N320 PH Exam 2 Ch. 11, 21, 22, 23, 24, 25

15. A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? a. Be willing to enter into a long-term relationship with families. b. Direct and control the clients care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency

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

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

ANS: A Homeless persons would probably avoid the police station, and many may not wish to go to the medical centeralso, there would be transportation issues. The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population the homeless shelter would be an appropriate location.

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

ANS: A It is important to provide comprehensive, family-centered, one-stop services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups.

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

ANS: A Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

3. A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? a. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

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

4. A patient tells a nurse, I know all about this already. I read about it on the Internet. The patient then summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a. Were you able to find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information? d. Did you enjoy reading the material on the website?

ANS: A, B, C To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc.

1. Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) a. I always address the problem that the client believes is the most important. b. I avoid asking clients for income or financial information, because this is an invasion of privacy. c. I try to observe the client's cultural traditions as I probe for signs of abuse. d. I make sure to do a complete assessment since we often don't know when the person will return to the clinic.

ANS: A, C Because poverty is a primary cause of vulnerability, the nurse should include questions about the clients financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used. Focus on what data are needed to help the client that day with the problem the client believes is most important.

1. A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning.

ANS: A, C For this audience, the best approach will be to use adult experiences and practical problems as learning motivators, for instance, appealing to adults sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions.

2. Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. The necessary ability to perform the skill b. An open mind to learning the new skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill

ANS: A, C, D Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor ability, having a sensory image of how to carry out the skill, having opportunities to practice the new skill.

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

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

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

ANS: B People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability.

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

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

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

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

3. Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Emphasize how to build learning from previous experiences. b. Use simple words to enhance understanding. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences.

ANS: B, C When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills.

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

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

1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge

ANS: C Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.

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

ANS: C Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB.

2. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material

ANS: C The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned.

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

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

5. A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. d. Strongly consider not applying, because this population will be expensive to treat.

ANS: D Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care).

6. Which of the following statements best describes an outcome of the Balanced Budget Act of 1997? a. Additional funding was provided to the State Childrens Health Insurance Program (SCHIP). b. Individuals were able to keep their health insurance when moving from one place to another. c. Patient privacy and security of health information was enhanced. d. A prospective payment system for home health services was created.

ANS: D The Balanced Budget Act of 1997 had some shifts in payment with the stipulations related to home health. In an attempt to curb the rapid growth in spending on home health and financial fraud in that industry, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective payment for home health services. The Health Insurance Portability and Accountability Act of 1996 was intended to help people keep their health insurance when moving from one place to another as well as provide privacy and security of personal health information. The State Childrens Health Insurance Program (SCHIP) was created by Title XXI of the Social Security Act in 1998.

2. Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a. Disadvantaged families b. Multi-problem families c. Resilient populations d. Vulnerable populations

ANS: D Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations.

11. A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider when providing care? a.All teen pregnancies are considered high-risk. b.Limited self-care knowledge can lead to pregnancy complications. c.Pregnant teens are likely to receive prenatal care late in the pregnancy. d.Pregnant teens may have limited financial resources to pay for care.

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

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

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

15. Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder abuse? A. "Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." B. "Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us." C. "She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake." D. "We have to feed Mom baby food now because she has trouble chewing and swallowing regular food."

ANS: A "Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." Giving medication to induce confusion or drowsiness so that the elders will be less troublesome or will need less care is considered a form of elder abuse. Such medication may also make it easier for adult children to control the elder's assets. All other options are examples of proper care. DIF: Cognitive Level: Apply (Application) REF: p. 467

18. A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? A. A combination of interventions, beginning with changing the environment B. Acupuncture to reduce the nicotine cravings C. Behavior modification through hypnosis D. Nicotine replacement products

ANS: A A combination of interventions, beginning with changing the environment The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker's environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases. DIF: Cognitive Level: Apply (Application) REF: p. 448

4. Which of the following persons is most likely to be assaulted? A. A young man B. A young woman C. An older man D. An older woman

ANS: A A young man Men are far more likely to be assaulted or killed than are women. The greatest risk factor for an individual's victimization by violence is age; youths are at significantly higher risk. DIF: Cognitive Level: Understand (Comprehension) REF: p. 457

6. In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? A. Absence of culturally competent care B. Availability of specialists C. Distance of health care facilities from the place of residence D. High cost of health care

ANS: A Absence of culturally competent care Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers. For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 395

1. A resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? A. Advanced nurse practitioner B. Allergist C. Pediatrician D. Pulmonologist

ANS: A Advanced nurse practitioner The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). In contrast, urban adults are more likely to seek care from a medical specialist. DIF: Cognitive Level: Apply (Application) REF: p. 393

14. Three women were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? A. Alcohol blood level B. Cardiac workup C. Pregnancy test D. STD tests

ANS: A Alcohol blood level Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. DIF: Cognitive Level: Apply (Application) REF: p. 444

4. A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? A. Cancer B. Memory loss C. Skin rashes D. Headaches

ANS: A Cancer Chronic exposure to pesticides and chemicals may lead to cancer. DIF: Cognitive Level: Apply (Application) REF: p. 393

4. A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child? a.Concern that the child is being mistreated by other children b.Concern that the child has developmental delays c.Concern that the child is given adequate food during lunch d.Concern that the child may need to sit in the front in order to be able to see well

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

9. A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following actions would the nurse most likely take? a.Assist teen mothers to learn about their body changes during pregnancy. b.Develop programs that allow teen mothers to complete their education. c.Offer courses in proper care of babies and how to be a parent. d.Monitor pregnant teens to detect early problems with pregnancy.

