Community Exam 4

Which statements about home health care are accurate? (Select all that apply.) a. Home health care is just as effective as care provided in the hospital setting. b. Home health care is typically more affordable than care provided in a skilled nursing facility. c. IV therapy can be provided through home health care. d. Care for clients facing a terminal illness is provided through home health care. e. The goal of home health care care is for clients to die with dignity. f. The goal of home health care is for clients to regain as much independence as possible.

ANS: A, B, C, F Home health care is typically more affordable than and just as effective as care that people receive in a hospital or skilled nursing facility. Examples of home health care services include wound care, education, IV therapy, nutrition therapy, follow-up with a patient after discharge from the hospital, and monitoring of an unstable or chronic illness. The goal of home health care is to help people get better in their own homes to regain as much independence as possible (Medicare.gov, 2016a). Hospice care focuses on caring for people facing a terminal illness when the goal is no longer curing the disease (National Hospice and Palliative Care Organization [NHPCO], 2016). The goal of hospice care is that each person will die pain free and with dignity.

Which type of behaviors would a nurse expect to see when a disaster first strikes a community? a. A sense of all being okay and that one can rebuild and go on b. Anger and despair that help being offered is insufficient, slow, and inadequate c. Everyone trying to help strangers, as well as their neighbors, survive d. People involved sharing their stories and reliving what occurred

ANS: C The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

Who is responsible for ensuring the safety and welfare of communities? (PowerPoint) a. Federal government b. Federal Emergency Management Agency c. Local government d. State government

ANS: C The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

What would a nurse who is aware of national statistics regarding mortality, morbidity, and epidemics in the United States emphasize at school meetings for parent and staff? a. Dangers of bioterrorism and how staff must be prepared for disasters b. How to react in the safest manner if violence breaks out in the school c. Importance of not sharing personal items to avoid spread of infections and parasites d. Need for physical exercise for each student on a daily basis

ANS: D Need for physical exercise for each student on a daily basis

Which cause of death on a death certificate would need correction by the forensic nurse? ***Mentioned in class*** a. Accident b. Homicide c. Natural d. Suicide e. Untimely

ANS: E The National Association of Medical Examiners identifies five acceptable options for recording manner of death: (1) natural, (2) accident, (3) suicide, (4) homicide, and (5) undetermined.

Which symptom would the faith community nurse (FCN) expect to see when caring for a client with the diagnosis of spiritual distress? ***Mentioned in Class*** a. Hopelessness, isolation, and loneliness b. Intense need for prayer and support c. Loss of faith d. Withdrawal from stress and the environment

ANS: A FCNs provide nursing interventions related to the nursing diagnosis as connected to spiritual distress (e.g., loneliness, isolation, and hopelessness).

Who should create a disaster plan including emergency supplies and where to meet in case of an emergency? a. All families b. All government officials c. All public health employees d. Members of Congress and the Supreme Court

ANS: A The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are: (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

An occupational health nurse (OHN) reminds employees to put on their safety glasses and use other personal protective equipment. Which level of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion

ANS: A The OHN uses a variety of primary prevention methods, with one-on-one interaction as an important strategy for evaluating risk reduction behavior for individuals. Understanding appropriate engineering and administrative controls and personal protective equipment specific to preventing workplace health hazard exposures is one of the responsibilities of the OHN. Secondary prevention strategies are aimed at early diagnosis, early treatment interventions, and attempts to limit disability. On a tertiary level, the OHN plays a key role in the rehabilitation and restoration of the worker to an optimal level of functioning. Health promotion is not a level of prevention.

Which disasters are considered natech (natural-technological) disasters? (Select all that apply.) a. Constant rain led to mud slides, and whole neighborhoods were buried. b. An earthquake caused structural collapse of bridges and highways in the area. c. People stampeded out of the overcrowded arena, trampling people who had fallen. d. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. e. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. f. Volcanic eruption covered the town with ash, making it difficult to breathe.

ANS: A, B, D, E Disasters are identified as natural, man-made, or a combination of both. A natech disaster is a natural disaster that creates or results in a widespread technological problem. Examples of natech disasters would include whole neighborhoods being buried by mudslides, earthquakes causing structural collapse of roadways or bridges, river flooding resulting in an overflow of the sewage plant and contaminated drinking water, and a tsunami washing out all of the power and telephone lines. People stampeding out of a crowded arena do not involve a disaster that results in a widespread technological problem, nor does a volcanic eruption that makes it hard to breathe.

What findings would be expected if a school nurse collected data related to the health issues experienced by students? (SATA) a. Almost half of all high school students have had sexual relations b. Asthma is a common cause of absenteeism c. Dental caries is the most common chronic health problem of children d. Children may be psychologically affected by skin disorders that affect their physical appearance e. Scabies and pediculosis necessitate that the student stay home f. Tinea capitis and impetigo are major contributors to absenteeism

ANS: A,B,C,D

Which is the most common form of elder abuse? ***Mentioned in class**** a. Emotional abuse by caregivers b. Financial abuse when resources are used without the elder's consent c. Neglect by self or caregivers d. Physical mistreatment resulting in injuries

ANS: C Neglect is the most common form of elder abuse, whether it is caregiver neglect or self-neglect. Neglect is more likely to occur than emotional abuse, financial abuse, or physical mistreatment resulting in injuries.

In which clinical areas are nurses most at risk for workplace violence? (Select all that apply.) a. Acute care/intensive care units b. Community health clinics c. Emergency departments d. Geriatric units e. Psychiatric units f. Rehabilitation units

ANS: C, D, E In the health care field, the most frequent areas for the occurrence of violence are the emergency departments, psychiatric units, geriatric units, and waiting rooms.

Which actions would public health professionals want to use as primary prevention against widespread community violence? (Select all that apply.) a. Women seen in emergency departments should be asked about abuse b. Courses for prisoners about avoiding violence and resolving conflict c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence f. Home visits to elderly clients should include screening for elder abuse

ANS: C, D, E The goal of primary prevention is to stop violence, abuse, or neglect before it occurs. Education plays a major part in primary prevention and may include parenting and family wellness, and anger management or conflict resolution. Professionals should increase their awareness of violence, identification of cases, and provision of early treatment. The nurse can work in or with the community to educate citizens about the problem of violence, potential causes of violence, and available community services. Screening is secondary prevention, and courses for those already known to be violent are tertiary prevention.

Which skill can a forensic nurse, serving in the elected office of coroner, bring to the situation compared with other professionals? ***MENTIONED IN CLASS*** a. Extensive knowledge of medicine b. Knowledge of the law c. Previous experience in testifying in court d. Superb communication and empathy skills

ANS: D Nurse coroners exhibit communication skills when dealing with grieving families. Nurses are educated in therapeutic communication and practice those skills in any setting. Nurses are acutely aware of the importance of using open-ended questions, attentively listening, and being fully present with family and friends.

Although originally school nursing's purpose was preventing the spread of contagious diseases, what additional responsibilities was quickly added? a. Incorporating health education into the curriculum b. Replacing physicians for those children whose parents could not afford a physician c. Substituting for classroom teachers when the teacher was ill d. Teaching safety, first aid, and universal precautions to teachers

ANS: A The health issues seen by the school nurses expanded the nursing practice to include prevention, examination, treatment, and advocacy.

Where is youth violence most likely to occur? (PowerPoint) a. At home b. At recreational facilities c. In inner city schools d. In fast-food facilities where young adults are employed

ANS: C Youth-related violence is more concentrated in minority communities and inner cities, causing a disproportionate burden on these communities. Children are often not taught peaceful ways of resolving differences and learn by default from what they observe on television, in movies, and through video games. Consequently, schools have become a common site for violence.

Which describes a responsibility of the forensic psychiatric nurse? ***Mentioned in class*** a. Assisting with the deposition b. Collecting evidence to be used in future legal proceedings c. Judging intent or diminished capacity of the client during the incident d. Preparing to testify in court

ANS: C Forensic psychiatric nurses collect evidence by determining intent or diminished capacity in the client's thinking at the time of the incident. To do this, they often spend several hours interviewing and observing the client, carefully documenting conversations and observations.

Which are the responsibilities of the Centers for Disease Control and Prevention (CDC) in relation to disasters? (Select all that apply.) a. Contacting family members with up-to-date information regarding victims and their condition b. Coordinating local services to prevent duplication and fragmentation c. Delivering first aid and arranging for prescription medications that were lost to be replaced d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims f. Setting up safe and comfortable disaster shelters (emergency housing) for families

ANS: D, E After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), the CDC—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross.

