Community Test 2

A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect? a. Common source b. Mixed c. Propagated d. Intermittent

ANS: A A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. A mixed outbreak is a common source outbreak followed by secondary exposures related to person-to-person contact. Intermittent source cases may be exposed over a period of days or weeks. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the most crucial aspect for the nurse to consider? a. Detecting an increase in people with similar signs and symptoms b. Identifying typical chemical or biological agents c. Identifying factors that put people at risk d. Recognizing areas of vulnerability within an area

ANS: A An unannounced dissemination of a biological agent may easily go unnoticed, and the victims may have left the area of exposure long before the act of terrorism is recognized. Therefore, the first and most important aspect is recognizing that an outbreak has occurred by noting the increase in people presenting with similar signs and symptoms. After the similar signs and symptoms have been detected, the next step is striving to identify the biological or chemical agent. Then the nurse will identify factors that place people at risk, implement measures to control the outbreak, and finally, inform the medical and public communities about treatments, health consequences and preventive measures.

A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? a. Contracting b. Family crisis c. Empowerment d. Health risk reduction

ANS: A Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased. A family crisis ocurs when the family is not able to cope with an event and becomes disorganized or dysfuntional. Making a pledge through contracting is a way to cope with a family crisis. Empowerment reflects a family seeking help with access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. The pledge does not address the multiple components of empowerment. Health risk reduction is based on the assumption that decreasing the number or the magnitude of risks will decrease the probability of an undesired event occurring. The pledge does not address multiple health risks.

A new mother is a full-time college student who lives with her parents, because the baby's father has been imprisoned related to theft and drug abuse. The infant's grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this family's needs? a. Developmental b. Family nursing c. Bioecological d. Systems

ANS: A Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughter's (and grandchild's) needs. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

When does disaster management begin? a. Before the disaster occurs b. During the disaster c. Immediately following the disaster d. During the recovery period

ANS: A Disaster management includes the four stages of a disaster: prevention, preparedness, response, and recovery. The first stage of prevention (or mitigation) occurs before the disaster occurs. Disaster management that occurs during the disaster is called response. Recovery occurs following the disaster.

A nurse noted that of 18 children in a daycare center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill? a. Some of the children were from very low socioeconomic families. b. Some of the children inhaled car exhaust while playing outside. c. The bacterial cause of the illness was easily removed by hand washing. d. The daycare center room was much warmer on three sides in comparison to the side with the floor to ce

ANS: A Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness and exposure to pollutants are considered agent factors, and the difference in temperature in the room is an environmental factor.

A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a. "Does your 4-year-old have a booster seat in the car?" b. "Have you noticed any physical problems as you go about your daily routine?" c. "What concerns do you have today? d. "Why did you decide to come in for a checkup?"

ANS: A Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Inquiring about why the client came in for the visit, asking about concerns, and physical problems does not address potential health risks that may need to be addressed for the client.

A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers' needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no

ANS: A In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group. As the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion, not necessarily a rebellion against adult authority. The group naturally progressed to leading itself based on normal group development. This did not occur because of the teenagers' attitudes, behaviors, or because of the feelings of the nurse.

A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most likely complete? a. Provide community educational programs and training on how to prepare for disasters. b. Request donations be sent to the affected area. c. Develop a notification procedure to be used by the international disaster relief office. d. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area.

ANS: A Mitigation refers to actions to prevent specific disasters from occurring or to reduce the severity of a disaster's effects if it cannot be avoided. Providing community educational programs on disaster preparedness is the only intervention that addresses mitigation. Requesting donations be sent to the affected area occurs during the disaster and is known as the response. Developing a notification procedure would occur as part of the preparedness stage. Depending on the timing of the recruitment, this would be part of either the preparedness or response stage.

A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of th

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

Which of the following levels of prevention is being used by a nurse who is helping to develop a community-wide disaster management plan? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. All prevention levels

ANS: A Primary prevention takes place before a condition occurs. Primary prevention occurs when one participates in developing a disaster management plan for the community. Secondary prevention occurs with at risk populations and is aimed at early diagnosis and treatment. Tertiary prevention occurs after a problem has already been detected or diagnoses. The development of a plan only addresses primary prevention, not the other levels described.

A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory tes

ANS: A Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. If the family members are eating clay, this demonstrates that a problem already exists. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.

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

ANS: A The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The Health Belief Model does not indicate the number of methods of education that should be used. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.

A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Family nursing theory

ANS: A The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

A nurse, after working 2 weeks at the site of the largest natural disaster to hit the United States, returns home. Which of the following behaviors would suggest the nurse needs professional assistance? a. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there. b. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured. c. Th

ANS: A The fact that the nurse needs to continue to ventilate about the disaster, even after the family has quit listening, would suggest a delayed stress reaction that is not resolving and therefore warrants professional intervention. The nurse presenting at a college about the disaster demonstrates that the nurse is able to engage in conversations about the disaster after it has occurred. It is understandable that the nurse would return exhausted and moody. Indeed, concerns of major importance to family members may seem trivial when compared with problems the disaster victims were confronting.