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

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

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

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

ANS: B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.

14. During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client indicates a lack of insight into his violent behavior? A. "I have been taking out my frustrations with work on my girlfriend." B. "I love my girlfriend and didn't want to hurt her; it was an accident." C. "It might be a good idea for me to temporarily leave the house when I feel myself becoming angry." D. "When I drink alcohol, I become more abusive toward my girlfriend."

ANS: B "I love my girlfriend and didn't want to hurt her; it was an accident." An alternative to ending the relationship is the male partner's attendance at programs for batterers. These programs are most effective if they are court-mandated and if the man's underlying values about women are addressed, as well as his violence. Violence is defined as those nonaccidental acts that result in physical or psychological injury. Although this client may now be feeling remorse, at the time the violent act was committed against the girlfriend, the intent was to inflict harm and maintain control. It was not an accident. The other three statements indicate an admission of a problem—at least on the surface. DIF: Cognitive Level: Apply (Application) REF: p. 466

11. Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child? A. "I have stopped using a switch on my child, and I am learning to count to 10 before reacting." B. "I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." C. "I use time-outs when my child acts out or is naughty. Sometimes my child doesn't cope well with this, but I am persistent." D. "When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are."

ANS: B "I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." Emotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. Yelling at a child and threatening loss of love are devastating. DIF: Cognitive Level: Analyze (Analysis) REF: p. 464

9. A home health client has been taking 50 mg of meperidine, a narcotic analgesic, every 4 hours for pain. Which of the following statements made by a nurse to the client's physician indicates a need for further education on narcotics? A. "You need to decrease the time interval between doses to every 3 hours so that my client will maintain pain relief." B. "You need to discontinue that order before my client becomes addicted." C. "You need to increase the meperidine so that my client will achieve adequate pain relief." D. "You need to give my client something in addition to the meperidine."

ANS: B "You need to discontinue that order before my client becomes addicted." Opiates are by far the most effective drugs for pain relief. When these drugs are used for pain control, only approximately 0.1% of those clients will develop addiction, and therefore, fear of addiction should not be used as a reason to undertreat pain. DIF: Cognitive Level: Apply (Application) REF: p. 439

4. A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? A. Alcoholism is determined primarily by the family environment. B. Alcoholism is determined partly by genetic factors. C. Persons who are alcoholics are usually women. D. Persons born with fetal alcohol syndrome are alcoholics from birth.

ANS: B Alcoholism is determined partly by genetic factors. Research has shown conclusively that familial transmission of alcoholism is at least in part genetic and not just the result of family environment. DIF: Cognitive Level: Apply (Application) REF: p. 436

8. Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? A. Beer B. Caffeine C. Cigarettes (nicotine) D. Mixed alcoholic beverages

ANS: B Caffeine Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications. DIF: Cognitive Level: Remember (Knowledge) REF: p. 438

10. A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? A. Avoiding touching the client except when necessary as part of the physical examination B. Calling the client by name, socializing before addressing the problem, and being very respectful C. Keeping all interactions direct, to the point, and targeted on the reason for presentation D. Maintaining a non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

ANS: B Calling the client by name, socializing before addressing the problem, and being very respectful The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual's dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior. DIF: Cognitive Level: Apply (Application) REF: pp. 400-401

18. Which of the following best describes a principle of care that the nurse should abide by when working with abusive families? A. Confront the abuser and shame him into penitence and a desire to change. B. Demonstrate respect for all family members, including the abuser. C. Exclude the abuser from family meetings because the abuser is the one creating problems. D. Notify the abuser's clergyman, boss, and others who can exert pressure for change.

ANS: B Demonstrate respect for all family members, including the abuser. Principles of giving care to families who are experiencing violence include the following: intolerance for violence; respect and caring for all family members; safety as the first priority; absolute honesty; and empowerment. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 470-471

13. The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which of the following should be the first action that is taken by the nurse? A. Arrange for the couple to attend marital counseling. B. Develop a plan for the wife's escape if the violence starts again. C. Teach the client how to avoid initiating her husband's anger. D. Work with the client on development of self-esteem.

ANS: B Develop a plan for the wife's escape if the violence starts again. Although marital counseling may be useful at an early stage of abuse, it is generally contraindicated at all other stages because of the risk to the woman's safety. Unfortunately, abuse tends to escalate in frequency and severity over time, and the man's remorse tends to lessen. A nurse encountering severe abuse needs to consider the safety of the woman and her children as the priority. The woman will need an order of protection and help in getting to a safe place. At the very least, the woman must design a carefully thought-out plan for escape and arrange for someone to call the police if another violent episode occurs. DIF: Cognitive Level: Apply (Application) REF: p. 466

12. A teacher sends a student to the school nurse because the student does not seem to be thinking clearly. The nurse notes that the student is having palpitations, as well as elevated pulse, blood pressure, temperature. Which of the following would most likely cause these symptoms? A. Alcohol B. Ecstasy (MDMA) C. Heroin D. Marijuana

