Pracrice ANDTake Your Time!

1. Increased violence toward nurses is associated with the following: a. high patient to nurse ratios b. the absence of law enforcement in the ER c. poorly controlled mental health patients d. education of the nurse

Correct A Too many patients and not enough nurses create stressful and unsafe environments leading to violence.

1. Assessing progress on health equity is achieved by: a. Measuring patient outcomes b. Measuring patient satisfaction c. Measuring how disparities have been reduced over time d. Is difficult to measure and not addressed

Correct C Measuring health equity is a long-term process that will be examined over time.

1. Achieving health equity requires which of the following? a. Actions the distributes resources equally b. Actions that distribute resources based on need c. Actions that distribute resources that strongly influence health d. Actions that distribute resources based on location.

Correct C resources must be distributed based on sound evidence that improve health outcomes.

A public health nurse is faced with an ethical dilemma. Which question should the nurse consider first when deciding how to resolve the dilemma? A) "What exactly is the ethical dilemma?" B) "What are the alternative courses of action?" C) "What are the consequences of each alternative courses of action?" D) "How should this dilemma be solved?"

A Feedback: A framework is applied in public health ethics inquiry. Three core functions of this inquiry include (1) identifying and clarifying the ethical dilemma, (2) analyzing it in terms of alternative courses of action and their consequences, and (3) resolving the dilemma by deciding which course of action best incorporates and balances the guiding principles and values.

A community health nurse is working to support programs to encourage preschool immunizations. The nurse is integrating which ethical principle in his or her practice? A) Beneficence B) Autonomy C) Nonmaleficence D) Justice

A Feedback: Beneficence means doing good or benefitting others, such as supporting programs to encourage preschool immunizations. Autonomy means freedom of choice and exercise of people's rights, such as promoting individuals' and groups' rights to and involvement in decision making. Nonmaleficence means avoiding or preventing harm to others as a consequence of a person's own choice and actions, such as encouraging physicians to prescribe drugs with the fewest side effects. Justice refers to treating people fairly, such as ensuring equal access to health care.

Application of nursing research results to community health nursing practice is essential. Which of the following must occur first before results can be applied? A) Be informed about research findings B) Demonstrate skill in examining research reports C) Assess abstracts of relevant research studies D) Check if the study was funded by a drug company

A Feedback: Community health nurses have many opportunities to apply the results of other investigator's research, but a necessary prerequisite is that the nurse must be informed about research findings. Critically examining research reports and assessing abstracts are all part of evaluating relevant research studies. However, the nurse needs to know what the research findings are before he or she can evaluate the research. Checking if the study was funded by a drug company might indicate that the results of the study could be questioned due to a conflict of interest.

Which of the following statements about disaster planning is most accurate? A) Disaster planning is essential for a community, business, or hospital. B) A disaster plan must be lengthy and detailed. C) A disaster plan should be created by the person responsible for the emergency management of the community. D) It is assumed that all professionals have addressed their personal preparation.

A Feedback: Disaster planning is essential for a community, business, or hospital. A disaster plan need not be lengthy. A disaster plan should be created by all involved, including community leaders, health and safety professionals, and lay people. All nurses should address their own personal preparedness to respond in a disaster, but this may not be assumed.

A community health nurse is working with a community that is involved with identifying risk factors for program development in case of a disaster. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) Recovery

A Feedback: During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

When performing triage during a disaster, which color would indicate that the victim is in urgent need of care? A) Red B) Yellow C) Green D) Black

A Feedback: During triage, red indicates that the victim has injuries or medical problems that will likely lead to death if no treated immediately. Yellow indicates that the person has injuries that require medical attention but time to treatment is not yet critical. Green indicates that the victim has minor injuries or are presenting with minimal signs of illness. Black indicates that the victim is dead or has suffered mortal wounds.

A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as nonchangeable

A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.

A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A) Insurance B) Acculturation C) Knowledge of disease D) Marital status

A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.

A community health nurse suspects Munchausen syndrome by proxy when a child A) experiences "seizures" only when a parent is present, not if a third party is present. B) has stunted growth and shortened limbs that have been noticeable since birth. C) has a noticeable limp when wearing shoes but not in bare feet. D) has periods of "acting out" and misbehaving, especially when there is company.

A Feedback: Experiencing seizures only when a parent is present would be a "red flag" for this syndrome if it were occurring in a child. Stunted growth, limp, or acting out are not associated with Munchausen syndrome by proxy.

A community health nurse is involved in a screening program for alcohol use with an ethnically diverse population. Which of the following would be the best instrument to use? A) Alcohol Use Disorders Identification Test (AUDIT) B) CAGE questionnaire C) Michigan Alcoholism Screening Test (MAST) D) Drug Abuse Screening Test (DAST)

A Feedback: For alcohol use, the screening instrument recommended by the NIAAA is the AUDIT. WHO developed this instrument for use across populations, and it has established high reliability and validity across ethnic groups. Other tests that can be used include the CAGE questionnaire and MAST. The DAST would be appropriate to screen for drug use.

When preparing a plan of care for a group of women who are victims of intimate partner violence, the nurse develops interventions aimed at the primary level of prevention. Which of the following would be most appropriate for the nurse to include? A) Assisting them to locate a safe shelter B) Providing immunizations C) Screening for sexually transmitted infections D) Teaching about basic hygiene measures

A Feedback: For women who are victims of intimate partner violence, counseling and helping them locate a safe shelter can assist in preventing homelessness. Providing immunizations and teaching about basic hygiene may be appropriate, but these would not priorities at this time. Screening for sexually transmitted disease would be a secondary level of prevention activity.

A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in care

A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.

When assessing a family in crisis, which of the following would the community health nurse need to do first? A) Assess the nature of the crisis B) Determine client's perception C) Define available supports D) Assess coping abilities

A Feedback: Initially, the nurse must assess the nature of the crisis and the client's response to it. Next, the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is available for support to the individual or family. Finally the nurse assesses the clients' coping abilities.

The nursing student reads the textbook in preparation for a class meeting about primary, secondary, and tertiary prevention related to families in crisis. The student determines which one of the following statements as most accurate regarding the levels of prevention? A) Often people in crisis are temporarily helpless and unable to cope on their own but are receptive to outside influence. B) Secondary prevention interventions include taking action to prevent the unwanted event from occurring. C) Tertiary prevention focuses on moving past the crisis and returning to the precrisis state. D) Primary prevention is the least effective level of intervention in terms of promoting client's health and containing costs.

A Feedback: Often people in crisis are temporarily helpless and unable to cope on their own, but understand the need for outside help and are receptive to other people's suggestions. Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted event from occurring. Tertiary prevention focuses on moving past the crisis, although returning to the precrisis state may not be possible. Primary prevention is the most effective level of intervention in terms of promoting client's health and containing costs.

The nurse educator knows the nursing student understands the effect of homelessness on the health of children when the nursing student identifies which of the following? A) "Homeless children are four times more likely to become ill." B) "While approximately 87% of homeless children are enrolled in school, only about 77% attend regularly." C) "Fewer than 25% of homeless children graduate from high school." D) "Homeless children are twice as likely as their housed counterparts to repeat a grade in school."

A Feedback: Only one of these statements that directly relates to the effect of homelessness on the health of children is, "Homeless children are four times more likely to become ill."

When determining a target population for education about alcohol use, which age group would the community health nurse most likely plan to address? A) 18- to 25-year-olds B) 30- to 40-year-olds C) 45- to 55-year-olds D) 65 years of age and older

A Feedback: Trends in alcohol use in the United States differ across subsets of the population. Young adults (age 18 to 25) have the highest incidence of problem drinking. Thus the community health nurse would most likely address this age group.

Which of the following research studies would most likely use a quantitative research approach? A) The relationship of maternal age and history of parents' vaccine-preventable disease and parents' efforts to have their children immunized B) The experience of parents whose children have had serious complications subsequent to immunization C) The experience of parents whose children were not properly immunized and developed a vaccine-preventable illness D) Reasons that parents who practice a particular religion do not have their children properly immunized

A Feedback: Quantitative research is helpful in identifying a problem or a relationship between two or more variables, such as type of treatment. A more subjective or qualitative approach is needed to study those areas that need a broader focus or that do not lend themselves to objective measurement. Qualitative research emphasizing subjectivity asks "how" or "why."

A community health nurse is meeting with a group of individuals who have been diagnosed with a serious mental illness. The nurse interprets this to mean which of the following? A) The clients have impaired level of functioning and quality of life. B) The clients' disorder is chronic and persistent. C) The clients have issues of impaired control and dependency. D) The clients have a significant behavior syndrome with present distress.