A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? a. "Be sure to take a 30-minute walk each day." b. "Call our office if you have any questions or concerns at all." c. "Come back in 2 weeks for follow-up on your surgery." d. "Continue to take the drug until it is gone, even if you're feeling better earlier."

ANS: A The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. Exercising for 30 minutes a day reduces the risk for many diseases. All the other options are treatment oriented rather than risk avoidance.

Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

ANS: A The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the 21st century exciting and challenging. All family units have functions (activities and purposes) and structure (organization). These functions and structures many be very different among family members, but they do exist. All clients are part of a family, even if they define their family as only themselves. Nurses should be open-minded and recognize that all families are different and a "traditional" family structure may mean something different to different individuals

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" Which of the following provides the best rationale for the nurse asking this question? a. To assess the family's environment and social resources and risks b. To communicate with relevant others as needed c. To determine financial assets available to the family in case of serious need d. To understand the extended family relat

ANS: A The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap. An ecomap does not assess extended family relationships or financial assets. An ecomap is not used as a communication method.

A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c. Parents who come with their child for his prekindergarten physical exam and want to be

ANS: A Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. The incorrect responses do not represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a. Why the data are needed b. How best to interview each individual in the family c. The most convenient time for you to visit the family d. The rationale or purpose of the visit

ANS: A, C, D Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. The preferred time to visit is when most family members will be available. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual).

In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. b. No further action is necessary because this short-

ANS: A Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. The nurse should recognize that depression can be seasonal and not attribute this problem to an error in the data that has been collected. Because this is being recognized as a seasonal problem, there is no need for the nurse to take action. However, the nurse should continue to monitor the data to make sure that this trend does not continue as the weather begins to warm and more hours of daylight occur.

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

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

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

ANS: A, B, C To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc. Assessing if the material was enjoyable to read does not help the nurse to assess the quality of information that was read by the client.

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

ANS: A, C, D Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor ability, having a sensory image of how to carry out the skill, having opportunities to practice the new skill. Having an open mind to learn a new skill is important. However, it is not necessary in order to master psychomotor learning.

A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) a. The nurse can assess the family environment. b. The family will feel more comfortable. c. Families typically welcome others into their home. d. More family members can typically be involved.

ANS: A, B, D Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the family s home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.

The nurse is scheduled to teach carbohydrate counting to middle-aged adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning.

ANS: A, C Because the nurse is working with middle-aged adults, the assumption can be made that they are members of Generation X. This generation tends to be self-directed, likes to work with teams, and may need to develop skills because they are not as likely to be as tech savvy. Members of this group can tolerate delayed gratification; they want clear information with practical value; and they are able to have fun and engage in games and activities when appropriate. Because of this, the best approach will be to use adult experiences and practical problems as learning motivators—for instance, appealing to adults' sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions. This generation tends to be self-directed so they most likely will not depend on the instructor to set goals for learning

Which of the following best defines a disaster? a. Any event that results in multiple deaths b. Devastation that cannot be relieved without assistance c. Devastation that covers a broad geographic area d. When the event results in multiple injuries and deaths as well as property damage

ANS: B A disaster is any human-made or natural event that causes disruption, destruction, or devastation that cannot be relieved without external assistance. A disaster does not need to involve injuries or deaths. The devastation may not cover a broad area, rather the main concept of the definition of a disaster is that it can not be relieved without assistance.

Which of the following best describes countries that bear the greatest burden of disasters? a. Arid regions that are prone to drought b. Developing countries with limited resources c. Industrialized countries with much to lose d. Water-boundary regions that are prone to floods and hurricanes

ANS: B Disasters create the most devastation in developing countries. The people of low socioeconomic status suffer the most because their houses are less sturdy and they have fewer resources and less means of social security. The climate and location of the country does not relate to its risk of bearing the burden of disasters. Industrialized countries have a higher socioeconomic status and can better address disasters if they occur.

A community is experiencing the Honeymoon phase following a disaster. Which of the following is most likely to occur in the community? a. First responders work tirelessly to save others b. Survivors share their stories c. Medical personnel experience exhaustion d. Community organizations rebuild the community

ANS: B During the Honeymoon phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the Heroic Phase. Medical personnel experience exhaustion during the Disillusionment Phase. The community begins to rebuild during the Reconstruction Phase.

A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the family's strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional

ANS: B Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the family's strengths gives the nurse assets on which to draw in planning care. The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used.