ANS: B Ecstasy (MDMA) Ecstasy raises the body's temperature, pulse rate, and blood pressure. The other drugs listed would have a depressant effect. DIF: Cognitive Level: Apply (Application) REF: p. 440

5. Which of the following is the most likely reason for a man to rape a woman? A. Because the woman was asking for it B. For power and control C. Provoked by the woman's dress and behavior D. Sexual pleasure and release

ANS: B For power and control The underlying issues of rape are hostility, power, and control rather than sexual desire. DIF: Cognitive Level: Understand (Comprehension) REF: p. 459

1. Which of the following approaches has research suggested is the most effective way to approach drug addiction? A. Criminal justice system B. Harm reduction C. Punishment approach D. Substance abuse education

ANS: B Harm reduction The harm reduction model is a health care approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. DIF: Cognitive Level: Understand (Comprehension) REF: p. 434

12. Which of the following conditions of the rural environment provides increased opportunities for teaching? A. Increased interaction among residents due to neighbors visiting neighbors on the family farms B. Involvement in rural community activities provides more contact with community residents than in urban areas C. Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention D. Increased illnesses and injuries of rural residents require that they see nurses more often

ANS: B Involvement in rural community activities provides more contact with community residents than in urban areas Rural areas have fewer churches, stores, and schools. Thus, nurses may go to the same church, shop at the same stores, and/or have children in the same schools as their clients. There are also fewer organizations, so it is easier to become involved and meet everyone while participating. Visiting neighbors does not increase opportunities for teaching. The fact that nursing responsibilities include all levels of prevention is true of both urban and rural areas. The statement about increased illness and injuries in rural residents is wrong, because although illnesses and injuries are increased, rural residents often do not seek care for these conditions. DIF: Cognitive Level: Understand (Comprehension) REF: p. 402

17. Which of the following statements accurately describes why methadone is used to treat heroin addiction? A. Addicts come to prefer methadone instead of heroin. B. Methadone blocks the effects of heroin and reduces the craving. C. Methadone prevents further dependence on drugs. D. Methadone gives an enjoyable high, so addicts continue treatment.

ANS: B Methadone blocks the effects of heroin and reduces the craving. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting and effective when taken orally, it does not produce a "high," it is inexpensive, and it has few known side effects. DIF: Cognitive Level: Understand (Comprehension) REF: p. 447

21. A school health nurse is conducting drug screening to detect drug use by students before problems develop. Which of the following levels of prevention does this action represent? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Primary and secondary prevention

ANS: B Secondary prevention One means of secondary prevention is to institute early detection (screening) programs in schools, the workplace, and other areas in which people gather to determine the presence of substance abuse. DIF: Cognitive Level: Remember (Knowledge) REF: p. 442

7. A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother's arms. Which of the following information should the nurse share with the parents? A. Fetal nicotine syndrome may cause complications in the newborn. B. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. C. The baby will eventually develop tolerance to tobacco smoke. D. The parents should switch to chewing tobacco as long as the child lives in the home.

ANS: B The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than does mainstream smoke. DIF: Cognitive Level: Apply (Application) REF: p. 437

15. A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) A. Cholera B. Hepatitis C. High blood level of lead D. Malaria

ANS: B, C B. Hepatitis C. High blood level of lead Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis, as well as exposure to high levels of lead. Tuberculosis (TB) is more prevalent in Mexico than in the United States, and some infected immigrants work as migrant farmworkers. Additionally, TB tends to spread in regions where housing is crowded. Migrant farmworkers have higher rates of TB than most population groups. DIF: Cognitive Level: Apply (Application) REF: p. 398

20. Which of the following factors may lead to increased violence? (Select all that apply.) A. Adequate social support B. Feelings of powerlessness C. Violence shown in the media D. Living in a crowded environment

ANS: B, C, D B. Feelings of powerlessness C. Violence shown in the media D. Living in a crowded environment Factors that increase violence include seeing violence in daily life or in the media, living in poverty with few opportunities for employment, and feelings of powerlessness. Crowded environments can be a factor but can also lead to banding together for the common good. DIF: Cognitive Level: Understand (Comprehension) REF: p. 455|p. 456|p. 461

14. Which of the following is the leading cause of disability for Americans 15 to 44 years of age? a.Accidents b.Arthritis c.Major depressive disorder d.Workplace injuries

ANS: C Major depressive disorder is the leading cause of disability for Americans between the ages of 15 and 44 years.

3. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a.The child is accident-prone and clumsy. b.The child is being bullied and pushed around by other children. c.The child is more likely to have school absences. d.The child is in need of a vision screening.

ANS: C Poverty also increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. These children may also be hungry and fatigued and experience dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism (Emerson, 2004).

21. A nurse is working to improve her self-awareness in order to provide better client-centered care to clients living in poverty. Which of the following questions should the nurse ask herself? a.What would I do if I lived in poverty? b.What can be done to get poor people motivated to work? c.How have the media images of poor persons shaped my image of poverty? d.How can community resources assist those living in poverty?

ANS: C Self-awareness is a key component of providing authentic, genuine client-centered care. To clarify their own values and perspectives about poverty, nurses should ask themselves questions about poverty and persons living in poverty. These questions should cause the nurse to reflect on how his or her ideas of poverty have been developed. The only question that relates to the nurse reflecting on how personal values and perspectives have been developed is, "How have the media images of poor persons shaped my image of poverty?" The other questions address how to address the issue of poverty or concerns of the nurse but do not address increasing the nurse's self-awareness.