A forensic nurse is responsible for conducting a thorough examination, including a history, performing a physical assessment, and collecting forensic evidence on a female client following a rape. In which subspecialty of forensic nursing is this nurse practicing? a. Sexual assault nurse examiner (SANE) b. Nurse coroner c. Legal nurse consultant d. Forensic nurse death investigator

ANS: A A SANE is a specially trained registered nurse who applies the nursing process during forensic examinations to victims or perpetrators of sexual assault. The SANE collects forensic evidence related to a reported crime and frequently testifies as an expert witness at subsequent trials. If the client is medically stable, the SANE is responsible for conducting a thorough examination, including obtaining a history, performing the physical assessment, and collecting forensic evidence. The nurse coroner would be responsible for ensuring that appropriate measures were taken to perform death investigations and certify death certificates. Legal nurse consultants provide assistance within the legal system using specialized nursing knowledge and expertise when interactions of law and health issues arise. The forensic nurse death investigator evaluates the death scene from a holistic nursing perspective and might interpret the scene differently.

Which ethical issue is often a concern to a faith community nurse (FCN)? a. The client's right to confidentiality if a client repents and confesses sin to the nurse b. Following the Health Insurance Portability and Accountability Act (HIPAA) requirements c. The nurse's legal responsibility to the faith community leader d. Setting up appropriate medical records of care given in case of a later legal suit

ANS: A Confidentiality issues have the potential to be problematic in a church community. Church members can ask how someone is doing. Another church member would respond with whatever they have heard. The FCN cannot respond in an equally open way but must maintain confidentiality. In the role of health minister, the parish nurse may receive private and sensitive information. Congregation members should not relate information in the form of confession or repentance; however, the connection with the church ministry team may put the nurse in a position to hear this type of sensitive information. The nurse must protect the client's right to confidentiality. The nurse should share confidential information with other church ministry leaders (or prayer groups) only when given permission by the client. FCN programs within faith communities generally are not required to follow HIPAA guidelines related to medical records and confidentiality because churches are not in the category of identified health care providers. DIF: Cognitive Level: Understand (Comprehension)

Which is most likely to physically abuse elderly Americans? a. A partner or spouse b. A caregiver c. A stranger d. An adult child

ANS: A In a study by Acierno et al. (2009), 1.6% of subjects report physical mistreatment, with family members accounting for 76% of the mistreatment, and specifically 57% was conducted by a partner or spouse.

A woman was seen in the emergency department with a greenstick broken arm and chest bruises. She explained she fell up a staircase at home while carrying laundry to the bedrooms. Besides assessing for other injuries, which action should be taken by the nurse? a. Ask about and educate regarding intimate partner violence (IPV) b. Assess for use of alcohol or other drugs that might have been a causative factor in the fall c. Get the patient an x-ray examination to determine location and severity of the break d. Immediately apply ice and immobilize in a sling

ANS: A Intimate partner violence (IPV) includes four different types of behavior: physical violence, sexual violence, psychological aggression, and stalking. IPV is often repetitive, progressive, and escalates in frequency and severity. IPV crosses all ethnic, racial, socioeconomic, and educational lines. Thus, the nurse must assess for IPV.

A man was crying and said, "I didn't mean to do it. She just got me so angry I lost control. It will never happen again." The woman said, "It was my fault. I shouldn't have upset him." Then, looking at the nurse, the woman added, "Please don't report this. It will never happen again." Which is the most appropriate response by the nurse? a. "Abusers don't stop unless intervention occurs. I have to report it." b. "If you're sure it won't happen again, I'll let it go this time." c. "Legally, I'm required to put this in the medical record." d. "The decision is up to the physician, not me."

ANS: A It is a common myth that abusers will stop the abuse on their own. Professional intervention is required to break the cycle of abuse. The only way to effectively begin breaking the cycle of abuse is to report the incident. The nurse has a professional responsibility to report the abuse, just as the physician does. Documenting the information in the medical record will not initiate stopping the cycle of abuse.

On the basis of what a faith community nurse (FCN) believed was best practice, she wanted to share various methods of dealing with infertility. However, the tradition of the church was that childbirth was in the hands of God and it was inappropriate to use artificial means of becoming pregnant. Which action should be taken by the nurse? ***Mentioned in Class*** a. Ask to be excused from the situation if a couple wants to obtain information inconsistent with the church's teaching b. Follow the teaching of the church and keep quiet; there are worse fates in life than infertility c. Suggest that a client consider adoption and suggest an appropriate adoption agency d. Tell the client all the various methods used in cases of infertility

ANS: A The FCN's roles include understanding the scope of practice for parish nurses related to ethical practice and the values and beliefs of the community served. The nurse must understand his or her own beliefs and values that are in conflict with the faith community's beliefs. It is necessary that the parish nurse know when to seek help, when to refer, and when to remove himself or herself from the ethical decision-making process.

Which do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives? a. Create fear to intimidate and coerce to accomplish a political goal b. Encourage others with similar beliefs to join them and their cause c. Obtain publicity for themselves and their goals d. Obtain increased negotiating power and respect

ANS: A The U.S. Code of Federal Regulations defines terrorism as "violent acts or acts dangerous to human life that appear to be intended to intimidate or coerce the civilian population or to influence the policy or conduct of a government."

A nurse had shared a great deal of information with a new client. Time had passed, but the nurse had more to share and was energetically doing so. Which should the nurse use as a guide to determine when to stop teaching and plan the next visit? a. After about an hour b. Depends on what other visits the nurse had scheduled that day c. When the client or family members start fidgeting d. When the client begins to look tired e. When the client demonstrates symptoms of sensory overload

ANS: A The average visit should not exceed 1 hour. The client receives a great deal of information during that hour, and the nurse collects a great deal of information. Most clients are tired at the end of a 1-hour visit and often cannot retain additional information.

Which reality would cause difficult ethical conflicts for a faith community nurse? a. Best clinical practice may suggest behaviors contrary to the faith community's values and beliefs. b. Individuals might pressure the nurse to make medical decisions for them. c. Persons do not always follow the nurse's advice as to appropriate actions. d. Some political maneuvers within the faith community have implications for the nurse's practice.

ANS: A The nurse must understand the policies and beliefs of the congregation related to specific health issues. Church doctrine may guide members to adopt values and beliefs that are in conflict with current health care recommendations, such as issues of homosexuality, infertility, birth control, or sex education for youth. The parish nurse must understand that the politics of working within the faith system require acceptance of individual and system values and beliefs.

A nurse is going to visit a client who needs assistance with personal hygiene and feeding. Which suggestion should be made to the family? a. "I'll teach you how to care for your family member to keep him comfortable or, if you can afford it, you can employ an aide." b. "It's important that he try to take care of himself and, if he can't or won't, he'll have to deal with the consequences." c. "Reimbursement is available for a nurse to come to the house each day if you would like this assistance." d. "You can always have your family member readmitted to the hospital for care."

ANS: A The only thing the nurse can do if the care needed is maintenance and assistance with activities of daily living is suggest a home health aide if the family can afford it, or teach the family how to help the client. Currently, most reimbursement for nursing services is based on the patient's need for skilled nursing. On each patient visit, the nurse must document that the care provided is of a skilled nature that requires the knowledge and assessment skills of a nurse and must verify that the patient or a family member could not provide the same level of care.

What was the primary reason why Lillian Wald was able to develop the practice of school nursing in this country in the early twentieth century? a. Concern over the increasing number of school absences b. Expansion of public health care from adults to children c. Government mandate to have nurses in the schools d. Additional funds available to finance health care in school systems

ANS: A Wald's project with Lina Rogers Struthers, the first school nurse, demonstrated that school nursing decreased school absences significantly, down 90% within 1 year.

When does disaster management begin? (PowerPoint) a. Before a disaster occurs b. Immediately after the disaster c. Throughout the disaster period d. When the disaster begins

ANS: A When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.