A Feedback: Serious mental illness (SMI) is mental illness that has compromised both the client's level of function and his or her quality of life. Serious and persistent mental illness (SPMI) is the preferred term for serious mental illness of a chronic nature. Impaired control and dependency are components of addiction. A significant behavior syndrome with present distress characterizes a mental illness.

Which of the following would the community health nurse identify as an act of sexual exploitation of a child? A) Child pornography B) Child molestation C) Fondling of child's genitals D) Vaginal penetration with an object

A Feedback: Sexual exploitation of children includes conduct or activities related to pornography that depict minors in sexually explicit situations and promotion of prostitution by minors. Sexual assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration of the genital or anal opening by a foreign object, and child molestation.

A group of students are reviewing for an examination on values. Identification of which of the following as an instrumental value indicates the need for continued study? A) Spiritual salvation B) Confidentiality C) Honesty D) Promise keeping

A Feedback: Spiritual salvation is an example of a terminal value, which refers to end states of existence. An instrumental value refers to a mode of conduct, such as confidentiality, promise keeping, and honesty.

A community health nurse is part of a disaster response team that is first to respond to an earthquake. The team evaluates the level of destruction and devastation, identifying this as which of the following? A) Intensity B) Scope C) Casualty D) Range of effect

A Feedback: The intensity of a disaster is the level of destruction and devastation it causes. The scope of a disaster is the range of its effect, either geographically or in terms of the number of victims. Casualty refers to the human being(s) injured or killed by or as a direct result of an accident.

As part of secondary prevention, the community health nurse engages in crisis intervention to achieve which of the following? A) Reestablish equilibrium to the lives of those involved B) Prevent the crisis altogether C) Involve as many people as possible in the resolution D) Triage clients during the recovery phase of the crisis

A Feedback: The stated goal of crisis intervention is to reestablish equilibrium. Prevention is the best approach, but some crises, such as natural disasters, cannot be prevented. They can, however, be prepared for to decrease the negative effects of the crisis as much as possible. It is important to have an adequate number of people needed to come to resolution. However, too many people involved in resolution may cause additional confusion, chaos, and unnecessary delays. Triage decisions need to be made during the response phase of the disaster or crisis and not deferred until the recovery phase. Triage is an ongoing process throughout the response phase.

A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A) Avoiding political involvement in issues B) Working with schools to reduce the dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needs

A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.

A community health nurse is responding to a disaster. Which of the following would most likely be the least appropriate area for the nurse to be located? A) The disaster site B) Triage C) Victim treatment area D) Local hospitals

A Feedback: Usually, the immediate disaster site is not the best place for the disaster nurse, who can be far more effective in triage and treatment of victims. One of the lessons of the World Trade Center bombing was that the greatest need for medical professionals was at the local hospitals, not at the disaster site.

Situations in which self-determination should be restricted include which of the following? Select all that apply. A) When some objectives of individuals are contrary to the public interest or the interests of others in society B) When a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals C) When it interferes with self-interest D) Self-determination and personal autonomy must never be restricted. E) When self-determination deteriorates into self-interest and poses a major roadblock to equitable care

A, B Feedback: There are two situations in which self-determination should be restricted: when some objectives of individuals are contrary to the public interest or the interests of others in society (e.g., endangering others with a communicable disease) and when a person's decision making is so defective or mistaken that the decision fails to promote the person's own values or goals. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care.

A community health nurse is assisting the local community in preparing a disaster plan. Which of the following would the nurse expect to be addressed? Select all that apply. A) Chain of command B) Routes for transportation C) Triage D) Basic equipment E) Copies of licenses

A, B, C Feedback: A disaster plan should address the chain of command, routes and modes of transportation, and triage methods. Basic equipment and licenses are items that a nurse should bring along when preparing to work in a disaster area.

When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A) Resource availability B) Relative risk C) Health status D) Housing E) Education

A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.

A community health nurse is preparing a presentation for a community group about possible agents of terrorism. Which of the following would the nurse include as an example of a bioweapon? Select all that apply. A) Mustard gas B) Sarin C) VX gas D) Nerve agents E) Bombs

A, B, C Feedback: Bioweapons include mustard gas, sarin, VX gas, and anthrax. Nerve agents and bombs are examples of chemical warfare agents.

Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless persons

A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.

Which of the following are necessary components of a nurse's personal preparedness? Select all that apply. A) Workplace and community disaster plans have been reviewed by the nurse. B) An individual disaster plan for the nurse's own family has been developed. C) The nurse participated in disaster drills at the workplace and had a family disaster drill to practice what actions to take in the event of a disaster. D) It is not necessary for the nurse to bring copies of their nursing license and driver's license. E) In the case of an actual disaster, the nurse will be able to use equipment made available to them.

A, B, C Feedback: To be personally prepared, a nurse should have read and understood workplace and community disaster plans, should have developed a disaster plan for his or her own family, and should have participated in disaster drills. Nurses preparing to work in disaster areas should bring copies of their nursing license and driver's license and bring basic equipment.

Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A) Patients feel that they are unable to trust the information given to them and may not follow it as explained. B) Limited access to appropriate level of care C) Poor access to quality care D) Overt discrimination E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts

A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.

When addressing homeless children and youth, which of the following situations are also considered homeless according to the education subtitle of the McKinney-Vento Homeless Assistance Act? Select all that apply. A) Children who share housing with others due to economic hardship or loss of housing B) Children who are abandoned in hospitals C) Children who are awaiting placement in foster care D) Children who are living in motels, trailer parks, or camping grounds E) Children who are living apart from one or more of their parents

A, B, C, D Feedback: The education subtitle of the McKinney-Vento Homeless Assistance Act expands on the definition of homelessness when addressing homeless children and youth. The act includes as homeless those children who share housing with others due to economic hardship or loss of housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in motels, trailer parks, or camping grounds. Children who are living apart from one or more of their parents may not be homeless.

Which of the following are reasons why it is difficult to estimate the number of persons who are homeless? Select all that apply. A) It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. B) It is difficult to locate and account for people who are homeless. C) Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. D) In rural areas, there are fewer housing options and resources for the homeless and as a result people may be forced to live temporarily with friends or family. E) Homelessness is increasing due to poverty and the growing shortage of affordable rental housing.

A, B, C, D Feedback: The following are reasons: It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. It is difficult to locate and account for people who are homeless. Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. In rural areas, there are fewer housing options and resources for the homeless, and as a result, people may be forced to live temporarily with friends or family. It is true that homelessness is increasing due to poverty and the growing shortage of affordable rental housing, but this is not a reason why it is difficult to estimate the number of people who are homeless.

Which of the following are subpopulations that are more likely to be sheltered homeless in urban areas? Select all that apply A) Adult males B) African Americans C) Veterans D) Disabled E) Migrant workers

A, B, C, D Feedback: When compared to their housed counterparts nationwide, the sheltered homeless are more likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural areas, the homeless are more likely to be White, Native American, or migrant workers.

Which of the following are reasons for the increase in poverty rates over recent years? Select all that apply. A) Declining wages B) Decline in public assistance C) Loss of jobs that offer security and carry benefits D) A decline in manufacturing jobs in favor of lower paying service jobs E) Globalization and outsourcing F) Homelessness

A, B, C, D, E Feedback: The increase in poverty rates over recent years may be attributed to declining wages, loss of jobs that offer security and carry benefits, and increase in temporary and part-time employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in favor of lower paying service jobs, globalization and outsourcing, and a decline in public service. As wages drop, the potential to secure adequate housing wanes. This does not mean that homelessness is a cause of poverty. Actually, it is poverty that is known to cause homelessness.

Which of the following statements about Healthy People 2020 and reducing substance use and addressing mental health needs is most accurate? Select all that apply. A) After a diagnosis is established, the nurse can decide on an intervention that can address the specific public health issue identified in the diagnosis using the Healthy People 2020 objectives. B) It could be considered a priority as two of the top ten health indicators relate to substance use and mental health. C) Target benchmarks and data derivation for each objective can be used to guide program development. D) Reducing substance abuse and addressing mental health needs are not priority with Healthy People 2020. E) The goals are to improve mental health through prevention and to reduce substance abuse to protect the health, safety, and quality of life for all, especially children.

A, B, C, E Feedback: Reducing substance abuse and addressing mental health needs is a priority with Healthy People 2020.