17. A nurse is trying to decrease the risk for depression among older adults. Which of the following interventions should the nurse implement? a.Encourage moving to a nursing home where others of the same age reside. b.Monitor for signs and symptoms of depression. c.Organize an exercise and health promotion program at the local senior citizen center. d.Teach older clients to focus on their strengths rather than their weaknesses.

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

2. A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse? A. "I'm so sorry to hear that. Is your mother able to be with you?" B. "It's good that you and the baby are safe from him." C. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" D. "You must hate him for leaving you alone with a new baby!"

ANS: C "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. DIF: Cognitive Level: Analyze (Analysis) REF: p. 435

9. A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities. Which of the following parents in attendance would be most at risk for abusing his or her own child? A. A new mother who has joined a parents' support group B. A father who is overwhelmed and exhausted by overtime work C. A depressed father who was laid off from work and is missing his work colleagues D. A mother who is missing her career challenges and friends but enjoying being home with her baby

ANS: C A depressed father who was laid off from work and is missing his work colleagues Parents with a lack of social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their own children. Abusive parents often have unrealistic expectations of a child's developmental abilities. DIF: Cognitive Level: Apply (Application) REF: p. 463

7. Which of the following is the most accurate description of a migrant farmworker? A. A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends B. A person who immigrates to the United States to "follow the crops" in performing seasonal farm work C. A person who moves from place to place to earn money performing seasonal agricultural work D. A person who specializes in the development of rural land for the purpose of farming

ANS: C A person who moves from place to place to earn money performing seasonal agricultural work The Office of Migrant Health of the U.S. Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode." The emphasis is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants. DIF: Cognitive Level: Remember (Knowledge) REF: p. 396

2. Which of the following best describes a health professional shortage area (HPSA)? A. An area with inadequate health care facilities for residents B. An isolated area of underserved populations within an urban region C. A region with insufficient numbers of health care providers D. A rural region of the United States with a population density of less than 10,000

ANS: C A region with insufficient numbers of health care providers An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties. DIF: Cognitive Level: Remember (Knowledge) REF: p. 393

9. A migrant farmworker brings his daughter into the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? A. It was a rare occurrence, which probably won't be repeated. B. The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. C. Children may work on small farms because the family may need the additional income. D. The parents were busy working and didn't realize the child was outside so long.

ANS: C Children may work on small farms because the family may need the additional income. Children 12 to 13 years of age can work on a farm with the parents' consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family's economic survival. DIF: Cognitive Level: Apply (Application) REF: pp. 399-400

3. A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? A. Drug abuse B. Drug addiction C. Drug dependence D. Substance abuse

ANS: C Drug dependence Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful. DIF: Cognitive Level: Apply (Application) REF: p. 435

7. A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most likely displayed? A. He has threatened harm to his school peers. B. He is between the ages of 15 and 19. C. He is depressed and has a history of being sexually abused. D. He has been accused of abusing an animal.

ANS: C He is depressed and has a history of being sexually abused. Leading risk factors for suicide are depression and other mental disorders or substance-abuse disorders. Other risk factors include prior suicide attempt, family history of suicide, mental disorder, substance abuse or violence, firearms in the home, incarceration, and exposure to the suicidal behavior of others (family, peers, or figures in the media). Children who threaten to harm others or who abuse an animal are more likely to hurt others than themselves. DIF: Cognitive Level: Apply (Application) REF: p. 460

10. A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect? A. Bruises in various stages of healing B. Failure of parent to attend parent-teacher conferences or return teacher phone calls C. Lack of weight gain and wearing dirty clothes D. Lice in the hair

ANS: C Lack of weight gain and wearing dirty clothes Physical neglect refers to failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect refers to the omission of basic nurturing, acceptance, and caring essential for health development. Lice are a common problem among school children, and the presence of lice does not indicate neglect. Failure to attend parent-teacher conferences should not be construed as neglect, because various reasons, such as employment requirements, may prevent parents who care from attending. Bruising is a sign of physical abuse rather than neglect. DIF: Cognitive Level: Apply (Application) REF: p. 464

16. A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking? A. Encouraging others to interfere when they see children hit or hurt in a public place B. Referring caregivers to community respite centers if abuse is beginning to occur C. Lobbying for passage of legislation to outlaw physical punishment in schools D. Screening each pregnant woman privately for intimate partner abuse

ANS: C Lobbying for passage of legislation to outlaw physical punishment in schools Primary prevention involves action before damage has occurred. The other options are all screening for abuse or reactions to abuse that has already taken place. DIF: Cognitive Level: Apply (Application) REF: p. 470

5. A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? A. Appendicitis B. Bacterial gastroenteritis C. Pesticide poisoning D. Viral illness

ANS: C Pesticide poisoning Although all of these conditions can cause some or all of the symptoms listed, because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild psychological and behavioral deficits such as memory loss, difficulty with concentration, and mood changes, abdominal pain, nausea, vomiting, diarrhea, headache, malaise, skin rashes, and eye irritation. DIF: Cognitive Level: Analyze (Analysis) REF: p. 395

8. Which of the following is a common factor typically found in those who abuse others? A. Fear and belief that others are "out to get them" B. Poor self-esteem and unawareness of alternatives C. Previous observations of violent behaviors to manage conflict D. Difficulty keeping commitments

ANS: C Previous observations of violent behaviors to manage conflict People who become involved in violence typically had previous exposure to some form of violence. Abusers were often beaten when they were children, or they witnessed siblings or one of their parents being beaten. They learned that violence is a way to manage conflict. DIF: Cognitive Level: Understand (Comprehension) REF: p. 461

5. A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when the other passes out and cannot continue? A. If their drinks are the same size, they'll both pass out about the same time. B. If they play fair, they'll probably both vomit before passing out. C. The man will win. D. The woman will win.