Although violence seems endemic in human society, which causative factors could be reduced if society agreed action was necessary? (Select all that apply.) a. Access to firearms b. Alcohol and other drug abuse c. Mental illness d. Intolerance of those with a different religious ideology e. Video games, television shows, and movies f. Pacifism as a belief system

ANS: A, B, C, D, E Pacifism is a belief in peaceful resolution of conflicts and refusal to participate in war. All other factors are universally recognized factors that contribute to violence. These factors are poverty, unemployment, economic dependency; polydrug and alcohol abuse; mental illness; media influence (e.g., violent video games, television shows, and movies); access to firearms; political and/or religious ideology; and intolerance and ignorance.

Which best describes when the nurse can share confidential information about an employee's health with others? (Select all that apply.) a. If needed for workers' compensation documents b. If a life-threatening emergency occurs c. If authorized by the employee to specific recipients, such as insurance companies or health care providers d. If requested by the employer for management purposes e. In compliance with governmental laws and regulation f. In educational programs so others can avoid similar injuries and risks

ANS: A, B, C, E Occupational health nurses sometimes experience ethical dilemmas because of dual responsibility to both their employer and employees. In dealing with health information, the employee has a right to privacy and should "be protected from unauthorized and inappropriate disclosure of personal information" (AAOHN, 2004, p. 1). However, exceptions to legal protection of health information may require the nurse to provide health-related records without the worker's knowledge or consent. These exceptions are cases in which public benefit from disclosure outweighs loss of individual privacy. Specific circumstances include life-threatening emergencies; workers' compensation situations in which state regulations limiting information to carriers and/or employers are followed; examination for drug and alcohol testing in some circumstances; compliance with government regulations; OSHA-mandated surveillance and/or occupational injury or illness evaluations; and other situations as required by law (e.g., public health purposes, law enforcement, judicial proceedings, or court order). The nurse is unable to share confidential information about an employee's health with the employer for management purposes or during an educational program. DIF: Cognitive Level: Understand (Comprehension)

In which ways are occupational health nurses (OHNs) role models of good community health nursing? (Select all that apply.) a. The majority of OHNs are prepared at the baccalaureate level or higher. b. OHNs actively influence policy in health and safety within a particular area. c. OHNs are skilled at assessing both people and their home environment. d. OHNs focus on health promotion and avoidance of injury or disease. e. OHNs plan and implement health programs for populations of employees. f. OHNs work closely with physicians in planning and implementing care for individuals and families.

ANS: A, B, D, E OHNs focus on the promotion, prevention, and restoration of health within the context of a safe and healthy work environment. Focus includes prevention of adverse health effects from occupational and environmental hazards. Approximately 70% of occupational health nurses work alone, making decisions regarding health and safety issues, influencing policy in health and safety, and planning and implementing myriad health programs. Nearly 70% of nurses practicing in occupational health are prepared at the baccalaureate level or higher. OHNs do not usually make home visits. Most collaboration is done with occupational health professionals, such as industrial hygienists and ergonomists, rather than physicians.

A nurse tells a friend that he has recently changed jobs and will now be an occupational health nurse. Which places is the nurse most likely to be working? (Select all that apply.) a. Factory b. Outpatient cardiac rehabilitation c. Hospital employee health d. College/University e. Public health department f. Residential group home

ANS: A, C, D, F As workplaces have continued to change over the past few decades, the role of the occupational health nurse has become even more diversified and complex. Occupational health nurses work in a variety of settings including manufacturing such as meat packing, food production, battery manufacturing, and textiles; hospital employee health institutions; and service industries such as banking and government and academic centers. Nurses who work in outpatient cardiac rehabilitation, public health departments, and residential group homes are working in community health settings, but not occupational health.

Which best explains how occupational health nursing differs from other nursing specialties?(Select all that apply.) a. Occupational health nursing has a major focus on the environment. b. Occupational health nurses are required to have a master's degree in occupational health. c. Occupational health nurses are more autonomous and work independently. d. Occupational health nurses have a primary emphasis on health promotion and disease prevention. e. Occupational health nurses may work with unions, as well as management groups. f. Occupational health nurses work in the community.

ANS: A, C, E The occupational health nurse (OHN) focuses on the workplace environment, examining the environment for hazards. Within the worksite, 70% of occupational health nurses work alone. The nurse often meets with unions representing the employees, as well as management. The roles and responsibilities of the OHN must be clearly articulated to lay people, managers, workers, union representatives, and colleagues. The nurse may interact with occupational medicine professionals, industrial hygienists, safety professionals, employee assistance counselors, personnel professionals, and union representatives. Nurses who work in occupational health settings are not required to have a master's degree in occupational health. It is hoped that all nurses emphasize health promotion and disease prevention. Several specialties such as home health nursing and school nursing also work in the community.

Which would most likely be the result of a medicolegal death investigation? (Select all that apply.) a. Clarification of the unnatural circumstances in which death occurred b. Court testimony as to cause of death based on evidence c. Consultation with defendant's attorney for a fee d. Consultation with prosecuting attorneys for a fee e. Death certificate with cause and manner of death f. Permission to use deceased organs for transplant

ANS: A, E Medicolegal death investigations are usually conducted to clarify the sudden, unexpected, and often nonnatural circumstances in which death occurred. One of the outcomes of death investigation is death certificates. Outcomes of medicolegal death investigations do not typically involve court testimony, consultation with the defending or prosecuting attorneys for a fee, or permission to use the deceased organs for transplant.

Which best describes how a legal nurse consultant (LNC) would best prepare for testifying in court as an expert witness? (Select all that apply.) a. By carefully analyzing the client's medical record and related documents b. By creating a PowerPoint slide presentation to help educate the jury c. By helping to examine all the witnesses in preparation for the court trial d. By personally doing or observing the autopsy on the deceased e. By preparing charts and tables illustrating the important legal points f. By summarizing the literature regarding the standard of care

ANS: A, F LNCs perform many different services and activities, including organizing and analyzing medical records and related materials; preparing chronologies of health care events; and identifying standards of care. It is essential that the LNC be prepared, having reviewed the case and all related materials very thoroughly. The LNC would probably not create a PowerPoint slide presentation, examine all witnesses in preparation for the trial, personally complete the autopsy, or prepare charts and tables to illustrate the important legal points.

A 14-year-old was found guilty of beating and raping a 73-year-old neighbor. The prosecutor had successfully argued for the child to be tried as an adult. The jury is considering a long adult prison term. Which would the nurse most likely suggest when called on as an expert witness? ***Mentioned in Class*** a. The child must be mentally ill to have done such a thing and should be in a mental hospital. b. The child should be in a juvenile facility to avoid the high risk of sexual assaults, beatings, and suicide in adult prison. c. The child should be given a long adult prison sentence to protect society from such a predator. d. The child must be given an opportunity to complete high school while incarcerated in the adult prison.

ANS: B Adult correctional facilities are not generally equipped to deal with the challenges of adolescent development. Adolescents in an adult correctional facility are the highest at risk than any other group. Juveniles in adult correctional facilities are 36 times more likely than the adult population to commit suicide. Thus, it is in the best interest of the adolescent to be placed in a juvenile facility. The placement of an adult prison or mental hospital would not be in the best interest of this child.

A male strong firearms advocate stressed his guns were for self-protection, and he wanted all criminals to know his family had loaded guns in their home. Which best explains why a nurse would not support his actions? a. Criminals carry more powerful and illegal guns. b. Guns in the home typically result in dead family members and friends. c. His children may be less careful than the adults in the family. d. Less trained individuals might think the guns were unloaded.

ANS: B Although some persons suggest that firearms provide protection, substantial evidence indicates that firearms increase the likelihood of homicide or, even more commonly, suicide (Weinberger et al., 2015). It is important for health care professionals to be comfortable speaking with their patients in a nonjudgmental manner about firearms, provide patients with factual information about firearms relevant to their health and the health of those around them, fully answer their patients' questions, and advise them on safe gun protection.

Which best describes how a community will know whether its disaster plan is adequate? a. After a disaster occurs and reports of deaths and injuries are fairly accurate b. By following practice drills involving various feasible scenarios as an initial step of planning c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the plan

ANS: B For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

Which best describes why it is crucial that the faith community nurse (FCN) have at least a baccalaureate degree, as well as several years of experience in clinical practice, in addition to formal education in the role? a. To ensure continued prestige and relatively high salary for the role b. To be autonomous with self-direction and independent decision-making c. To enable the FCN to assess the faith community and prioritize its needs d. To function in varied settings from the religious building to the clients' homes

ANS: B Incredible diversity and autonomy are found in faith community nursing. The self-direction and independent decision-making required by the autonomous roles of the FCN require a highly educated nurse experienced in clinical nursing and community-based nursing practice. Typically, there is not a high salary associated with the role of FCN. The autonomy and independent decision-making required in this role allow the nurse to be able to effectively assess the community and function in a variety of settings.