A community health nurse is engaged in primary prevention activities related to disasters. Which of the following would be examples of appropriate activities? Select all that apply. A) Providing anticipatory guidance B) Practicing an escape plan C) Providing emergency assistance D) Planning disaster drills E) Providing immediate response F) Reducing the degree of disability

A, B, D Feedback: Anticipatory guidance, practicing escape plans, and planning disaster drills all constitute primary prevention activities. Providing emergency assistance and immediate response reflect secondary prevention activities. Reducing the degree of disability or damage resulting from the disaster reflects tertiary level prevention activities.

When assessing a group of individuals for factors related to an increased risk for alcohol use disorders, which of the following would the nurse expect to find? Select all that apply. A) Academic engagement/achievement B) Antisocial peer affiliations C) Decreased impulsivity D) Positive mother-child/father-child relationships E) Stressful life events

A, B, E Feedback: Individual factors associated with the development of AUDs include problems with academic engagement/achievement, antisocial peer affiliations, problems in the mother-child/father-child relationship, and other stressful life events.

Which of the following would lead a community health nurse to suspect possible child neglect? Select all that apply. A) 15-year-old Lucy misses school once a week to watch her baby sister while mom works. B) 6-year-old Sam plays in the yard with a sweater on when it is 60 degrees outside. C) Twins, Bobby and Billy arrive at school in dirty and smelly clothing most school days. D) 11-year-old Samantha comes to school without lunch or lunch money each day. E) 9-year-old Tommy misses school two or three times a month due to asthma attacks. F) 14-year-old Jennifer watches her neighbor's 2-year-old every Saturday.

A, C, D Feedback: Educational neglect involves Lucy missing school to watch her baby sister and general neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how hard and long he is playing—he may be comfortable. Although Tommy is missing a number of days of school, he has a legitimate excuse. Fourteen is an appropriate and legal age to babysit.

Which of the following statements about the impact of research on community health nursing are true? Select all that apply. A) It is important to conduct research to affect public policy. B) Public policy will continue to have a negative effect on the community's health. C) Research will affect the effectiveness of community health nursing practice. D) Research will affect the status and influence of nursing as a profession. E) The impact that research has on community health nursing is negligible.

A, C, D Feedback: Research has the potential to have a significant impact on community health nursing in three ways: by affecting public policy and the community's health, the effectiveness of community health nursing practice, and the status and influence of nursing as a profession. Community health nurses have been involved in research addressing all three of these dimensions.

Which of the following are involved in accessing and using epidemiologic data to understand and serve populations with mental illness? Select all that apply. A) Identifying the incidence and prevalence of mental disorders B) Understanding that all data are accurate C) Examining the causes and risk factors associated with mental illness D) Identifying the needs of people with mental disorders

A, C, D Feedback: This means identifying the incidence and prevalence of mental disorders, examining the causes and risk factors associated with mental illness, and identifying the needs of populations with mental illness. However, not all data are accurate.

Which of the following examples of disasters are natural disasters? Select all that apply. A) The Earthquake and tsunami in Japan in 2011 B) The 2008 shootings at Virginia Tech C) The terrorist attacks on the United States on September 11, 2001 D) Wildfires that affected California in October 2007 E) The oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife

A, D Feedback: Examples of natural disasters include the earthquake and tsunami in Japan in 2011 and wildfires that affected California in October 2007. The following disasters are man-made: the 2008 shootings at Virginia Tech; the terrorist attacks on the United States on September 11, 2001; and the oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife.

A community health nurse is preparing a presentation for a community center group about crisis. Which of the following concepts about situational crises should be included in the presentation? Select all that apply. A) A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. B) Situational crises can be predicted, expected, and planned. C) Situational crises are never positive. D) Situational crises often occur without warning. E) Situational crises occur to people because of where they are in time and space.

A, D, E Feedback: A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur to people because of where they are in time and space. Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.

For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually transmitted infections? A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infections. B) They lack education or job training skills and may resort to prostitution or survival sex, which increases their risk for HIV, hepatitis, and sexually transmitted infections. C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility. D) It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

Ans: B Feedback: The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually transmitted infections is that they lack education or job training skills and may resort to prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infection; they may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A) Keeping the clients to a firm schedule of visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitations

B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).

. Which of the following would the community health nurse identify as a major limitation for using biological markers for screening for substance use? A) Sensitivity of the test B) Cost of the test C) Factors influencing the test D) Ease of obtaining a specimen

B Feedback: Biological screening tests are rarely used in a community-based screening program due to the cost and the problems with obtaining biological specimens. In addition, numerous factors can influence sensitivity and specificity of biological markers, including other metabolic disorders or other diseases, medication use, and reliability of the method.

Which one of the following statements regarding mental illness and homelessness is most accurate? A) 75% of the sheltered homeless report a severe mental illness. B) Deinstitutionalization or being released from institutions into the community contributes to the number of persons who have a severe mental illness who are homeless. C) Mental illness only contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. D) Mental illness and substance abuse are not often comorbid conditions that contribute to homelessness.

B Feedback: Deinstitutionalization or being released from institutions into the community contributes to the number of severely mentally ill persons represented in the homeless population. Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. Mental illness and substance abuse are often comorbid conditions, which, coupled with poor physical health, make it especially difficult to secure employment and safe, affordable housing.

A community health nurse is working with a community that is involved with improving community and individual reaction and responses, so that the effects of a disaster are minimized. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) Recovery

B Feedback: Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

While visiting a family in their home, a community health nurse hears a parent screaming who says, "Everything you do is wrong. Can't you do anything right ever?" The nurse suspects which of the following? A) Neglect B) Emotional abuse C) Sexual abuse D) Physical abuse

B Feedback: Emotional abuse involves psychological mistreatment or neglect and may involve verbal abuse such as statements like, "Everything you do is wrong. Can't you do anything right?" Neglect occurs when physical, emotional, medical, educational resources necessary for healthy growth and development are withheld or unavailable. Sexual abuse involves acts of sexual assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain, physical injury, or death.

A nursing instructor is preparing a teaching plan for a class comparing evidence-based practice and critical thinking. Which of the following would the instructor include? A) Evidence-based practice and critical thinking are polar opposites. B) Both involve problem clarification of central concepts. C) Interpretation of accumulated evidence is unique to evidence-based practice. D) Problem exploration is unique to evidence-based practice.

B Feedback: Evidence-based practice and critical thinking share commonalities including exploring a problem, addressing a purpose or goal, making assumptions, clarifying the problem around central concepts or indicators, accessing data, interpreting accumulated evidence, using reasoning, processing, defining, planning and documenting, acting on the problem, and evaluating, adjusting, generalizing, and applying to a broader problem set. In addition, critical thinking is an important component of evidence-based practice.

After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A) Homelessness B) Acute illness C) Income D) Immigrant status

B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.

A community health nurse working with a group of families who come to local community health care center tells them that she is going to be setting up child care so that the families can participate in the various classes being offered by the center. Three months have passed, and the nurse still has not instituted the child care program. The nurse has violated which ethical principle? A) Veracity B) Fidelity C) Justice D) Respect

B Feedback: Fidelity means keeping promises or commitments to foster trust and trustworthiness. By failing to set up the child care program, the nurse has violated this fidelity. Nurses who follow through on what they have said earn their clients' respect and trust. In contrast, when a commitment is not kept, community members may lose faith and interest in participation. Veracity refers to telling the truth, giving clients accurate information in a timely manner. Veracity involves treating clients as equals. Justice refers to treating people fairly, such as by ensuring equal access to health care and not limiting the amount or quality of services due to income level. Respect involves acknowledging clients as valued participants in shaping their own and the community's health outcomes.

Which one of the following statements about mental health issues and homeless young people is most accurate? A) 87% of homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. B) Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. C) It is not common for homeless youths to be arrested for running away, breaking curfews, or being without supervision. D) Homeless youth are persons under age 18 who lack parental, foster, or institutional care.

B Feedback: Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. One in six homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision. Homeless youth are persons under age 18 who lack parental, foster, or institutional care, but this is not necessarily related to mental health issues.

A community health nurse working as a part of a disaster response team is told that the disaster is classified as a multiple-casualty incident. The nurse would interpret this to mean which of the following? A) There is more than 1 but less than 10 casualties. B) The number of casualties is between 2 and 100. C) Casualties number over 100. D) There are too many casualties to count.

B Feedback: If casualties number more than two people but fewer than 100, the disaster is characterized as a multiple-casualty incident. A mass-casualty incident involves100 or more casualties.