ANS: C The man will win. Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men (except for males with chronic alcoholism). DIF: Cognitive Level: Apply (Application) REF: p. 436

3. Which of the following is the top risk factor for intimate partner homicide? A. There is a gun in the house. B. The husband has made threats against wife before. C. The wife has previously called 911 because of husband's beating her. D. The woman's young daughter also lives with them.

ANS: C The wife has previously called 911 because of husband's beating her. The top risk factor for intimate partner homicide (IPH) is previous domestic violence. Other risk factors are access to guns, estrangement, threats to kill or threats with a weapon, nonfatal strangulation, and a stepchild in the home if the victim is a female. DIF: Cognitive Level: Understand (Comprehension) REF: p. 457

2. Which of the following statements best explains the primary reason why violence is so high among young African-American men? A. Men tend to be more violent than women. B. They are young and thus lack maturity. C. Unemployment is higher in this population. D. Violent tendencies are transferred genetically along racial lines.

ANS: C Unemployment is higher in this population. Most analyses conclude that the differential rates of violence between African Americans and whites in the United States have more to do with economic realities, such as poverty, unemployment, and overcrowding, than with race. Although violence among men may be higher than among women, this question specifically addresses "young African-American men." DIF: Cognitive Level: Understand (Comprehension) REF: pp. 454-455

19. A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, "I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal." Which of the following would be most appropriate response from the nurse? A. "I'm so glad you're beginning to recognize the need to control your blood sugar." B. "Now you just have to make sure you don't give that habit up!" C. "Sounds like you're not ready to really plan your eating yet." D. "That is great. You've started to take action and make changes."

ANS: D "That is great. You've started to take action and make changes." There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. As the client learns how to eat and recognizes what she is eating, she is preparing for action. Therefore, the nurse should be encouraging and recognize that the client has begun serious change. DIF: Cognitive Level: Apply (Application) REF: p. 449

20. At a county board meeting, a nurse reports statistics on drug use in the school. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? A. Help prevent obesity and boredom. B. Offer alternatives to being "on the streets." C. Prevent children from getting in trouble before their parents get home from work. D. Promote healthy lifestyles with physical activity.

ANS: D Promote healthy lifestyles with physical activity. The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors. DIF: Cognitive Level: Analyze (Analysis) REF: p. 441

19. A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? A. Abide by the mother's wishes because this information was provided in confidence. B. Arrange for counseling for the boyfriend at the earliest possible availability. C. Encourage the mother to take the child and find alternate housing right away. D. Report the incident to child protective services or other appropriate legal authority.

ANS: D Report the incident to child protective services or other appropriate legal authority. Nurses are mandatory reporters of child abuse, even when only suspected, in all states. All of the other options put the child's welfare at risk, including encouraging the mother to seek alternatives, since encouraging an action will not ensure that it will happen. DIF: Cognitive Level: Apply (Application) REF: p. 471

12. A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse? A. The daughter's inability to do well in school B. Intimacy problems with the daughter's boyfriend C. The mother's abuse of the daughter over a long period of time D. Sexual abuse by the father

ANS: D Sexual abuse by the father Nurses must be aware of the incidence, signs and symptoms, and psychological and physical trauma of incest. Symptoms include headaches, as well as other physiological problems. Children often try to avoid or escape the abusive behavior. DIF: Cognitive Level: Apply (Application) REF: p. 465

17. A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would most likely have a positive effect? A. Being assertive and taking control of decisions because family members cannot be expected to have this ability B. Focusing attention on family weaknesses that need to be fixed before healing can begin C. Pointing out things that victims should do differently to avoid antagonizing the abuser D. Soliciting ideas from the family regarding what they feel will improve their situation

ANS: D Soliciting ideas from the family regarding what they feel will improve their situation To empower the family, the nurse needs to recognize and capitalize on the violent family's strengths and to guide the family in recognizing and dealing with its problems. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach. Families often can generate many of their own solutions—in fact, the family's own solutions tend to be more culturally suitable and individualized than those the nurse generates. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 470-471

15. A male IV drug abuser admits to the nurse that he has no desire to stop using drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels him on how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? (Select all that apply.) A. Primary prevention by educating about safe injections B. Primary prevention by avoidance of future legal complications C. Secondary prevention to reduce the risk for infection or other complications D. Tertiary prevention to reduce the transmission of blood-borne diseases

ANS: D Tertiary prevention to reduce the transmission of blood-borne diseases Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Abstinence is ideal, but it is unrealistic for many addicts. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. DIF: Cognitive Level: Apply (Application) REF: p. 445

6. Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? A. A discussion of which drugs are commonly used on campus B. How students can learn to "just say no" when offered drugs or drinks C. How to recognize and overcome peer pressure to continue bad habits D. The fact that tobacco smoking causes more deaths than any other behavior in the United States

ANS: D The fact that tobacco smoking causes more deaths than any other behavior in the United States Although all these options are worthy of discussion, the most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. DIF: Cognitive Level: Apply (Application) REF: p. 436

16. A man is addicted to alcohol. In which of the following scenarios is a family member enabling the man to continue drinking? A. The wife asks the nurse to explain why her husband's continued drinking is dangerous. B. The son threatens to leave home because he finds the father's behavior embarrassing. C. The teenage daughter turns to a favorite teacher for emotional support. D. The wife tells her husband's boss that her husband is sick when he is actually inebriated.

ANS: D The wife tells her husband's boss that her husband is sick when he is actually inebriated. Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. DIF: Cognitive Level: Apply (Application) REF: p. 446

8. An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? A. Their personal belongings may be stolen while they are at the clinic. B. Immigration officials will send them back to their home country. C. The clinic personnel will look down on them and be biased against them. D. They weren't getting paid for that day, and continued employment is never certain.

ANS: D They weren't getting paid for that day, and continued employment is never certain. Any of the answers might be true; however, most migrant farmworkers are legal residents or U.S. citizens, not illegal immigrants. Many do not have their own transportation and must rely on friends. Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain. DIF: Cognitive Level: Analyze (Analysis) REF: p. 398

13. A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? A. Observe farmworkers for evidence of unsafe handling of pesticides. B. Provide teaching on how to handle pesticides to avoid or decrease exposure. C. Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. D. Treat a client who has pesticide exposure to prevent complications.

ANS: D Treat a client who has pesticide exposure to prevent complications. Tertiary prevention involves actions taken when a person already has a condition so that complications and worsening of the condition are avoided. DIF: Cognitive Level: Analyze (Analysis) REF: p. 395

13. A home health nurse believes a client may be a drug addict. However, the client denies the use of drugs when questioned by the nurse. Which of the following is the most likely cause of the client's denial? A. Confusion resulting from dementia B. History of compulsive lying C. Mental status changes D. Use of addictive drugs

ANS: D Use of addictive drugs Denial is a primary symptom of drug addiction. DIF: Cognitive Level: Apply (Application) REF: p. 443

1. Which of the following statements is the best explanation as to why some countries are more violent than others? A. Civilized societies are less violent than primitive societies. B. Geographical differences are the primary factor. C. Population differences are the main determinant—for example, having more males than females. D. Violence is a learned behavior controlled or allowed by social norms.

ANS: D Violence is a learned behavior controlled or allowed by social norms. Some societies are basically nonviolent, and for them violence is not a significant health problem. Violence is a learned behavior, and social norms can keep violence at low levels or even eliminate it. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 455-456, 461

6. A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while being raped? A. Confusion B. Satisfaction C. Sexual release D. Helplessness

ANS: D Helplessness During the act of rape, survivors are often hit, kicked, stabbed, and severely beaten. It is this violence, as well as the violation of the sense of self, that most traumatizes the person because of the fear for her life and her feelings of helplessness, lack of control, and vulnerability. DIF: Cognitive Level: Apply (Application) REF: p. 459

15. A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging the location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenager's needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a. The group became cohesive enough to share leadership tasks. b. Teenagers don't like feeling dependent on adults with power. c. Teenagers often rebel against adult authority. d. The nurse was overwhelmed and lost control of the task process.

ANS: A In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. However, as the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group.

8. Which of the following statements regarding the Health Belief Model is accurate? a. Cues to action are an important component of the model. b. Multiple methods of education should be used when implementing this model. c. The first stage experienced in this model is the pre-contemplation stage. d. To successfully implement this model, ongoing maintenance of the behavior must be considered.

ANS: A The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.

10. When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a. Educator b. Content c. Learners d. Objectives

ANS: A Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. The educator determines how content can be tailored to the learner. The educator determines the objectives. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge.

16. A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

ANS: A When you respond to conflict by avoiding (suggesting that they avoid further discussion), forcing with power (assuming adult authority), capitulating, or excluding some members (asking the deviant members to leave), the behavior fails to satisfy the concerns of those involved. Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict.

19. A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of the following actions should be taken by the nurse? a.Apply for a grant to fund a mobile clinic to take health care to the clients. b.Distribute flyers to the homeless that detail the location of various types of health care services. c.Refer homeless clients to areas that provide temporary housing. d.Solicit donations for food and clothing to be distributed to the homeless.

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

3. A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? A. Emergency department for immediate care B. Migrant Health Act clinics C. OSHA, because the man was injured by farm machinery D. Workers' Compensation, because injury was at work

ANS: A Emergency department for immediate care Farming and ranching do not often fall under OSHA guidelines, because they are considered small enterprises. Therefore, safety standards are not enforceable, nor is Workers' Compensation insurance usually available for the agricultural industry. Although there are migrant health clinics, they are not always geographically convenient. The only source the nurse can count on using is sending injured workers to emergency departments for immediate care. DIF: Cognitive Level: Apply (Application) REF: pp. 394, 398

11. A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? A. Evil eye B. Fallen fontanel C. Soul loss D. Indigestion

ANS: A Evil eye A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye. DIF: Cognitive Level: Apply (Application) REF: p. 401

23. A nurse is helping a client's family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client's family members would be most effective? (Select all that apply.) A. "Express your love and your belief that he can change." B. "Point out that his behavior is his choice and his responsibility." C. "Let him know that you understand how much he loves being with his drinking pals and that you agree that their friendship is important." D. "Remind him that entering treatment is better than going to prison."