The female nurse was called to the emergency department (ED) to help with a woman who had been beaten and raped. Which are the nurse's responsibilities as a forensic nurse? a. Discuss with police officers what is known and what needs to be known to close the case b. Initiate the proper collection, preservation, and chain of custody of evidence with appropriate documentation c. Serve as chaperone while the physician completes the physical examination d. Be empathetic and supportive to the victim

ANS: B It is imperative that ED registered nurses identify forensic cases and initiate the proper collection, preservation, and chain of custody of evidence and provide accurate documentation for this unique population. This collection of evidence plays an important role in the investigation of crimes and can have a major impact on legal decisions. Accurate collection of evidence is the primary responsibility of the nurse and needs to be completed before any additional action is taken. The recognition, collection, and documentation collected within the emergency department may play an important role in the investigation of crimes and can have a major impact on legal decisions. It is important for the nurse to collect the necessary evidence whereas it is the responsibility of the legal system to prosecute and close the case. The primary role of the female forensic nurse would not be to serve as a chaperone to the physician or provide support to the victim.

The 7-year-old boy's hands were badly burnt; it was suspected that his mother had forced his hands into boiling hot water after she caught him masturbating. The staff did not want the mother to be allowed near the boy. Which statement would be made by the nurse to encourage the staff to interact more objectively with the mother? a. "If we won't let the mom near, who does the child have for support at this painful time?" b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." c. "The child may feel responsible; we have to let the mother fix their relationship." d. "We need to encourage the mother to continue parenting him or the boy will become a ward of the state."

ANS: B Most child maltreatment occurs within the family. Maltreatment is more commonly seen in families who are under a great deal of stress, are living in poverty or isolation, or when a family member has a history of violence. Child maltreatment can have serious long-term effects. Thus, it is most important that the staff provide support to the mother. The purpose of allowing the mother with the child is not for additional support for the child or mother, rather the recognition that the mother may have a history of abuse as well and needs assistance to change the patterns of behavior that have been learned through her own life experience.

Which action should the home health nurse take to get in touch with a client if the client apparently has no telephone? a. Determine whether the client has family members in the area who might be able to get in touch with the client to ask the client to call the agency b. Go to the client's address and discuss making a home visit with the client c. Send a formal letter asking the client to call the agency for an appointment d. Tell the referral source you cannot accept referrals without usable telephone numbers, so this client was not visited

ANS: B Not all clients have a telephone. If that is the case, the nurse should check the referral for a telephone number where messages can be left. It is also worthwhile to contact the health care provider who made the referral to see whether the telephone number was omitted unintentionally. If the client does not have a telephone, the nurse may choose to make a drop-in visit. This type of visit consists of an unannounced visit to the client's home, during which the nurse explains the purpose of the referral, receives the client's permission for the visit, and appoints a time for a future visit with the client. The client may agree to the first visit while the nurse is there. It may be very difficult to determine if the client has family members in the area to relay information to the client. Sending a formal letter would not get to the client who needs services in a timely manner.

A correctional nurse was preparing to give an inmate his psychotropic drug when the prisoner hit the nurse's arm, sending the medication flying, and yelled, "No more. I'm not taking that poison anymore!" The prisoner is obviously mentally ill. Which action should be taken by the nurse? a. Inject the medication rather than debate taking the oral pill with the inmate b. Recognize the prisoner's right to refuse treatment c. Throw the medication away, obtain another pill, and try to persuade the prisoner to take the drug d. Force the medication down the prisoner's throat with the assistance of two prison guards

ANS: B Nurses practicing in correctional settings must recognize that involuntary medical treatment is not undertaken until after internal review and judicial proceedings.

Which best explains the purpose of the Outcome and Assessment Information Set (OASIS)? ***Mentioned in Class*** a. To analyze the cost-effectiveness of health agencies b. To evaluate and improve clinical performance quality c. To measure and publicize hospital data on outcomes such as death rates d. To survey patient satisfaction with care received from health agencies

ANS: B OASIS is a data set that measures outcomes of adult home care patients to monitor outcome-based quality improvement. These items are used to monitor outcomes, plan patient care, provide reports on patient characteristics for each agency, and evaluate and improve clinical performance. The use of OASIS is mandatory for all Medicare and Medicaid patients receiving skilled care. The primary purpose of OASIS is not to analyze the cost-effectiveness of health agencies. This data set does not publicize hospital data or survey patient satisfaction of care from the health agencies.

Which disaster would most likely cause the most long-lasting mental health concerns for its victims? a. For the fourth year in a row a flood hit an area, demolishing several houses, but families heard the warning siren and evacuated in time. b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. c. A tsunami hit the beach with unbelievable force, water sweeping over the entire harbor, although most boats had been moved to deep water. d. A volcano erupted and lava destroyed the main road to the village where several houses burned, but no one died in the eruption.

ANS: B Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are: (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged.

On which level of care do most faith community nurses (FCNs) focus? a. Hospice care b. Primary c. Secondary d. Tertiary

ANS: B The FCN practice focuses on health promotion and wellness, which is primary intervention. It holds the spiritual dimension central to health and healing within the context of the faith community.

Which agency should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response? a. Federal Emergency Management Agency (FEMA) b. Office of Emergency Management c. State Disaster Office d. The National Disaster Relief Agency

ANS: B The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. There is no specific government agency called the State Disaster Office or the National Disaster Relief Agency.

A prisoner was bleeding where another inmate had attacked him with a fork. Which would be the correctional nurse's first and most crucial responsibility? ***Mentioned in Class*** a. Perform a complete physical assessment, specifically looking for internal injuries b. Maintain an escape route to help ensure personal safety c. Report the incident to administration, indicating who was responsible for injuring the inmate d. Stop the bleeding, apply an antibiotic, and bandage the wound

ANS: B Unlike any other care setting, clients are inmates, and care is negotiated and provided with recognition of safety and security issues for the nurse. The nurse must maintain an escape route, should a situation of personal violence be imminent. If the nurse is able to maintain an escape route, the nurse would then be able to complete a physical assessment, stop the bleeding, and then report the incident to administration.

An 80-year-old woman lived with her eldest daughter, the daughter's husband, and their three children. On this visit, the nurse noted the woman looked dehydrated and seemed depressed. Both wrists were red and scabbed. When asked if she was all right, the woman protested she was fine and her daughter took good care of her. Which action should be taken by the nurse? a. Begin the paperwork to have the elderly woman put in a nursing home b. Discuss respite care and other stress relief measures with the daughter c. Report the elder abuse to the state department of aging d. Review with the total family how to share responsibilities for the woman's care

ANS: B Working with victims of elder abuse, the nurse must establish rapport and trust. The nurse should remember that competent adults have the right to make decisions about their own care, including staying in an abusive situation. The nurse should support the family in examining potential respite care options and support groups for the elderly woman and her caregivers.

A woman is in the emergency department for the fifth time this year, each time with more severe injuries. Which is the primary responsibility of the nurse? a. Insist she be discharged to a safe shelter where the perpetrator cannot find her b. Provide information regarding safe shelters and sources of support c. Report the assault and battery to the local police department so the perpetrator is arrested for the crime d. Treat the injuries and inform the woman she may be killed if she stays with the perpetrator

ANS: B Working with victims of intimate partner violence (IPV) requires the nurse to establish rapport and trust; deal with issues of confidentiality honestly; provide current information regarding shelters and sources of support; and recognize and accept that clients may "choose" to stay in an abusive relationship. Because the nurse wants to establish rapport and trust, it would not be in the best interest of building this relationship if the nurse insist that she go to a safe shelter (rather the nurse should provide her the necessary information) or inform the woman she may be killed (rather the nurse should recognize and accept that the client may "choose" to stay in an abusive relationship). Additionally, the nurse should recognize that even if the assault is reported, it may be denied by the woman and will not result in an arrest of the perpetrator.