Which one of the following statements about cultivating a spirit of inquiry is most accurate? A) It is not very important; research will be performed anyway. B) In order for effective change to occur, current practices must be continually examined, questioned, and challenged. C) It involves "asking the burning clinical question." D) The agency does not have an important role in cultivating a spirit of inquiry.

B Feedback: In order for effective change to occur, current practices must be continually examined, questioned, and challenged. It is very important that the spirit of inquiry is cultivated. "Asking the burning clinical question" is part of the next step of asking the question. The agency does have a role in cultivating a spirit of inquiry. The organization must be open to a cultural shift from the status quo. The foundations of this spirit of inquiry are ongoing curiosity and a culture that supports it.

Which of the following would a community health nurse expect to assess in the population of homeless men? A) Marital status B) Substance abuse C) Permanent employment D) Frequent use of shelters

B Feedback: The majority of homeless men are single adults. Homeless men are more likely to be employed than their homeless female counterparts; yet, they usually hold temporary, low wage jobs that offer little security. They are also more likely than homeless women to have uncontrolled substance abuse issues. This makes it more difficult for them to access shelters, which tend to require abstinence for admission

Which of the following would be most appropriate for community health nurses to encourage when helping communities cope with the anxiety associated with terrorism? A) Maintaining high levels of alertness and fear B) Spending time with children and young people C) Spending more time indoors D) Keeping a fear journal

B Feedback: Most young people carry a charge of positive energy that is infectious. Maintaining high levels of alertness and fear are not healthy. Instead individuals should be a little afraid because a certain level of fear is healthy if the person learns to use it as positive energy. Spending more time outdoors is helpful remedy. Individuals should keep a courage journal; fear immobilizes and courage takes action.

Which of the following statements about the National Alliance on Mental Illness (NAMI) is most accurate? A) NAMI focuses on the needs of the people who actually have mental illness. B) NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. C) The NAMI Web site contains some information that is intended to be used exclusively by care providers. D) All services of NAMI are provided at the main headquarters.

B Feedback: NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. NAMI focuses on the needs of the families, peers, and consumers of Mental Health services. The NAMI Web site contains extensive information that can be utilized by both consumer and care providers. NAMI is a nationwide organization with chapters in each state and county.

When describing primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax to a local community group, which of the following would the nurse include? A) Investigating outbreaks to determine source B) Administering vaccines C) Screening suspected cases D) Treating persons who have been infected

B Feedback: Primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax would include administering vaccines. Investigating outbreaks to determine the source, screening suspected cases, and treating persons who have been infected would be secondary prevention activities.

Which one of the following statements about relative risk is most accurate? A) Lifestyle, behaviors, and choices do not relate to relative risk. B) Relative risk refers to exposure to risk factors identified from a substantial body of research. C) Relative risk means that if a risk exists, the illness or adverse event will occur. D) Any factor that is likely to cause increased risk is considered relative risk.

B Feedback: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.

Which one of the following statements is true regarding social capital? A) Social capital includes investments in individuals' capabilities and skills. B) Social capital includes marital status and family structure. C) Social capital includes jobs, income, housing, and education. D) Examples of social capital are education and job training.

B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.

After teaching a class on values, which of the following, if stated by the class, indicates the need for additional teaching? A) Some values are descriptive, while others are evaluative. B) Keeping a promise is an example of a terminal value. C) Values persist, remaining relatively stable over time. D) Certain values have more importance than others.

B Feedback: Terminal values refer to end states of existence such as spiritual salvation, peace of mind, or world peace. Instrumental values refer to modes of conduct such as confidentiality, keeping promises, and honesty. Some values are descriptive or capable of being true or false, while other values are evaluative, involving judgments of good and bad. Values remain relatively stable over time and persist to provide continuity to personal and social existence. A hierarchical system of values occurs in which certain values have more weight or importance than others.

Which of the following federal agencies would a community health nurse expect to be contacted to assist with a disaster in the United States? A) American Red Cross B) Federal Emergency Management Agency (FEMA) C) WHO's Emergency Relief Operations D) Pan American Health Organization

B Feedback: The Federal Emergency Management Agency (FEMA) is the federal agency responsible for assessing and responding to disaster events in the United States. The American Red Cross is authorized to provide disaster assistance free of charge across the country through its more than 1 million volunteers. It is not supported by the federal government. The World Health Organization's Emergency Relief Operations provide disaster assistance internationally, and the Pan American Health Organization works to coordinate relief efforts in Latin America and the Caribbean.

A community health nurse is working with a community-based organization to develop programs to provide quality accessible health care to the homeless population. Which of the following would be the most appropriate source from which to seek funding for this program? A) Projects for Assistance in Transition from Homelessness (PATH) B) Health Care for the Homeless (HCH) C) The Interagency Council on Homelessness D) U.S. Department of Housing and Urban Development

B Feedback: The HCH program (a provision of the McKinney Act) awards grants to community-based organizations that seek to provide quality, accessible health care to the homeless and would be the most appropriate source for funding. PATH is a grant program created under the McKinney Act to support the delivery of services to persons with severe mental illnesses, including those who are homeless or at risk of becoming homeless. The Interagency Council on Homelessness coordinates the federal response to homelessness and creates a national partnership with public and private sectors to reduce and end homelessness in the United States. HUD provides funding for supportive housing for low-income families, as well as low-income individuals with disabilities, and low-income elderly.

A group of ten people from the commune in the hills come into town dressed in robes and have their faces covered. They have weapons hidden in their clothing and begin entering the three banks in town to rob them. These actions can be classified as which of the following? A) Natural disaster B) Terrorism C) Casualty D) Adventitious crisis

B Feedback: The actions resemble terrorism, the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population or any segment thereof in furtherance of political or social objectives. The actions are not a natural disaster. Casualty refers to the person who is injured or killed by or as a direct result of an accident. An adventitious crisis is an event that is out of the ordinary in magnitude and personal experience.

After teaching a class about the factors that contribute to disasters, the instructor determines that the teaching was successful when the students identify which of the following as the agent? A) Population's age B) Radiation C) Level of preparedness D) Flood-prone location

B Feedback: The agent is the natural or technologic element that causes the disaster. For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs. The population's age is an example of host factor. The level of preparedness and flood-prone location are examples of environmental factors.

After teaching a class about family and domestic violence directed toward children as a community health problem, which of the following if stated by the class indicates to the instructor that the teaching was effective? A) Family violence is new and occurs as a result of our fast-paced technological society. B) Family violence has occurred in most countries for centuries as children have been thought of as the property of their parents. C) Family violence occurs mostly in the urbanized areas of the United States mostly in the urbanized areas where exposure to crime is more prevalent. D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

B Feedback: The history of family and domestic violence is long. For centuries, children were thought of as the property of their parents, and any treatment doled out by the parents was their prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned and begun to do something about family violence. Family violence is brought to the attention of officials more frequently today than in yesteryear, especially in urban areas where more people live, but it occurs throughout the world—in urban, rural, and remote areas with no signs of decreasing. Family violence in the United States occurs mostly in the urbanized areas where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

. Which time after the disaster would be the ideal time for this to occur? A) Within 18 hours B) 1 to 3 days C) 4 to 6 days D) 7 to 10 days

B Feedback: The ideal time for CISD is between 24 and 72 hours after the disaster event.

When would the nurse expect the response phase of a disaster to occur? A) When no disaster is expected or anticipated B) Immediately after the onset of the disastrous event C) Long-term phase occurring after the disastrous event D) Prior to the disastrous event

B Feedback: The response phase of disaster occurs immediately after the onset of the disastrous event. During the prevention phase no disaster is expected or anticipated. Long-term phase occurring after the disastrous event is the recovery phase. Prior to the disastrous event is the preparedness phase.

socioeconomic gradient of health? A) The behavior of smoking is lowest among those who have low income and low educational levels. B) The socioeconomic gradient of health has been found in populations around the world. C) All persons who have a low socioeconomic status will develop particular health problems. D) The socioeconomic gradient of health is universal.

B Feedback: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.

After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A) Direct B) Inverse C) Positive D) Unequal

B Feedback: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.

A group of families are attending a local community group for a class on Internet safety and children. Which of the following statements by the group indicates effective teaching? A) "It's not so much the time they spend but the sites they use." B) "We'll move the computer to the family room so we can easily observe the child's internet use." C) "We'll set the Internet browser feature to medium." D) "The firewall program that we have from 2 years ago should still be good."

B Feedback: To promote Internet safety with children, the computer should be placed in a high traffic area in the home so that others can easily observe what is going on. Parents need to monitor the time as well as the sites that the child uses. The Internet security browser should be set to high. With the advances in technology, a firewall program that is 2 years old may not be adequate to protect the child. However, it would be better than no firewall program at all.