ANS: A, B A. "Express your love and your belief that he can change." B. "Point out that his behavior is his choice and his responsibility." Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person's own personal Responsibility for any changes made, and give Advice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of Self-efficacy. DIF: Cognitive Level: Analyze (Analysis) REF: p. 448

17. A nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) A. It is very difficult to obtain continuing education, except for online programs. B. Neighbors seem to expect the nurse to know everything about all health care and illness conditions. C. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. D. People come to the health clinic before their situation becomes relatively serious.

ANS: A, B, C A. It is very difficult to obtain continuing education, except for online programs. B. Neighbors seem to expect the nurse to know everything about all health care and illness conditions. C. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. Rural people often develop independent and creative ways to cope because of the distance, isolation, and sparse resources they encounter. The boundaries between home and work blur because clients are also neighbors and friends of immediate family members. Nurses are highly regarded by the community and viewed as experts on health and illness. Residents may ask health-related questions and request recommendations whenever they see the nurse. Nurses in rural areas may also be expected to, in general, know something about everything, and this can be a demanding expectation. Some of the challenges are professional isolation, limited opportunities for continuing education, lack of other health personnel or professionals with whom the nurse can interact, heavy workloads, the need to function well in several clinical areas, lack of anonymity, and for some, a restricted social life. DIF: Cognitive Level: Apply (Application) REF: p. 402

22. A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following strategies would the nurse suggest the mother implement? (Select all that apply.) A. Provide opportunities for her daughter to develop her talents. B. Provide realistic feedback to the daughter about her performance at school. C. Encourage her daughter to become involved in extracurricular activities. D. Encourage her daughter to develop new friendships.

ANS: A, B, C A. Provide opportunities for her daughter to develop her talents. B. Provide realistic feedback to the daughter about her performance at school. C. Encourage her daughter to become involved in extracurricular activities. Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategies: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic appraisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions. DIF: Cognitive Level: Apply (Application) REF: p. 441

10. A school nurse stops a student in the hall and asks whether the student has been having trouble with her eyes, which look rather red and dry. The female student yawns and says that she hasn't noticed any eye problems. However, she does confess to the school nurse that she has gained 15 pounds since she began smoking "special cigarettes." Which of the following is the student most likely smoking? A. Tobacco B. Crack cocaine C. Ice methamphetamine D. Marijuana

ANS: D Marijuana Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. DIF: Cognitive Level: Apply (Application) REF: p. 439

16. A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) A. "Community members will probably hold you in higher regard and will look up to you." B. "Expect to have less autonomy in a small town than you have working as a nurse in a medical center." C. "You may feel like an isolated outsider, because the community may not immediately accept you." D. "You will have to be very sensitive about the differences in the rural lifestyle."

ANS: A, C, D A. "Community members will probably hold you in higher regard and will look up to you." C. "You may feel like an isolated outsider, because the community may not immediately accept you." D. "You will have to be very sensitive about the differences in the rural lifestyle." Nurses working in rural areas usually have a prestigious status in the community and are viewed as role models. They have greater (not less) independence and autonomy, fewer (not more) resources, and need to have more generalist (not specialized) knowledge and skills. DIF: Cognitive Level: Apply (Application) REF: p. 402

14. Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) A. About 25% of all U.S. residents live in rural settings. B. People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. C. Diagnoses in rural areas are usually for physical injuries, not mental health concerns. D. A high prevalence of poverty exists among rural families.

ANS: A, D A. About 25% of all U.S. residents live in rural settings. D. A high prevalence of poverty exists among rural families. About 25% of all U.S. residents live in rural settings. Rural residents are less likely to engage in preventive behavior and they tend to be poorer than their urban counterparts (more than 25% of rural Americans live in or near poverty, and nearly 40% of all rural children are impoverished). Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations. Often rural health professionals live and practice in a particular community for decades. Consequently, rural respondents tend to know their usual provider of health care. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 391-392

24. A nurse is screening a client for ATOD problems. Which of the following actions would the nurse most likely complete? (Select all that apply.) A. Assist with identifying help or resources. B. Advise about the need to enter a treatment program. C. Ask about how relationships with family members and friends have been affected. D. Assess amount and pattern of use.

ANS: A, D A. Assist with identifying help or resources. D. Assess amount and pattern of use. The nurse should use the 5 As when screening for ATOD problems: ask about use (how taken, how much, how long and how often); assess amount and pattern of use; advise about safe use as appropriate; and assist with identifying help or resources. DIF: Cognitive Level: Apply (Application) REF: p. 443

4. A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Ask the students why they are being so rude. b. Explain why the information is crucial to their current clinical practice. c. Nothing; let the instructor of the course handle the problem. d. Tell a joke to get the students attention.

ANS: B Before learning can take place, you need to gain the learners attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally.