A School nurse completed a needs assessment and concluded that illegal use of drugs, including alcohol and tobacco, was a major problem. What would be the nurse's first intervention? a. Ask police officers to educate the students about the penalties for illegal drug use b. Create, with administrative support, a policy of no smoking while on school grounds c. Inform teachers that smoking on school grounds will not be tolerated d. Tell the local newspapers of the findings so that the media can inform parents

ANS: B One of the recommendations for school substance use prevention programs is to develop and enforce a school policy on substance abuse.

In which ways is a hospice nurse different from any other nurse who provides care to a client in the context of their family and home environment? (Select all that apply.) a. Hospice nurses approach care in a holistic fashion. b. Hospice nurses continue to support the family after the client has died. c. Hospice nurses focus more on care and comfort than cure and control. d. Hospice nurses are expert in both physical and psychosocial care. e. Hospice nurses are more skilled at pharmaceutical pain management. f. Some hospice nurses see patients at home and others in institutions.

ANS: B, C Nurses who work with the terminally ill seek to enhance the patient's quality of life by focusing on relieving suffering throughout the illness, supporting the patient and family through the dying process, and providing grief support to the family after the patient has died. When the patient becomes terminally ill, the focus shifts from cure to comfort care. Hospice and palliative nursing care is provided in a variety of settings including hospitals, nursing homes, residential homes, and palliative care clinics. Ideally, all nurses approach care holistically and are expert in pain management and both physical and psychosocial care.

Which competencies should occupational health nurses be able to fulfill? (Select all that apply.) a. Completing thorough physical assessments of employees b. Understanding of the business climate c. Managing total worker health independently as appropriate d. Knowing relevant federal, state, and local regulations e. Adhering to the principles of professional practice f. Practicing culturally appropriate nursing care

ANS: B, C, E, F According to the American Association of Occupational Health Nurses, occupational and environmental health nurses should be able to fulfill the following competency categories: manages total worker health independently and with other team members; adheres to principles of professional practice; demonstrates understanding of the business climate and its impact on the health of the community; practices culturally appropriate, evidence-based nursing care within licensed scope of practice. The occupational health is not responsible for thorough physical assessments of employees or for knowing relevant federal, state, and local regulations.

Which best describes why home health care has continued to grow until very recently? (Select ll that apply.) a. Consumers prefer home care, so they will personally pay for it. b. Demographics—there are more elderly persons in U.S. society. c. Home care does not cost much more than institutional care. d. Insurance companies are encouraging home care. e. Medicare is encouraging home care rather than institutional care. f. Physicians prefer to visit clients in their homes rather than institutions.

ANS: B, D, E Home care is less expensive than institutionalized care. Physicians rarely make home visits. Consumers cannot usually afford to personally pay for home care. The rapid growth of the home health market reflects the increasing proportion of people aged 65 years and older; the lower average cost of home health care compared with institutional costs; active insurer support; and Medicare promotion of home health care as an alternative to institutionalization.

3. A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. Which action should the hospital take immediately? a. Ask the governor of the state to declare the area a disaster area so state help can be obtained b. Call surrounding hospitals to set up burn units, because there will be too many patients for one hospital to manage c. Call in physicians and nursing staff who are experts in burn care d. Get in touch with the American Red Cross to assist families of the victims

ANS: C A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

Which type of maps is crucial to be included in any disaster plan? a. Communication map showing telephone wires and cell phone towers b. Geographic map showing, for example, roads, highways, and train routes c. Resource map showing potential resources in persons and supplies d. Response maps showing sites of first responders, such as fire stations and police stations

ANS: C A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed).

Which must be involved for an act to be considered a terrorist act? (PowerPoint) a. A commitment to a political or religious belief b. An attempt to force compliance with a particular set of religious or political beliefs and behaviors c. Fear, intimidation, and violence d. Violence resulting in plural deaths

ANS: C All terrorist acts include three key elements—violence, fear, and intimidation.

A nurse had 5 years of experience in a community health clinic when she accepted a position in occupational health. Which best explains how the nurse will know what to do in this new setting? a. On the basis of past experience, she can focus on relevant aspects and adapt protocols as deemed necessary b. By focusing immediately on critical aspects and determining priorities in the setting c. By following company procedures and relying on assessment checklists and clinical protocols d. By using extensive previous experience, the nurse can grasp situations quickly and initiate appropriate action(s)

ANS: C As a newcomer to the site, although experienced in other areas of nursing, the nurse would probably have sufficient experience to recognize a range of practice issues and function comfortably in such roles as clinician and case manager. But to be competent in the new role, the nurse should follow company procedures and rely on assessment checklists and clinical protocols to provide treatment. To go beyond that (i.e., adapt protocols and immediately recognize what is relevant in these new situations) will require experience in the new role.

Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. Which best describes how these patients are different from the first patients to arrive? a. Burn patients probably have skin damage, whereas the firefighters have lung damage. b. Burn patients will need extensive care over time, whereas the firefighters can probably stay the night with oxygen treatment and then be discharged. c. The burn patients were direct victims, whereas the firefighters are indirect victims. d. The second set of victims may have scarring, shortness of breath, and persistent hoarseness for the next few days.

ANS: C Both sets of victims would have inhaled smoke and have lung damage. The treatment and length of stay would be determined by the amount of damage, which may vary from victim to victim. Both sets of victims, depending on the severity of the burns, may have scarring, shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an individual who is immediately affected by the event; the indirect victim may be a family member or friend of the victim or a first responder.

What are today's children and adolescents more likely to confront as health problems in comparison with previous generations? a. Problems resulting from alcohol and tobacco use b. Problems resulting from STIs c. Problems resulting from high-risk behaviors d. Problems resulting from communicable diseases

ANS: C Formerly, children and adolescents had to confront contagious diseases, but today adolescents face risks related to high risk behaviors. Adolescents die from MVAs, other unintentional injuries, homicides and suicide

A rape victim says to the nurse, "He said he loved me; he had been so nice; he said he wanted to show me how much he loved me. And then he...." Which is the most appropriate response by the nurse? a. "Anyone can lose control; I'm sure he'll never do it again." b. "I'm not sure he loves you; he may just have wanted easy sex." c. "Rape isn't about love or even sex; it's about power and control." d. "You shouldn't have gone up to his room alone when the two of you had both been drinking."

ANS: C Intimate partner violence is a crime of power and control. It is important the nurse is aware of the myths around IPV which include: victims deserve the abuse, victims can change the abusers' behavior, and abusers will stop the abuse on their own without professional intervention.

If not at a meeting or giving an educational program, which best describes why an occupational health nurse (OHN) would be absent from the health station during the nurse's employment hours? a. The nurse is reviewing position descriptions in the main company office. b. The nurse is in the management office to use the company computer. c. The nurse planned a walk-through of the workplace. d. The nurse is taking a quick bathroom break.

ANS: C Performing "walk-throughs" in the workplace on a regular basis, recognizing potential and existing hazards, and maintaining communications with safety and industrial hygiene resources to prevent illness and injury from occurring will continue to be critical work for the OHN. It is unlikely that the nurse is reviewing position descriptions in the main company office or using a company computer when these are tasks that could most likely be done in the health station. It is also unlikely that the nurse is taking a quick bathroom break.

Which best describes the incidence of abuse among pregnant women? a. It is too difficult to determine the actual incidence of abuse among this population. b. It is estimated that approximately 1 out of every 10 women experiences abuse. c. Approximately one out of every six women has been abused by a partner. d. Abuse does not occur among pregnant women.

ANS: C Pregnancy does not protect women from the danger of abuse. Indeed, pregnancy may increase stress within the family and provoke the first instances of battering. It is estimated that one in six pregnant women have been abused by a partner.

If a forensic nurse was employed in the most widely recognized subspecialty in forensic nursing, which would be the nurse's primary tasks? a. Be employed by insurance companies to review and interpret medical records b. Complete the death certificate, including causes of death c. Do a history and physical assessment and collect evidence d. Review the crime scene for insights with police officers

ANS: C Sexual assault forensic examiner (SANE) is the most widely recognized subspecialty in forensic nursing. The SANE assesses and documents detailed examination findings, collects forensic evidence related to a reported crime, and frequently testifies as an expert witness at subsequent trials.

The legal nurse consultant (LNC) was surprised to find that former friends were no longer interested in a colleague relationship and one even accused the LNC of trashing clinical nursing practice in the courtroom. Which would be the best response by the LNC? a. "I've just accepted a position that pays an incredible amount more than staff nursing in a hospital." b. "I'm not part of clinical nursing; I'm part of the legal system now." c. "I'm defending the expertise and experience of skilled nursing clinicians by helping remove dangerous practitioners from the field." d. "I'm helping clients who were hurt by poor practice to obtain revenge."