A community health nurse responding to a disaster is involved with caring for the bodies of the casualties who have died. Which of the following would be an appropriate method for documentation? A) Making a note on the triage tag B) Using a toe tag for identification C) Placing the name on a casualty list D) Recording the name on the victim's body

B Feedback: Toe tags make documentation visible and accessible and are the most appropriate means for documentation. Making a note on the triage tag, placing the name on a casualty list and recording the name on the victim's body are inappropriate.

When discussing elder abuse with a senior citizen group, which of the following would the community health include? A) Older men experienced abuse at a higher rate than elderly women. B) Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. C) The majority of cases of elder abuse are perpetrated by persons unknown to the victim. D) Elders with dementia are less likely to be abused since they have less social interactions.

B Feedback: Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder abuse may be either known or unknown to the elder. Some elders are especially vulnerable to elder abuse.

The community health nurse is using effect theory to design a prevention program for behavioral health. Which of the following would be the most likely place for the nurse to start? A) Identifying antecedent factors leading to the problem B) Identifying the specific health problem C) Determining the desired health problem impact D) Specifying the health problem outcome

B Feedback: When using effect theory to design a prevention program for behavioral health, a good place to start is to identify the specific health problem and then the desired health problem impact and health problem outcome. As the program is developed, the community health nurse starts by identifying the antecedent factors that lead to behavioral health problems. This provides a clear rationale for why the intervention should provide the desired impact.

A community health nurse who will be working with a homeless population is planning care. Which of the following would the nurse need to do first? A) Develop trust with the population B) Clarify personal values and beliefs C) Focus on the issue of homelessness D) Visit the local shelter where the clients are

B Feedback: When working with the homeless population, it is crucial that the nurse clarify personal beliefs and values about poverty, homelessness, addictions, and mental disorders to ensure nonjudgmental care. Trust too is essential, but this would need to occur after the nurse has clarified his or her values and beliefs. Biases or judgments on the nurse's part would undermine the development of trust. The nurse needs to use a comprehensive, holistic approach or focus, not just focus on the population's homelessness. Visiting the local shelter may be helpful to gather information about what the nurse might expect, but it isn't the first thing the nurse would do.

After teaching a group of women in the community about common mental health disorders affecting them, the community health nurse determines that the teaching has been effective when the group identifies which one of the following? A) Anxiety disorders and mood disorders occur twice as frequently in men as in women. B) Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. C) The three main types of eating disorders affect more men than women. D) The three main types of eating disorders include undereating due to food unavailability.

B Feedback: Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. Anxiety disorders and mood disorders occur twice as frequently in women as in men. The three main types of eating disorders affect more women than men. The three main types of eating disorders (anorexia, bulimia nervosa, and binge eating) also affect more women than men.

A community health nurse is discussing alcohol use disorders and is explaining what is meant by a standard drink. Which of the following would the nurse include as an example? Select all that apply. A) Two 12-oz. cans of beer B) 5-oz. glass of wine C) 1.5 oz. of an 80-proof spirit D) 3 oz. of a cordial E) Two bottles of wine cooler

B, C, D Feedback: A standard drink contains about 14 g of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-oz. bottle of beer or wine cooler; 8 to 9 oz. of malt liquor; one 5-oz. glass of table wine; 3 to 4 oz. of fortified wine, 2 to 3 oz. of cordial, liqueur, or aperitif; 1.5 oz. of brandy; or 1.5 oz. of 80-proof distilled spirits.

A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which of the following as developmental crises? Select all that apply. A) A windstorm that damaged 20 homes in a community B) Grandpa Jones dying at age 82 years C) A couple getting engaged D) The Smiths getting a divorce E) The Jones experiencing a home invasion F) Seven people dying in an automobile crash

B, C, D Feedback: Developmental crises are periods of disruption that occur at transition points during normal growth and development. Developmental crises, as a rule, do not occur suddenly. They are more evolutionary than revolutionary. Even the advancing, age, illness, or death of a grandparent or parent is a developmental expectation. However, the actual event may occur suddenly. Experiencing damage from a windstorm, a home invasion, or an automobile crash are situational crises.

A community health nurse suspects that a client who was a victim of a disaster 3 months ago is experiencing post-traumatic stress disorder. Which of the following would the nurse expect to find? Select all that apply. A) Diminished startle response B) Hypervigilance C) Feelings of detachment D) Flashbacks E) Full range of affect

B, C, D Feedback: Signs and symptoms of post-traumatic stress disorder include increased startle response, hypervigilance, feelings of detachment, flashbacks, and restricted affect.

According to the Institute of Medicine's landmark report, The Future of Nursing, nurses should: Select all that apply. A) work independently from other health professionals to promote the profession of nursing. B) work collaboratively with other health professionals to promote health care. C) attempt to redesign health care. D) improve practices through evidence-based means. E) The Future of Nursing report does not express the importance of evidence-based nursing.

B, C, D Feedback: The Future of Nursing highlights the need for nursing to work with other health professionals in "redesigning health care" by "conducting research" and improving practices through evidence-based means.

Healthy People 2020 objectives focus on tobacco, alcohol, and illicit drug use education. Which of the following are steps in the process to providing this education? Select all that apply. A) Identifying the impact of substance use on the environment B) Identifying trends of substance use to develop a prevention program C) Understanding the consequences of substance use that affect a community as a whole D) Differentiating between legal and illegal substance use E) There are no differences in prevention programs for different populations

B, C, D Feedback: The three steps in the process for providing tobacco, alcohol, and illicit drug use education are in order (1) identifying trends, (2) differentiating legal versus illegal use, and (3) consequences of use. Identifying the impact of substance use on the environment is not one of the steps. There are differences in prevention programs—if the target population is young adults, the prevention of binge drinking might be a top concern; if homeless adults, the focus will be on chronic alcohol, cocaine, and heroin use; cultural and ethnic differences in alcohol and SUDs are noted in American Indians with increased rates of fetal alcohol syndrome and increased prevalence in prison and jail populations.

A community health nurse assesses a child during a home visit. Which of the following would lead the nurse to suspect that the child is a victim of sexual abuse? A) Bruising of the arms and back B) Evidence of numerous dental caries C) Complaints of pain on urination D) Burns on the hands and feet

C Feedback: A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising on the arms and back and burns on the hands and feet would suggest physical abuse. Numerous dental caries may suggest neglect.

A community health nurse has completed a community assessment. Which of the following would be next? A) Decide on an intervention B) Locate an appropriate the specific focus area in Healthy People 2020 C) Establish a community diagnosis D) Determine the level of prevention

C Feedback: After completing a community assessment, the nurse then establishes a community diagnosis. Once this is done, the next step is to decide on an intervention that can address the specific public health issue identified in the diagnosis. A good starting point in the development of community/public health intervention is to begin with the Healthy People 2020 objectives, locating the specific focus area that matches the community diagnosis. Once the nurse identifies the focus of the intervention, the next step is to determine the level of prevention.

Which one of the following statements regarding the etiology of substance use disorders is most accurate? A) It is believed that nurture has substantially more influence on the development of substance use disorders than nature. B) With the mapping of the human genome, hope has decreased that the genes related to substance use disorders could be identified. C) Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene-environment interaction). D) Only genetic heritability is involved in the etiology and course of substance use disorders.

C Feedback: Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene-environment interaction). It is believed that genetics is a risk factor in the range of 50% to 50%. With the mapping of the human genome, hope has increased that the genes related to substance use disorders could be identified. In addition to genetic heritability, both personal and environmental factors are involved comparably in the etiology and course of substance use disorders.

After teaching a class about commonly used illicit substances, the instructor determines that the teaching was successful when the class identifies which of the following as the most frequently reported illicit drug? A) Heroin B) Methamphetamine C) Marijuana D) Cocaine

C Feedback: Although heroin, methamphetamine, and cocaine are frequently used illicit drugs, marijuana is the most frequently reported illicit drug.

The community health nurse is explaining the reasons for health problems in the homeless population. Which of the following would the nurse identify as the most likely reason? A) Issues related to storage of medications B) Lack of transportation to keep appointments C) Time and energy focus on survival needs D) Limited access to health care services

C Feedback: Although issues related to medication storage, lack of transportation, and limited access to health care play a role, many homeless people expend their time and energy trying to meet basic survival needs such that health care takes a backseat to finding food, clothing, or shelter.

