensure their safety. Means restriction does not involve blocking out thoughts of self-harm, counseling, or constant surveillance.

The client states a history of substance abuse but reports current abstinence. If valid, this report means that the client has not used alcohol or illicit substances in at least how many months? A)3 B)6 C)9 D)12

D)12 Feedback If there is no use of illicit substances or alcohol in the preceding 12 months, a person is considered abstinent.

On the basis of the understanding of demographic risk factors related to mental illness, which individual would be most likely to have an untreated psychiatric disorder? A)50-year-old Caucasian man B)35-year-old Korean woman C)12-year-old Hispanic girl D)18-year-old African-American man

D)18-year-old African-American man Feedback Young African-Americans and the elderly have the highest rates of unmet psychiatric needs.

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)A conversation the client has with his healthcare provider 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.

Which mental illness is most likely to go untreated? A)Anxiety B)Bipolar disorder C)Depression D)Alcoholism

D)Alcoholism Feedback Those suffering from alcoholism and addictive disorders are most likely to go untreated (78%), followed by anxiety disorders (57%), depression (56%), and bipolar disorder (50%).

There is substantial variation in the incidence of mood disorders and suicide across cultures worldwide. The two most consistent factors associated with the incidence of depression and anxiety are: A)Number of parents in the home and education level B)Degree of social support and employment status C)Number of parents in the home and degree of social support D)Education level and employment status

D)Education level and employment status Feedback Across all cultures, the two most consistent social factors associated with the incidence of depression and anxiety are education level and employment status. The social factors with the lowest impact are degree of social support and number of parents in the home.

The nurse counsels a college student who admits to frequent binge drinking. Based on her age and environment, the most likely reason for this student's binge drinking is to: A)Deal with family dysfunction B)Cope with violence C)Escape painful emotions D)Enhance mood or affective state

D)Enhance mood or affective state Feedback Unlike their younger peers, who may use alcoholic beverages to cope with family dysfunction, violence, or painful emotions, college students are more likely to engage in heavy or binge drinking to enhance their mood or affective state.

The nurse assesses a 19-year-old client for alcohol abuse. Which would be the most significant risk factor for alcohol abuse in this client? A)African-American race B)Female gender C)History of type 1 diabetes D)Enrollment in college

D)Enrollment in college Feedback A major risk factor for problem drinking in young adults is enrollment in college. The significant difference (p < .05) in binge and heavy drinking between college students (39.1%) and their peers (35.4%) not enrolled in college has remained unchanged over the past decade and suggests campus cultural norms are a strong factor contributing to significantly higher health risks. Rates of binge alcohol use vary by race and ethnicity and are highest among American Indians or Alaska Natives (24.3%). Female gender and history of type 1 diabetes are not significant risk factors for alcohol abuse.

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)Interfamily strain 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").

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)Living room because there are windows Feedback Components for safety planning include a crisis/"disaster" plan, a place to go, how to get there, and other considerations. Safety planning involves discussing measures that the client may not have considered. For example, if an argument occurs at home, the woman should stay away from (1) the kitchen because sharp instruments are there and (2) the bathroom because the space is small and contains many hard surfaces. She should go to a room with a window or door, carry her cell phone, with 911 set to speed dial, and tell family members and neighbors. The basement is not appropriate because it is less likely to have windows or doors.

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)Mental status examination Feedback There is high comorbidity of substance use disorders with major mental illness. The mental status examination is a valuable tool in identifying signs and symptoms of major mental illness that co-occur with substance use. The mental status examination can alert the nurse to cognitive changes that are the result of chronic substance use and can help differentiate symptoms from other medical conditions, such as dementia or delirium.

The nurse works in the ER when a client arrives with respiratory depression associated with a heroin overdose. Which medication should the nurse expect to be ordered for this client? A)Naltrexone B)Acamprosate C)Disulfiram D)Naloxone

D)Naloxone Feedback Naloxone is an opioid antagonist that blocks the opioid receptors and temporarily reverses respiratory depression associated with opioid overdose. Naltrexone and acamprosate have pharmacologic properties that diminish craving for alcohol, whereas disulfiram induces aversive effects if alcohol is consumed.