ANS: C Some practitioners have differing opinions regarding LNCs and nurse attorneys. They may be perceived as either defending the profession or prosecuting peers by testifying against professional colleagues. Many law firms hire LNCs to review and interpret medical records and charts, provide objective opinions based on standards of care, and possibly to testify in court as expert witnesses. LNCs are able to provide the link between clinical nursing and the legal system to help keep the practice field safe from dangerous practitioners. In contrast, meticulous practitioners who are wrongfully accused of negligence will be defended. The salary of the position does not address the accusation of the LNCs former friends. The purpose of LNCs is not to help clients obtain revenge if they were harmed by poor care.

A 4-year-old child is seen in the emergency department with a spiral fracture of the right arm. X-ray examination shows previously broken and healed bones. Which is the immediate responsibility of the nurse? a. Call social services to immediately set up foster care for the child b. Provide information about parenting and anger management classes c. Report the child abuse to the local legal authorities d. Try to establish rapport and trust with the child's family

ANS: C Spiral fractures are only possible from abuse, because they require a wringing motion to occur. When working with victims of child abuse, the primary obligation of all health care providers is to protect the child. The abuse must be reported as a legal and ethical obligation.

Although it was uncomfortable, a home health nurse finally learned to discuss finances with the client and family on the very first visit. Visits had to be reimbursed. Now that she is working for a different agency, funding was no longer such a concern. Which offers the best explanation for this change? ***Mentioned in Class*** a. Because the nurse was an unpaid volunteer professional, visits made by that nurse had no cost to the agency. b. Only clients of high socioeconomic class were admitted for care, so the agency was always immediately reimbursed for care rendered. c. Taxpayers fund official (i.e., public) home health agencies for care not reimbursed by third parties. d. The new agency has a large foundation that funds its activities from investment profits.

ANS: C Taxpayers fund official (i.e., public) home health agencies, but they also receive reimbursement from third-party payers such as Medicare, Medicaid, and private insurance companies. This additional taxpayer funding eliminates the stressor as to who will be paying for the nursing visits for both the client and the home health agency. The nurse is not working as an unpaid professional volunteer for this agency. The clients served by the official agency are not likely of a high socioeconomic class and the agency most likely does not have a large foundation to assist with paying for services that are provided.

A candidate's resume demonstrates a perfect fit for a position, but one glance showed the candidate was wheelchair bound. Which suggestion should the nurse make to the employer? a. Be as polite as possible, but point out how difficult it would be to fulfill job responsibilities while confined to a wheelchair b. Be sure that another candidate is more qualified and "fits more closely with our company goals" c. Employ the candidate and rearrange the work area for easy access and exit for someone in a wheelchair d. Point out that other employees would probably not be kind to someone in a wheelchair who is unable to join in many of the physical recreational activities

ANS: C The Americans with Disabilities Act prohibits discrimination on the basis of disability. The core of this law requires employers to adjust facilities and practices for the purpose of making "reasonable accommodations" to enhance opportunities for individuals with disabilities. The occupational health nurse has the duty to provide or facilitate reasonable accommodations based on the nurse's familiarity with the physical requirements of jobs in the workplace. If this candidate was indeed the perfect fit for the position, not hiring the candidate because of the disability would be considered discrimination. If other employees are not kind to this candidate after the candidate is hired, they will likely face reprimand by the employer.

The legal nurse consultant (LNC) was asked to submit an affidavit to both the prosecutor's and the defendant's office. Which information needs to be included? a. List of all literature reviewed in preparation for being paid as an expert witness b. Notarized signature on a summary of the LNC's education and clinical experience c. Summary of nurse's educational and experiential credentials and an analysis of the case d. An opinion under oath as to what happened in the crime situation

ANS: C The LNC may submit an affidavit, which is a written statement explaining the expert's credentials, background, and licensing or certification(s). It also provides a list of the materials read and considered in the case, and the findings of the review are summarized into a case analysis.

Which is one of the most challenging areas for the occupational health nurse (OHN)? **Mentioned in Class** a. Allocating time between direct service to employees and management tasks b. Collaborating with other worksite professionals and retaining leadership in the arena of employee health c. Managing ethical conflicts between responsibilities to management and responsibilities to employees d. Maintaining competence through attending conferences and maintaining services when the nurse (sole provider) is absent

ANS: C The OHN is a worker advocate and has the responsibility to uphold professional standards and codes. The OHN is also responsible to management, is usually compensated by management, and must practice within a framework of company policies and guidelines. Ethical dilemmas arise because the nurse is loyal to both workers and management.

A hospice patient is taking rather strong narcotics with good pain control, but today the patient's family tells the nurse that the client does not want to become addicted. Which is the best response by the nurse? ***Mentioned in Class*** a. "But you're dying, what difference will it make if you become addicted?" b. "You can try not to take so much so frequently if you are concerned." c. "You may develop tolerance but you can't be addicted when you're using the medication for pain control." d. "You need strong narcotics to control your pain; we want to keep you comfortable." e. "We'll keep you comfortable using some nonnarcotic drugs if that is what you prefer."

ANS: C The key to successful pain control for the terminally ill is to convince patients to take their medications on a regular basis. Many patients, especially the elderly, are afraid of becoming "junkies" or "druggies" and want to delay using pain medication until they "get really bad." Many people believe that using these medications signals "the end of the line," and they are amazed to learn that patients do well while receiving this drug for months, even years, before death occurs. Almost every family must learn that addiction is not the same as tolerance and that their physicians will not "cut off their supply if they take too much."

Which best describes when faith communities first began to be involved with health and healing? a. In 1998, when parish nursing was first officially recognized b. In the time of Jesus and similar religious leaders of the early years AD c. Throughout history, faith communities provided basic health care d. When parish nursing began in the Lutheran Church in the 1980s

ANS: C The majority of the world's populations belong to organized faith communities. All of these religions have traditions and rituals related to health and healing. Throughout history, religious communities have provided care for the indigent and disenfranchised, meeting basic human needs of food and clothing and basic health care. Thus, parish nursing began before time of Jesus. The Old Testament discusses Shalom, or God's desire for health and wholeness for the Earth and its people.

Which is the primary task to be accomplished during the initial telephone contact between the home health nurse and the client? a. Make sure that the name, address, telephone, and other data are accurate b. Confirm that the nurse will be a guest in their home so socialization can occur c. Allow the client to give permission and agree to a time for a home visit d. Warn the family that the nurse will always need to immediately see the proof of insurance before proceeding further

ANS: C The nurse contacts the client and informs him or her about the service referral. The first telephone contact with the client or family consists of an exchange of essential information, including an introduction by the nurse, identification of the agency that received the referral, and the purpose of the visit. After the initial exchange of information, the nurse informs the client of his or her desire to make the home visit, the client gives permission, and the group sets a mutually acceptable time for the visit. The nurse is a guest in the client's home but not in the usual social sense. Public health nurses who are reimbursed by tax dollars may not require evidence of insurance coverage.

An emergency department nurse was not sure whether there was enough evidence one way or the other to suspect child abuse with a child client, because there was not much evidence of physical harm. The forensic nurse agreed to see the child. Which would be the forensic nurse's primary focus? a. Ask the child whether the family has any secrets b. Assess for old injuries or injuries in the process of healing c. Observe the child's appearance and behavior and how the child interacted with other children and adults d. Question the parents concerning the child and any discipline problems

ANS: C The nurse obtains a thorough history and assessment, focusing on several facets of abuse and neglect. These include child-parent interaction, the child's appearance and behavior, child-child interaction, and the environment.

In addition to factual data such as name, address, and diagnosis, which information is crucial to the nurse when a referral is received? a. The amount of reimbursement the agency will receive for a visit b. The family's reaction to the suggestion that a nurse visit in their home c. The purpose of the referral for a home visit d. The patient's agreement with the home visit referral

ANS: C The nurse prepares for the home visit by reviewing the referral form including the purpose of the visit, the geographic residence of the family, and any other pertinent information.