After teaching a group of students about agents associated with chemical warfare, the instructor determines that additional teaching is needed when the students identify which as an example? A) Explosives B) Nerve agents C) Anthrax D) Jet fuel

C Feedback: Anthrax is considered a bioweapon. Explosives, nerve agents, and jet fuel are considered agents of chemical warfare.

Which of the following would a community health nurse expect to assess in a perpetrator of intimate partner violence? A) Occasional marijuana use B) High academic achievement C) Belief in male dominance D) Desire for complacency

C Feedback: Characteristics of perpetrators of intimate partner violence include a belief in strict gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement, and desire for power and control in relationships.

A community health nurse is working with people who experienced a tornado and have been forced to leave their homes to escape the effects of a disaster. The nurse would identify these people as which of the following? A) Indirect victims B) Refugees C) Displaced persons D) Casualties

C Feedback: Displaced persons are those who have been forced to leave their homes to escape the effects of a disaster. Indirect victims are the relatives and friends of direct victims. Refugees are direct victims who are forced to leave their homeland, usually due to war, religious persecution, or political turmoil. A casualty is a human being who is injured or killed by or as a direct result of an accident.

A community implements a plan to enforce the underage drinking law. The community health nurse interprets this action as reflecting which public health model? A) Primary prevention B) Behavioral prevention C) Environmental prevention D) Clinical prevention

C Feedback: Environmental prevention relies on a societal commitment for the implementation of the interventions and aims to alter the environment by reducing risk (e.g., community-wide decrease in availability of the substance; underage drinking law enforcement). Primary prevention is conducted when no disease is present in the target population with the primary goal being prevention of disease development. Behavioral prevention includes a broad array of strategies aimed at changing lifestyles (e.g., exercise, smoking cessation, balanced nutrition). The goal of the intervention is to change behaviors that put the person at risk for developing the disease or to prevent consequences of the disease. Clinical prevention is based on the medical model for preventive services. It relies on one-to-one, provider-to-patient interaction and occurs within the traditional health care delivery system.

The nurse is using the epidemiological triad to explain the factors contributing the disaster. Which one of the following statements about the environment factors that contribute to disasters is most accurate? A) The environment is the natural or technologic element that causes the disaster. B) The environment is the human being who experiences the disaster. C) Factors that could potentially contribute to or mitigate a disaster are environmental. D) Examples of environmental factors that cause a disaster are high winds of a hurricane and the lava of an erupting volcano.

C Feedback: Factors that could potentially contribute to or mitigate a disaster are environmental. The agent factor is the natural or technologic element that causes the disaster, for example the high winds of a hurricane and the lava of an erupting volcano. The host is the human being who experiences the disaster.

When developing appropriate programs for adult mental health promotion, the nurse incorporates knowledge about the most prevalent mental disorders. Which of the following would the nurse identify as the most prevalent? A) Major depression B) Bipolar disorder C) Anxiety disorders D) Schizophrenia

C Feedback: For American adults, the most prevalent mental disorders are anxiety disorders, followed by mood disorders, especially major depression and bipolar disorders. Schizophrenia, which affects approximately the same number of adults as bipolar disorder, is problematic because it is so persistently disabling.

After teaching a group of students about abuse and families, the instructor determines that the students have an understanding of this issue when they state which of the following? A) Less than 10% of women worldwide reported being physically abused by an intimate partner at some point in their lives. B) A woman's risk of intimate partner violence decreases during pregnancy, but increases once the baby is born. C) Intimate partner violence is a leading cause of morbidity and mortality in women worldwide. D) Intimate partner violence is a private matter and not a public health issue

C Feedback: Intimate partner violence is a leading cause of morbidity and mortality in women worldwide and is a public health issue. It is estimated that between 10% and 52% of women report being physically abused by an intimate partner at some point in their lives worldwide. A woman's risk of intimate partner violence increases during pregnancy with 44% to 48% of all women being abused at least once during the pregnancy.

After a class discussion on moral evaluations, which characteristic if identified by the class would lead the instructor to determine that the discussion has been effective? A) There is specificity that applies to an individual person. B) A special place is given to a person's own welfare. C) Other values cannot override the moral evaluation. D) They relate to a matter of individual taste.

C Feedback: Moral evaluations have distinctive characteristics: the evaluations are ultimate, having a preemptive quality, meaning that other values or human ends cannot, as a rule, override them; they possess universality or reflect a standpoint that applies to everyone, such that everyone in principle ought to be able to make and understand, even if some individuals, in fact, do not; moral evaluations avoid giving a special place to a person's own welfare, having a focus that keeps others in view, or at least considers one's own welfare on a par with that of others. Moral evaluations are prescriptive-proscriptive beliefs that have certain characteristics separating them from other evaluations including matters of taste.

After teaching a class on ethical principles, the instructor determines that the class needs additional instruction when they identify which of the following as an ethical principle? A) Respect B) Autonomy C) Morality D) Justice

C Feedback: Morality is the behavior or judgment that conforms to a standard that is right and good. When judgments involve moral values, conflicts are inevitable. There are seven fundamental ethical principles that guide decision making. These include respect, autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.

Which one of the following statements about primary prevention for family violence is most accurate? A) The cycle of violence within the family cannot be interrupted. B) Persons who have been victims of family violence will repeat the behavior with others. C) Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. D) It is not possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

C Feedback: Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. The cycle of violence within the family can be interrupted, and persons who have been victims of family violence can learn to use more appropriate coping strategies. It is possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

When working with clients, a community health nurse promotes the clients' self-concept and health promoting behaviors. The nurse is attempting to achieve which outcome? A) A value system B) Prescriptive-proscriptive beliefs C) Individual autonomy D) Values clarification

C Feedback: Promoting clients' self-concept and health-promoting behaviors are associated with the value of self-determination that promotes individual autonomy. Value system, prescriptive-proscriptive beliefs, and values clarification are not associated with self-determination. A value system is an organized set of beliefs that guide individual behavior. Prescriptive-proscriptive beliefs are viewed as desirable or undesirable beliefs. Values clarification is a process that helps identify the personal and professional values that guide actions.

A community health nurse is evaluating a population for socioeconomic resources. Which of the following would the nurse address? A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providers

C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.

An instructor reviews the definition of homelessness according to the McKinney Vento Homeless Assistance Act with a group of community health nursing students. The instructor determines that the students need clarification when they include which of the following as homeless? A) Someone living in a public shelter B) Someone living in a park C) Someone who is incarcerated D) Someone who lives in his or her car

C Feedback: The McKinney-Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a person as homeless who lacks a fixed, regular, adequate night time residence including supervised public or private shelters that provide temporary accommodations, institutional settings providing temporary shelter, or public or private places that are not designed for or used as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds). Incarcerated individuals, however, are not considered homeless under this definition.

After teaching a group of community health students about public and private sector programs and initiatives aimed at combating homelessness, the instructor determines that they need additional teaching when they identify which of the following as a private sector organization? A) National Coalition for the Homeless B) National Alliance to End Homelessness C) National Resource Center on Homelessness and Mental Illness D) National Low Income Housing Coalition

C Feedback: The National Resource Center on Homelessness and Mental Illness is a federally sponsored public program for addressing the needs of the homeless. The National Coalition for the Homeless, the National Alliance to End Homelessness, and the National Low Income Housing Coalition are private sector resources.

A community health nurse is working with a political group to lobby for changes in funding for a mental health promotion program. The nurse is functioning in which role? A) Educator B) Collaborator C) Advocate D) Case manager

C Feedback: The advocacy role requires being politically involved by serving on decision-making boards and committees, lobbying for legislative changes, and helping to influence mental health policy development that will better serve this population. In the educator role, the community mental health nurse teaches clients individually and in groups about their mental health conditions, their treatment protocols, ways to function more independently in the community, prevention and health-promoting strategies, and much more. In the collaborator role, the nurse works with others, pooling the groups professional expertise to enhance the quality and effectiveness of services. In the case manager role, the nurse is involved with screening, assessment, care planning, arranging for service delivery, monitoring, reassessment, evaluation, and discharge, often within the context of a community mental health center (CMHC). Case management helps the person with an SMI to access services and live as independently as possible.

When providing secondary prevention activities for individuals experiencing psychological consequences of a disaster, which of the following would the nurse do as a generic approach? A) Providing situational support for stress relief B) Conveying warmth and concern for the client C) Teaching about expected emotional reactions D) Reunifying family members who were separated

C Feedback: The generic approach is designed to reach high-risk individuals and large groups who have experienced the same disaster, teaching them about the expected emotional reactions to the type of disaster they have experienced and promoting adaptive responses. Environmental manipulation results in the change of a person's physical or interpersonal situation, providing situational support to relieve stress. An example of environmental manipulation is when a community health nurse coordinates the reunification of family members separated by the disaster. General support is defined as the caring, warmth, and concern the community health nurse conveys to the client as she or he delivers services.