Primary, secondary, and tertiary levels of prevention help reduce risk, identify and limit disabilities, and reduce complications of mental health problems. Which exemplifies a tertiary prevention strategy for mental health problems? A)Screen for mental health disorders B)Refer high-risk people for diagnostic services C)Provide mental health services following stressful community events D)Promote support groups for people with mental health disorders

D)Promote support groups for people with mental health disorders Feedback Tertiary prevention strategies include promoting support groups for people with mental health disorders and initiating health-promotion activities as a part of rehabilitation services. Secondary strategies include screening for mental health disorders, referring high-risk people for diagnostic services, and providing mental health services following stressful community events.

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)Providing a woman who is being abused by her husband the number to an abuse hotline so that she can get help leaving him 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 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)Relationships across two or more generations 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.

The nurse works with a client who was just diagnosed with major depression. Which would the nurse most suspect will be prescribed as the first line of treatment for this client? A)Tricyclic antidepressant (TCA) B)Electroconvulsive therapy (ECT) C)Stimulant D)Selective serotonin reuptake inhibitor (SSRI)

D)Selective serotonin reuptake inhibitor (SSRI) Feedback In general, the SSRIs are the first line of treatment for major depression because they are well tolerated and easy to administer in once-a-day dosing. An older class of antidepressants, TCAs, is a second-line treatment because these antidepressants have strong anticholinergic side effects and dosing has to be gradually titrated before a client reaches a therapeutic level. Both the SSRIs and the TCAs can take 4 to 6 weeks before reaching therapeutic blood levels—a serious concern when working with acutely suicidal clients. For that reason, electroconvulsive therapy (ECT) may be used for clients who are acutely suicidal or exhibiting profound neurovegetative signs of depression. Stimulants are prescribed for those with attention-deficit/hyperactivity disorder.

The case manager for two families with children who have type 2 diabetes is struck by the differences between the families. In one family, the parents are intentional about providing fruits and vegetables for their child to eat, regularly remind him to check his blood glucose level, and make sure that he engages in some sort of outdoor activity every afternoon. In the other family, the kitchen is stocked primarily with potato chips and processed snack foods, the child does not monitor her glucose level consistently, and she spends her afternoons texting or watching videos on the sofa. By this comparison, the case manager realizes how critical the family is in forming the attitude the child has toward caring for his or her own health. Which grand nursing theory does this experience best illustrate? A)Science of Unitary Beings B)Health as Expanding Consciousness C)Roy Adaptation Model D)Self-care Agency

D)Self-care Agency Feedback In the Self-care Agency theory, family is the foundation for self-care and a setting for care. In the Science of Unitary Beings theory, family represents a group energy field and is part of an individual's environment, along with individual patterns. In the Health as Expanding Consciousness theory, families are environments that are active, constantly interacting, and evolving. In the Roy Adaptation Model, roles and relationships within the family are part of family functioning and adaptation.

Epidemiologic studies are essential to target programs to populations in greatest need. To help measure progress toward improving mental health, which is a primary focus of epidemiologic studies? A)Physical costs B)Emotional costs C)Mental costs D)Social costs

D)Social costs Feedback Epidemiologic studies describe the social costs of mental illness and are essential to target programs to populations in greatest need.

The school nurse follows up with a third grader who was recently diagnosed with attention-deficit/hyperactivity disorder (ADHD) to make sure that he takes his prescribed medication. What type of medication would the nurse most suspect this client is taking? A)First-generation antipsychotic B)Second-generation antipsychotic C)Mood stabilizer D)Stimulant

D)Stimulant Feedback The pharmacologic treatment for ADHD is stimulants and for bipolar disorder second-generation—not first-generation—antipsychotics and mood stabilizers.

The nurse screens a woman who is 6 months pregnant for alcohol use. Which screening instrument should be used? A)AUDIT-C B)CAGE C)SMAST-G D)T-ACE

D)T-ACE Feedback The T-ACE screening instrument has been validated for use with women who are pregnant. All adults in primary care should be routinely screened for alcohol use with the AUDIT-C or CAGE questionnaire. The AUDIT-C, CAGE, and SMAST-G screening instruments are available in a pocket-sized brochure to facilitate use in all primary care settings.

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)Traditional gender roles 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.

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)Unhealthy family interactions 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.