Which should be included when the nurse writes a proposed treatment plan for a home health client? a. Outline of specific client goals with measurable outcomes b. Specific nursing interventions to treat identified client problems c. Type of services needed and frequency of visits by each discipline d. Typical nursing care plan information from assessment to evaluation

ANS: C There are differences between the treatment plan and the nursing care plan. The plan of treatment includes the type of home health services received, the projected frequency of visits by each discipline, and the necessary interventions. The nursing care plan addresses specific nursing interventions designed to treat the patient's actual or potential problems and includes identified goals with measurable outcomes.

A nurse was a volunteer in a faith community when a police officer asked for specific information related to a member's behavior and mental health. The faith community nurse (FCN) told the police officer, "I'm a part-time volunteer; I'm not paid. Besides, I have client-professional privileges so I can't share information with you." Which will most likely be the outcome of this encounter? ***Mentioned in Class*** a. The Health Insurance Portability and Accountability Act (HIPAA) will require the nurse to maintain confidentiality. b. The matter will be referred to the faith community leader for resolution. c. The nurse is still accountable and has no legal right not to disclose information requested by a legal authority. d. The police officer will have to accept the nurse's refusal to share information.

ANS: C Volunteers in a church are held to the same degree of accountability as are paid employees. Ministers, both ordained and nonordained, may be required to disclose confidential information in court. FCNs, as nonordained ministers, do not have client-professional privilege. Thus, HIPAA does not apply as the information has been requested by a police officer and there is not client-professional privilege involved. The faith community leader is not able to offer a resolution to this problem as client-professional privilege does not exist in this situation. Because there is not client-professional privilege, the police officer does not need to accept the nurse's refusal to share information.

Which is considered appropriate preparation for engaging in forensic nursing specialty practice? a. Adequate number of continuing education credits plus licensure as a registered nurse b. Baccalaureate nursing program and previous community health experience c. College-based educational program including supervised clinical hours and internship d. Interest in and willingness to be employed in the field

ANS: C Simply completing a continuing education course is not adequate. Several colleges and universities offer a variety of programs to educate practitioners. During the formal programs of study, the student usually completes a minimum specified number of supervised clinical hours; a clinical internship or fellowship also may be required.

Which best describes why earthquakes would be more frightening than floods to many people, even though both can cause extensive damage? (Select all that apply.) a. Death rate and scope are higher in earthquakes. b. There is a higher frequency of earthquakes. c. Imminence of earthquakes is unknown. d. It is not possible to prevent an earthquake. e. The intensity of earthquakes is higher. f. The predictability of earthquakes is lower.

ANS: C, D, F Death rate, intensity, and frequency depend on location and other factors. Hawaii, for example, has frequent earthquakes with little damage resulting. However, earthquakes cannot be predicted or prevented, whereas flooding can usually be predicted and most communities have taken steps to avoid or at least lessen the damage from floods. The frequency or intensity of earthquakes is not higher than that of flooding.

Which best describes how the practice of faith community nurses is different from the practice of other nurse specialists? ***Mentioned in Class*** a. Advanced education is required before attempting such a challenging role. b. Practice setting is in a building dedicated to a purpose other than health care. c. The nurse is a member of the same community where the nurse practices. d. The central focus of the practice is the spiritual dimension.

ANS: D A key element of the philosophical basis of parish nursing is the spiritual dimension, which is central to the practice. All specialties require advanced education and are often practiced in non-health-oriented settings, such as workplaces, schools, or client homes.

Which best describes how the faith community nurse, as a health educator, decides which educational programs to offer the faith community? ***Mentioned in Class*** a. Based on feedback from the local public health department nursing professionals b. Based on what will help implement the Healthy People 2020 goals c. Based on what is consistent with the health laws of scripture or holy books d. Based on the health status and needs of faith community members

ANS: D Although any response could be the basis of a program, the program should address the needs of the local faith community. Educational efforts are planned on the basis of the church community's priorities consistent with Healthy People 2020 objectives. Because the faith community membership includes people across the life span, church-based educational programs can address all 10 major health indicators. Early in the development of a parish nurse program, and periodically thereafter, the parish nurse should assess the health status and needs of the congregation members to determine educational priorities.

Which is the primary factor in how a hospice nurse makes decisions while giving care in the client's home, surrounded by the client's family? a. To allow the patient a comfortable, pain-free death b. To assure the caregiver and the whole family that they are not hastening the client's death by anything they do to keep the client comfortable c. To encourage the family to grieve and confront the reality of the client being terminal d. To prevent a decline in the caregiver's health

ANS: D Although the nurse tries to do everything possible for the client, the caregiver, and the whole family, the nurse must prevent a decline in the caregiver's health. Although the dying patient is the focus of all skilled nursing care, the experienced home care nurse knows that a careful assessment of the caregiver's mental and physical health is important. The spouse, lover, children, friends, and neighbors who have made the commitment to stay until the end need the nurse's time and attention as much as, if not more than, the patient. Although the patient's wishes are important, all decisions regarding care are made considering the health of the caregivers. Encouragement of the family to grieve and confront the reality of the client being terminal would not be a primary factor in how the nurse makes decisions.

Which best describes the typical perpetrator of homicide? a. A person trying to engage in rape with the woman fighting back b. A person who wanted money and she refused to give it to him c. A stranger d. An intimate partner

ANS: D Approximately 50% of the victims were killed by someone they knew. Notably 37% of female murder victims are killed by an intimate partner. Thus, the typical perpetrator would be an intimate partner. It would be less likely to be a stranger, someone who wanted money, or someone trying to engage in rape.

Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster? a. American Red Cross (ARC) b. The Department of Homeland Security (DHS) c. Federal Emergency Management Agency (FEMA) d. The National Incident Management System (NIMS)

ANS: D Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President George W. Bush established the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2017a). The ARC is not a governmental agency. It is chartered by Congress to provide disaster relief. It works in partnership with FEMA, DHS, the Centers for Disease Control and Prevention, and other local, state, and federal agencies to provide and manage needed services. The DHS was established to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.

The legal nurse consultant (LNC) felt more than a little stressed after being cross-examined by both the prosecuting attorney and the defendant's attorney in intricate detail at a deposition. Which action should be taken next by the LNC? a. Get together with friends and share the experience b. Go out and have a stiff drink to relax and get over the stress c. Pray the case does not go to trial when the LNC will have to go through all this again d. Review the written transcript for accuracy

ANS: D During the deposition, the LNC will present the facts of the case and be questioned by attorneys from both sides. This process may be quite lengthy and stressful. It is essential that the LNC be prepared, having reviewed the case and all related materials very thoroughly. Following this process, the LNC will be given a written transcript of the deposition; this needs to be carefully reviewed for accuracy. It is not appropriate for the LNC to share this experience with friends. Consumption of alcohol will not help the nurse address the stressors that are being encountered. Reviewing the transcript for accuracy should decrease the level of stress experienced by the nurse and decrease the worry about this case going to trial.

Which best describes why hate crimes involving violence are often considered worse than other crimes involving violence? a. Because hate crimes cannot be avoided because one cannot change one's race or religious or sexual orientation b. Because hate crimes often are committed by groups rather than individuals c. Because more damage is typically done in a hate crime than in a typical assault and battery d. Because the crime is personal, attacking the victim's identity

ANS: D Hate crimes are crimes based on an individual's race, sexual orientation, religious beliefs, ethnic background, or national origin. Hate crimes may include rape, sexual or physical assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate crimes attack an individual's identity, the emotional effects are compounded.

Which has been confirmed by research regarding the relationship between religion, spirituality, and health? a. Essentially, religion gives persons a sense of hope. b. Faith communities help by praying for ill persons during services. c. Healthy persons have a tendency to be active within their faith communities. d. Persons who attend services have decreased anxiety, depression, and stress.

ANS: D Individuals who reported intrinsic religion (internalized or regularly practiced) and regular attendance at a religious service reported decreased stress. In 147 studies, it was found that there was an inverse relationship between religiosity and depression. The authors found evidence in another 49 studies that indicated people who practiced religious coping had lower levels of anxiety, depression, and stress and coped more positively with many chronic diseases.

Which is the most important task to be accomplished during the initial home visit? a. Assess the client and the family b. Discuss social topics c. Educate the client and the family regarding the health problem d. Establish rapport and trust

ANS: D Many clients in need of nursing visits do not trust the health care system and are uncomfortable with the representative from an agency visiting their home. The nurse must build a trust relationship early in the visit or the client will not allow additional visits. Beginning with social topics is often a helpful tool to help establish trust and rapport. After rapport and trust have been established, the nurse can assess the client and family and provide education. Discussion of social topics would not be the primary task to accomplish during any nurse-client interaction.