Which of the following statements about evidence-based practice has been identified by multiple reports over the past decade, such as To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003)? A) We must continue to cling to "the way we've always done it." B) We have spent billions of dollars each year researching new treatments and have translated that knowledge into clinical practice. C) We are not translating the knowledge that we are gaining into clinical practice. D) We have continued to spend more than a trillion dollars a year providing care and do translate that capacity into improved clinical practice.

C Feedback: To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Priority Areas for National Action: Transforming Health Care Quality (2003). These reports draw attention to the fact that we spend billions of dollars each year researching new treatments, and more than a trillion dollars are spent annually on health care, but "we repeatedly fail to translate that knowledge and capacity into clinical practice."

Which of the following would a community health nurse use to define vulnerable populations? A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illness

C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.

Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedback

C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.

Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining grounded

C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.

1. What should a population health approach to provide treatment for violent persons include? a. Advocate for availability of treatment services and facilities. b. Referral for necessary services c. Educate the public about factors that contribute to the risk of violence. d. Remove victims of abuse to safe environments as needed.

Correct: A Advocating for treatment services and facilities addresses the population health goal of providing treatment for violent persons. Referral to necessary services and removing victims of abuse addresses approaches on an individual level. Educating the public about factors that contribute to the risk of violence is a population health approach that addresses identifying persons at risk for violence, not providing treatment for violent persons.

1. A nurse has been working with groups of parents from families who are either victims of abuse or are abusers themselves. The nurse asks which priority question to identify potential stressors that increase the risk of family violence? a. How many parents in this room were spanked as children?" b. What kinds of activities do you engage in when there is a crisis in your family?" c. Do your children create tension for you when you are home?" d. How many people are victims of abuse?"

Correct: B Families with poor coping skills have difficulty dealing with situational stressors that create tension, resulting in violence. Constant family crises or upheavals indicative of poor coping abilities are frequently charact

1. What should the population health nurse recommend to prevent suicide clusters and copycat murders in a community? a. Assist family members who are affected work through feelings of guilt and grief. b. Advocate for services to address victims and perpetrators of violence. c. Assist in developing community response plans to these events. d. Reduce the sources that contribute to suicide or homicide.

Correct: C A population oriented strategy to prevent suicide clusters and copycat murders is to have a community response plan. In addition, media exposure to these events can be controlled. Assisting family members and reducing sources that contribute to suicide and homicide address other prevention goals. Advocating for available services for victims and perpetrators of violence is not considered preventing suicide clusters and copycat murders, but a treatment of the consequences of violence.

1. A primary prevention strategy to address health disparities would include a. Educating communities about when to call the doctor b. Screening a community for diabetes c. Providing a social media campaign designed alert residents to prepare for a disaster. d. Educated the community on the sign of stroke.

Correct: C Helping clients prepare for a potential disaster is a primary prevention strategy because low income populations suffer the greatest impacts after a disaster.

1. Health Equity can viewed as a. A process to follow b. An outcome to achieve c. A goal to be considered d. Both a process and outcome

Correct: D The RWJ foundation sates that health equity is a process of reducing disparities and an outcome because the ultimate goal is to eliminate the root causes of health equity.

1. During a physical assessment the population health nurse learns that a client is experiencing nightmares, anxiety, and is 20 lbs. below normal weight. The client casually mentions a suicide attempt but refuses to discuss her relationship with her spouse. Which issue should the nurse suspect is occurring with this client? a. substance abuse b. child abuse c. intimate partner abuse d. Anorexia.

Correct: c

When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A) Vulnerable populations are fairly similar across the nation and globally. B) Statistics about vulnerable populations are highly accurate. C) The most important causative factor is race or ethnicity. D) Many of the factors and conditions suggest vulnerability overlap.

D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

A community health nurse discovers that a bill in the legislature would eliminate a state law that currently funds child health promotion services for low-income children. Which action at the primary level of prevention would be most appropriate? A) Advocate for amendment to the passed law to allow some funding for children to remain B) Once the bill has been passed, seek private resources to support funding of health promotion services for low-income children. C) Gather a group of health professionals to volunteer to provide the health promotion services eliminated by the passed bill D) Advocate through active lobbying against the bill and gather community support

D Feedback: Appropriate activities at the primary level of prevention would include actively lobbying against the bill, garnering community support in favor of the revised bill, and advocating for the clients. Advocating for amendments would be appropriate at the secondary level. Seeking private resources and gathering volunteers to provide the health services would be appropriate at the tertiary level.

When describing the cycle of violence to a group of students, the instructor includes which of the following as occurring as the cycle continues? A) Frequency of the cycle slows B) Tension-building occurs less often C) Loving reconciliation lasts longer D) Acute battering occurs more often

D Feedback: As the cycle of violence continues, the frequency of the cycle increases, with the tension-building phase and the acute battering incident occurring more often, and elimination of the loving reconciliation phase. Without intervention, this shorter, more violent cycle becomes increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner, incarceration, or death of a partner.

11. Which of the following would the community health nurse do first when making an ethical decision? A) Engage in critical thinking B) Choose a value C) Identify isolated values D) Clarify one's values

D Feedback: Clarification of a person's values is the first step in the process of ethical decision making. Critical thinking is a strategy that can be used to help clarify values. Choosing a value is the first step in the process of valuing. Identifying isolated values are those which are organized into a hierarchical system where certain values have more weight or importance than others.

A community health nurse is applying the value of equity in decision making with clients. Which of the following best describes this value? A) Forming, revising, and pursuing personal life plans B) Promoting clients' health and a sense of well-being C) Fulfilling one's desires over those of others D) Treating similar cases in the same fair fashion

D Feedback: Equity is defined as the value directing like cases to be treated alike and that all individuals be treated fairly. Self-determination refers to a person's exercise of the capacity to shape and pursue personal plans for life. Well-being involves promoting clients' health and sense of well-being. Self-interest is the fulfillment of one's own desires without regard for the greater good.

Which one of the following statements about nonprofit organizations that serve those with mental health issues is most accurate? A) They are all associated with the government. B) A for-profit organization that promotes mental health is Mental Health America, which was established in 1909. C) The organization National Mental Health Association is a scam. D) They focus on advocacy, education, service, and funding research endeavors.

D Feedback: Nonprofit organizations focus on advocacy, education, service, and funding research endeavors. They are not all associated with the government. Mental Health America was formerly known as National Mental Health Association, which is a leading nonprofit organization that promotes mental health.

After reviewing statistics on homelessness, which of the following would a community health nurse identify as the fastest growing segment of the homeless population? A) Children under age 18 years B) Families headed by a female single parent C) Families headed by a male single parent D] Families with children

D Feedback: Families with children are the fastest growing segment of the homeless population based on statistics, accounting for approximately 34% of the homeless population. Single female parents account for most of the homeless families. However, because many two-parent families and families headed by single fathers are becoming homeless because of the recession, and most homeless provider organizations serving families are geared to serving single women with children, it can be harder for intact families and families headed by men to access shelter.

A community health nurse is part of community discussion group on alcohol. The nurse recommends that adult males should have less than A) 6 standard drinks weekly. B) 8 standard drinks weekly. C) 10 standard drinks weekly. D) 14 standard drinks weekly.

D Feedback: For the general male adult population, the recommended drinking limits are fewer than five standard drinks daily or 14 weekly. For the general female adult population, the recommended drinking limits are fewer than four standard drinks daily or eight weekly, and for people age 65 and older, recommended drinking limits are no more that one standard drink daily or seven standard drinks weekly.

Which of the following would be least appropriate for a community health nurse to include in a plan of care at the secondary prevention level for families who may need to respond in a case of crisis in the future? A) Teaching social problem-solving skills B) Helping women develop assertiveness skills C) Providing parenting classes D) Helping to reestablish as sense of safety

D Feedback: Helping to reestablish a sense of safety would be appropriate at the secondary level of prevention. Teaching social problem-solving skills, helping women develop assertiveness skills, and providing parenting classes are appropriate primary prevention level activities.

In preparation for an examination on the history of family violence, a group of students reviews the various laws enacted for protection. The students demonstrate understanding when they identify which of the following as one of the earliest laws enacted? A) Child Abuse Prevention and Treatment Act B) Family Violence Prevention and Services Act C) Keeping Children and Families Safe Act D) Child Abuse Prevention and Treatment and Adoption Reform Act

D Feedback: In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as the Keeping Children and Families Safe Act.