7. The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlines. d. The nurse gave them too much information too fast for them to want to cope with it all.

ANS: B Although visual images are certainly helpful, this does not explain why the handouts were discarded. Most health information is printed at a tenth-grade reading levelyet the average U.S. adult reads at the eighth-grade level and 40% of adults over age 65 read below the fifth-grade level. If people cannot read or understand the material, they discard it.

5. A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a. I should change. b. I am willing to change. c. Its important to change. d. I want to change.

ANS: B Motivational interviewing uses the term change talk to refer to statements by the client that he or she is motivated and willing to make change. An easy to use mnemonic is DARN-CAT which refers to desire, ability, reason, need, activation, commitment, and taking steps. I am willing to change demonstrates activation, a client who is ready, prepared, and willing to make the change. The other statements refer to the client who is preparing to make the change, but not yet ready to implement the change.

20. According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a.$21,200 b.$23,050 c.$25,200 d.$27,050

ANS: B According to the Federal Register in January 2012, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $23,050.

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

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

5. Which of the following is the most rapidly growing group of homeless? a.Adolescents b.Families with children c.Persons in crisis d.Single men

ANS: B Families with children are the fastest-growing segment of the homeless population.

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

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

2. Which of the following racial groups experiences the highest incidence of poverty? a.Non-Hispanic Whites b.Blacks c.Hispanics d.Asians

ANS: B In terms of racial differences in the rate of poverty, non-Hispanic Whites had a rate of 9.9 %; Blacks had a rate of 27.4% and Hispanics had a rate of 26.6% (U.S. Bureau of the Census, 2012).

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

ANS: B Men over age 85 are in the highest risk category for suicide.

11. Which of the following is an accurate concern about the use of marijuana? A. Marijuana has painful withdrawal symptoms. B. Marijuana may damage the respiratory tract. C. Marijuana can often reduce pain but physicians refuse to prescribe it. D. Marijuana quickly leads to psychological and physiological dependence.

ANS: B Marijuana may damage the respiratory tract. Marijuana is the most widely used illicit drug in the United States. It may reduce pain but is currently illegal with national efforts at total prohibition. It is not highly toxic except for possible damage to the respiratory tract from smoking. It does not quickly lead to dependence, and withdrawal symptoms are mild. DIF: Cognitive Level: Understand (Comprehension) REF: p. 439

2. A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.) a.Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. b.Cuddle and hold the baby while smiling and gazing into the baby's eyes. c.Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face. d.Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes.

ANS: B, D Suggestions for promoting interaction between an adult and a baby include the following: maintaining a distance of 8 to 10 inches from the baby, smiling, and making eye contact. Talk to the baby, but avoid "baby talk." Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). Babies love to play and enjoy "taking walks" and looking at brightly colored objects or toys that make noises.

3. A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a. Each participant will state why TSE is important and explain how to do it. b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c. 90% of the men will correctly demonstrate testicular self-examination. d. 100% of the men will do a testicular examination correctly on a model.

ANS: C If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.

6. A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a. Evaluation b. Experience c. Participation d. Understanding

ANS: C Educators should include participation. (This is one of the six principles of education.) Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic.

11. A man says, I just cant get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself. Which of the following would be the best action for the nurse to take? a. Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set up rewards for himself, such as a nice snack after he gets back from walking.

ANS: C Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior.

14. The leader of an Alzheimers support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a. Group norms b. Task norms c. Maintenance norms d. Reality norms

ANS: C Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space.

1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge

ANS: C Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.

2. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material

ANS: C The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned.

8. A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern? a.Elevated blood pressure b.First prenatal visit at 5 months' gestation c.Persistent homelessness d.Positive STD test

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

15. A community mental health nurse is working within the community to help prevent youth violence. Which of the following interventions would most likely be implemented by the nurse? a.Distributing literature that associates violence with a lack of intelligence b.Explaining to youth why youth violence is detrimental to society c.Partnering with associations to provide alternative activities that improve social skills d.Recommending increased funding to prosecute and jail teens associated with violent activity

ANS: C Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act.

1. A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describe why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a.Her friends were suggesting ways to make the problem go away. b.She knew she could not be pregnant because her boyfriend said he used a condom. c.She was afraid her parents would pressure her to terminate the pregnancy. d.She kept hoping the pregnancy would just go away.

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

12. A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag. Which of the following best describes the group purpose that is being served by the teenagers statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking about food c. Task function of resolving problems about what to nibble during movies d. Task function of sharing information and resources

ANS: D A task function is anything a member does that deliberately contributes to the groups purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenagers statement shared information about a good resource for the group.

13. A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, I dont know if I want to share all the problems Im having with strangers. Which of the following is the best nurse response? a. Don't share anything with anyone until youre comfortable doing so. b. I can understand what you are saying. c. No one will require you to do anything you dont want to do. d. The purpose of the group is to have a safe place to share problems with others who may be having similar problems.

ANS: D All the responses are empathetic and supportive. However, during the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. Even though a statement such as Dont share anything until youre comfortable is supportive, the response explaining that the purpose is to have a safe place both recognizes what was said and clarifies the purpose of the group.

9. A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a. At the beginning of the program b. At the program midpoint c. Immediately following program completion d. Throughout the program

ANS: D Not only should learners receive feedback, but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified.

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

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

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

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