Which 66-year-old client who needs skilled nursing care would be eligible for home health care reimbursement by Medicare? ***Mentioned in Class*** a. A client who always worked for the state and enjoys going to the neighborhood coffee shop on a daily basis b. A client who needs his wounds cared for every day, including weekends, and needs the nurse to visit at 8 AM every day c. A client who is a loner and has no one to assist him except for the home care agency d. A client who is homebound and has a very strong support system e. A client who is an illegal immigrant who has lived in the United States for 25 years but begged the nurse not to tell

ANS: D Medicare pays for short-term, skilled health care on a part-time or intermittent-care basis for persons aged 65 years or older who are eligible under Title XVIII of the Social Security Act. If family and caregiver support is available in the home to care for the patient between nurse visits, the patient is eligible.

Which best describes what the Occupational Safety and Health Act of 1970 requires? a. All employees are eligible for a free health examination before beginning employment. b. Employers are required to make suggestions on standards for improving worker safety. c. Employers have the right to request an Occupational Safety and Health Administration (OSHA) inspection for ways to improve worksite safety. d. Employers must keep the worksite free from recognized hazards.

ANS: D OSHA promulgates occupational health and safety standards, which are published in the Code of Federal Regulations and updated on a regular basis. Having access to the most recent publication of these standards is a crucial responsibility of the occupational health nurse (OHN). The OHN must be knowledgeable of Title 29 of the Code and other sections that apply to specific hazards in the workplace.

Which responsibility does the occupational health nurse (OHN) have in relation to an injured employee and the Workers' Compensation Act? **Mentioned in class** a. To assist the employee in obtaining legal representation to negotiate a financial settlement b. To assist the employer to work out a settlement with the employee to avoid legal suits against the employer c. To file a claim for the employee with Workers' Compensation to ensure continued full salary until the employee is able to return to work d. To work with the employee to keep the employee informed, limit disability, and provide opportunity for rapid return to employment

ANS: D The Workers' Compensation Act protects the employer if the compensation received by the employee precludes legal suits against the employer. Workers receive an average of 66% of their take-home pay before taxes. The OHN educates the employee regarding benefits under the Workers' Compensation Act and is often the one who files the claim. The goal is to limit the worker's disability and provide an opportunity for early return to work through appropriate workplace accommodations.

Which best explains why job opportunities for occupational health nurses (OHNs) have continued to expand? a. Federal legislation has required an OHN at any site with more than 50 employees. b. Legislation has required employers to engage in certain tasks, and nurses were the most expert at those tasks. c. Nurses have done an excellent job of describing the role and its benefits to the media. d. Nurses are able to document cost savings to employers.

ANS: D The cost-effectiveness of providing health care to employees achieved recognition, and by 1912, following implementation workers' compensation legislation, 38 nurses were employed by business firms. As businesses seek ways to maximize the value of their dollars spent on health care services, OHNs and other health professionals face an opportunity from being able to demonstrate that cost-effective, quality health programs do improve the health of employees and their dependents, positively influencing their company's attempts to control rising health care costs.

A client was quite ill and the family was doing their best. After careful assessment and diagnosis, the home health nurse was setting priorities for care. Which should be the basis for deciding which intervention to implement first? a. Address the problem that is easiest to fix first, so the client and family could see some success fairly quickly b. Address the most serious problem first for the client's long-term health c. Address the problem that is partly causing other problems first d. Address the problem that the client and family think should be addressed first

ANS: D The plan, including short-term and long-term goals, is developed in consultation with the client and the family. To maximize the plan's success, it is important that the patient and family are involved in the planning process and that they access community resources. Thus, it is most important to address the problem that the client and family think should be addressed first. The other problems can be addressed after meeting the immediate needs of the client and family.

A nurse is developing secondary prevention strategies to reduce violence for individuals in the community. Which strategy would the nurse most likely select to implement? a. Providing counseling services for victims of violence b. Offering parenting classes at a local high school c. Educating children on methods of conflict resolution d. Creating of a safety plan for victims of violence

ANS: D The public health nurse develops prevention strategies using the three levels of prevention: primary (promotion of optimal parenting and family wellness), secondary (diagnosis of and service for families in stress), and tertiary (reeducation and rehabilitation of violent families). Creation of a safety plan for victims of violence demonstrates the use of secondary prevention. Providing counseling services for victims of violence is done by using tertiary prevention. Primary prevention is used when educating children on the methods of conflict resolution and offering parenting classes at a local high school.

Which best describes the mission of the U.S. Department of Homeland Security (DHS)? a. To consolidate all existing agencies, groups, and organizations into a single department b. To distribute federal financial aid to disaster-stricken areas c. To enable appropriate response to assist a state having a disaster d. To prevent terrorism and ensure resilience to disasters

ANS: D There are five homeland security missions: prevent terrorism and enhance security, secure and manage U.S. borders, enforce and administer immigration laws, safeguard and secure cyberspace, and ensure resilience to disasters. This agency was created to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland, but this is not the mission of the agency. The Federal Emergency Management Agency distributes federal financial aid to disaster-stricken areas and is responsible to enable the appropriate response to assist a state having a disaster.

Which argument would the occupational health nurse (OHN) use when trying to convince a large employer of the need for a breast cancer education program? a. It will be excellent media coverage for the employer, especially if the public is invited. b. A large number of female employees of childbearing age may be interested. c. This program would help balance all the male-oriented programs. d. Women employees who believe their employers are interested in their well-being are more productive and satisfied.

ANS: D Women who believe their employers are interested in the well-being of themselves and their families are more apt to be productive and satisfied employees. Thus, the large employer can demonstrate this belief by offering a breast cancer education program. The primary purpose of offering this program would not be to provide media coverage for the employer, spark the interest of the female employees, or help balance the male-oriented programs.

Which best explains why more nurses do not report violence against themselves to authorities? a. Assumption that the nurse somehow "asked for it" by not being cautious enough or alert enough to avoid it b. Assumption that nothing would be done about the situation anyway c. Assumption that nurses can accept anything, from taking blame to being scapegoats for when outcomes are not positive d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job

ANS: D Workplace violence tends to be higher in some service-oriented work environments, including health care. In the health care field, frequent areas for the occurrence of violence include emergency departments, psychiatric units, geriatric units, and waiting rooms. Nurses and nursing assistants who work directly with patients are often at risk. Nurses who work in public health roles are not immune to violence because their work may bring them in direct contact with individuals prone to violent behavior.

Which best explains why home health care agencies that are part of national chains are doing better in the competitive marketplace than individually owned agencies? ***Mentioned in Class - Propriety*** a. There is better media coverage and a nationally known "name" recognized by prospective clients. b. They are able to offer lower quality care using less well-prepared caregivers to ensure maximum profit. c. The chief executive officer usually has extensive experience and makes wise decisions. d. There are lower administrative costs and easier negotiating when buying in bulk.

ANS: D Agencies within chains have a financial advantage over single agencies. The chains have lower administrative costs because a larger single corporate structure provides many services. For example, a multiagency corporation has greater purchasing power for supplies and equipment because they purchase a larger volume. A single corporate office can provide administrative services such as payroll and employee benefits for all chain employees, thereby reducing duplication of these services. It is unlikely that they are doing better because they receive better media coverage, offer less quality care, or have a more experienced chief executive officer.

Which interventions would be appropriate for a faith community nurse who bases care on the CIRCLE Model of Spiritual Care? (Select all that apply.) a. Giving a mini sermon based on the specific client problem b. Listening and showing respect without any actual intervention c. Suggesting to the client what would be an appropriate response to the situation d. Showing love and empathy toward the client and the situation e. Calling the client by name during the conversation f. Allowing time for prayer during the client interaction

ANS: D, E, F Faith community nurses should avoid giving sermons or preaching religion to clients. Listening without any intervention is not possible, because listening in and of itself can be therapeutic. Clients retain their autonomy, so nurses can give information but cannot suggest to clients what their decision should be. Appropriate emotional interventions include working with feelings, showing love, and using appropriate touch and empathy. Calling a patient by name is part of showing caring during the interaction. Intuition includes allowing time for prayer and sacrament and supports and encourages religious activities.