A community health nurse is developing a plan of care for families in crisis. Which of the following would be most appropriate for the nurse to include? A) Encourage clients to suppress feelings to minimize pain B) Avoid correcting distorted facts to reduce stress C) Allow clients to blame others for the crisis D) Help clients confront crisis

D Feedback: In a crisis, the community health nurse encourages clients to accept help by acknowledging the problem. The nurse should encourage clients to express their feelings openly, assist them in finding facts (distortions create additional tension that may lead to maladaptive responses), and avoid blaming others to promote responsibility for problem solving.

Which of the following statements about basic values that guide decision making in community health nursing is true? A) Client empowerment means that the provider must use a paternalistic approach to health care. B) Self-interest does not interfere with self-determination. C) When matters of well-being are considered, the client's preferences and needs should not be considered. D) Equity is not possible in times of limited resources.

D Feedback: In times of limited technical, human, and financial resources, however, it may be impossible to fully respect the value of equity. Client empowerment is an approach that differs from the paternalistic approach to health care in which decisions are made for, rather than with, the client; instead, it enables patients and professionals to work in partnerships. When self-determination deteriorates into self-interest, it poses a major roadblock to equitable health care. Well-intended interventions sometimes fall short if they are in conflict with clients' preferences and needs.

A community health nurse is applying the Institute of Medicine model based on Gordon's Classification of Disease Prevention model to address prevention of alcohol use during pregnancy and prevention of fetal alcohol syndrome. Which of the following populations would the nurse target indicated prevention strategies? A) Local women in the community of childbearing age B) Women of childbearing age living in a city C) Women of childbearing age considered at risk D) Pregnant women who have a child with fetal alcohol syndrome

D Feedback: Indicated prevention strategies would be designed to prevent the use of alcohol in pregnant women who had screened positive for alcohol use during pregnancy or already had a child diagnosed with FAS or FASD. Universal prevention strategies would address the entire population of women of childbearing age (national, local community, school, neighborhood), with messages and programs aimed at preventing the use of alcohol if pregnancy is a possibility. Selective prevention strategies would target subsets of women of childbearing age who are deemed to be at risk for alcohol use by virtue of their membership in a particular population segment.

A community health nurse obtains a client's informed consent for care demonstrating the understanding that this is derived from which value? A) Self-interest B) Well-being C) Equity D) Self-determination

D Feedback: Informed consent derives from self-determination. Self-interest refers to a deterioration of self-determination in which the person focuses on fulfilling one's own desires without regard for the greater good. Well-being is a state of positive health, the intent of all therapeutic interventions. Equity refers to justice or fair and equal treatment.

Which of the following would a community health nurse address as a means for enhancing the life of the public? A) Proper nutrition B) Healthy sleep patterns C) Use of community supports D) Creative outlets

D Feedback: Life-enhancing activities to enhance public well-being include meaningful work, whether through or outside of employment, creative outlets, interpersonal relationships, recreational activities, and opportunities for spiritual and intellectual growth. Proper nutrition, healthy sleep patterns, and use of community supports are life-sustaining activities.

When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor? A) Social support networks B) Crime rates C) Transportation D) Living conditions

D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

A community health nurse is providing an in-service program to the agency staff about effect theory, which will be used to develop behavioral intervention programs. The nurse determines that the staff needs additional teaching when they identify which of the following as a component of the theory? A) Determinant theory B) Intervention theory C) Impact theory D) Process theory

D Feedback: Process theory is a theoretical framework used in community/public health science. It is not a component of effect theory. Effect theory has four components: determinant theory, intervention theory, impact theory, and outcome theory.

A nurse is planning a research study to answer a clinical question. Which of the following would be most appropriate for qualitative research approach? A) Evaluating the reported cases of post vaccination complications after varicella immunization B) Determining the use of complementary and alternative health care by middle-aged adults in rural areas C) Ascertaining the effect of using calming music on older adults with dementia in extended care facilities D) Assessing the emotional responses and feelings of individuals requiring isolation due to a highly communicable illness

D Feedback: Qualitative research is used to study those areas that need a broader focus or that do not lend themselves to objective measurement. This type of research emphasizes subjectivity and the meaning of the experiences to individuals. Thus, qualitative research would be most appropriate for assessing the emotional responses and feelings of individuals who require isolation for a communicable illness. Quantitative research would be used to evaluate the reported cases of post vaccination complications, to determine the use of complementary and alternative health care, and to ascertain the effect of calming music.

Which of the following would likely provide the best estimate of the number of persons who are homeless? A) Counting the number of homeless people on a particular day B) Counting the persons who are homeless in a given week C) Counting the number of persons who are homeless at a specific time on a specific date D) The number of people who have been homeless over the course of a year

D Feedback: Rather than trying to count the number of homeless people on a given day or week (point in time counts), it may be more prudent to measure the number of people who have been homeless over a longer timeframe such as over the course of a year (period prevalence counts).

When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse

D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavio

A community health nurse is preparing a program for a local community group about homelessness. A portion of the program will address homeless men. Which of the following would the nurse include? A) Homeless men are not looked down upon less than other groups. B) Homeless men are usually eligible for social services. C) Homeless men are perceived as blameless for their situation. D) Single, low-income men only qualify for medical assistance if disabled.

D Feedback: Single, low-income men only get medical assistance if they are disabled. Homeless men are more likely to be treated with disdain than other homeless subgroups. Some people perceive homeless men as largely to blame for their plight, believing that they are able bodied and should be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough to warrant eligibility for health and social services. Often health and social programs give priority to women and children.

A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizations

D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.

A community health nurse is working with a group of homeless clients with substance abuse problems. Which of the following would be appropriate for the nurse to do at the tertiary level of prevention? A) Conduct mass screening for common communicable diseases B) Institute a mobile van to assist in early diagnosis of common illnesses C) Advocate for counseling programs to address high risk behaviors and abuse D) Assist in ensuring participation in substance abuse rehabilitation programs

D Feedback: Tertiary prevention level activities include treatment of complications of advanced disease, providing rehabilitative care, such as participation in a substance abuse rehabilitation program, and offering counseling and support. Conducting mass screenings for common communicable diseases associated with substance abuse and a mobile van program to assist in early diagnosis are secondary prevention level activities. Advocating for counseling programs to address risk behaviors and abuse would be a primary prevention level activity.

A community health nurse is designated as a "mandated reporter." Which of the following best describes this designation? A) The nurse must witness abuse and neglect before being mandated to report. B) The nurse commands that battered women report the abuse. C) The supervising community health nurse is responsible for reporting only known cases of elder abuse. D) The nurse must report any case of known or suspected abuse and neglect in children or elders.

D Feedback: The abuse or neglect simply needs to be suspected in order for the nurse to report. In most states the nurse can receive a jail sentence and a fine for not reporting suspected abuse. Reporters may never witness the actual abusive event, but they can often see the resulting damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects according to the community's laws.

Which one of the following are the primary roles that the community health nurse must use to understand and serve populations with mental illness? A) Advocate B) Educator C) Case manager D) Consumer of epidemiologic data

D Feedback: The access and use of epidemiologic data to understand and serve populations with mental illness are primary.

Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A) Exposure to risk factors affects the population's social and human capital. B) Everyone is at risk because of stressful events occurring in life. C) A risk for a negative outcome increases with lower education and income levels. D) Certain groups are impacted by stressful events more than others.

D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.

Which of the following statements about the steps of the EBP process is most accurate? A) One of the last steps of the EPB process is to search for and collect the most relevant best evidence. B) One of the earliest steps in the EBP process is to disseminate the outcomes of the EBP decision or change. C) It is optional to integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. D) The first step in the EBP process is to cultivate a spirit of inquiry.

D Feedback: The steps of the EBP process in order are cultivating a spirit of inquiry; asking the burning question in PICOT format; searching for and collecting the most relevant best evidence; critically appraising the evidence for its validity, reliability, and applicability and then synthesizing that evidence; integrating the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluating outcomes of the practice decision or change based on evidence; and disseminating the outcomes of the EBP decision or change.

A community health nurse is providing a community education program about suicide. Which of the following would the nurse include as a common method used by women? A) Hanging B) Firearms C) Vehicle crash D) Overdose

D Feedback: Women usually choose less violent methods, such as overdosing on medications. Men choose more violent forms of suicide, such as hanging, use of firearms, or vehicle crashes.