The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepa

ANS: B Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. However, if family members are supportive, they will want to try to help the ill member. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill member's needs without making drastic changes in the overall eating patterns of the family. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. Because of the rapid change and stress in stress in American society, preparing different sets of meals is not very realistic. If the family member who prepares the meals does not attempt to make some changes, this would not be therapeutic for the family member who is ill.

Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurse's plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurse's plan. d. Nurse has informed family how to complete the required actions.

ANS: B Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The family must have the skills and commitment necessary and to complete the developed plan. The plan cannot be the nurse's choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan.

The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The family's basic needs are being met. c. The couple's in-la

ANS: B In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

Which of the following types of surveillance systems is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? a. Active b. Passive c. Sentinel d. Special

ANS: B In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.

A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

ANS: B It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family. It is probably most important that the immediate, not necessarily the extended, family is present. If the nurse is making an appointment with a family this would be part of the role of the nurse, and it would be within the scope of the nurse's practice to make time to complete home visits. The nurse may need to be creative in how to best meet the needs of the family to arrange a meeting. The larger barrier is finding a common time, not distance of the family member.

A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family

ANS: B Making referrals when appropriate is part of the termination phase as the nurse ends the relationship with the family. It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure. If sessions were the nurse were to increase, it would be unlikely that the relationship was going to be soon terminated or ended. Formative evaluation occurs throughout the relationship and is ongoing; an evaluation be done at the closure of the relationship would be summative. It would be appropriate for the nurse to extend an invitation for follow-up, not refuse additional communication.

An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? a. Avoidance of alcohol b. Regular physical exercise c. Daily consumption of calcium-rich foods d. Monthly self-breast and testicular exams

ANS: B Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlin

ANS: B Most health information is printed at a tenth-grade reading level, which is too difficult for almost half of the adult readers in the United States. If people cannot read or understand the material, they discard it. Although visual images are certainly helpful, this does not explain why the handouts were discarded. Audience expectations of the use of PowerPoint or video presentations or receiving too much information too fast does not explain why the handouts were thrown away. If the nurse covered information too fast, it is likely that the participants may have been more inclined to keep the handout.

A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements demonstrates the client is ready to make the change? a. "I should change." b. "I am willing to change." c. "It's important to change." d. "I want to change."

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

A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic? a. Because nurses are employed in public health agencies b. Because nurses are often the first to recognize and respond to a problem c. Because nurses are responsible for ensuring that action is taken when necessary d. Because nurses are typically the ones to interact with the public and the media

ANS: B Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. Nurses may work in a variety of community agencies, including public health agencies. Nurses will collaborate with others to take action as necessary; it would not be the sole responsibility of the nurse. A wide variety of public health professionals interact with the public and the media, not only nurses.

A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a. "I make most of the decisions so the kids don't notice much difference." b. "My daughter is pretty independent; she's active in both sports and theater." c. "My son is old enough to get a job and help pay all these

ANS: B Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships, equal power structure, and a high degree of autonomy by each member. Flexible role relationships is not being demonstrated if only the daughter is taught how to cook and only the son is expected to get a job. Equal power structure is not being displayed if the husband makes all the decisions.

On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is feeling irritable and having difficulty focusing. Which of the following actions should the nurse take in response to the complaint of headache? a. Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later. b. Explain that he is experiencing signs and symptoms of psycho

ANS: B Symptoms of early stress and burnout include minor tremors, nausea, inability to concentrate, difficulty thinking, and problems with memory. Suppressing feelings of guilt, powerlessness, anger, and other signs of stress eventually will lead to symptoms such as irritability, fatigue, headaches, and distortions of bodily functions. It is normal to experience stress, but it must be addressed. The worst thing anyone can do is to deny that it exists. The American Red Cross recommends that the worker get enough sleep and take time away from the disaster (i.e., take breaks). The colleague should deal with his emotions now and not put them off to deal with later. The symptoms that are described relate to early stress and burnout, thus, not multi-tasking or drinking more water are probably not going to help relieve his symptoms.

After a house fire, a 4-year-old child begins sucking his thumb and wetting his bed. Which of the following would be the most appropriate action for the nurse to take? a. Explain to the child that it is important to be strong and not act like a baby. b. Explain to the family that this behavior is a normal reaction to disaster. c. Recommend admission for inpatient psychological counseling. d. Recommend behavior therapy as a means to overcome regression.

ANS: B The effects on young children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumbs, wetting their beds, crying, and clinging to parents. This regression is normal in response to the event. Regression is a normal response; thus, it is not necessary to recommend psychological counseling or behavior therapy. It would not be appropriate to explain to a 4-year old child that he/she should be "strong".

The local hospital, health department, and university together planned and implemented a mock casualty drill, with the university's theater and nursing students playing the injured victims. After the drill, which of the following would the nursing students most likely complete? a. Volunteer as leaders in the next casualty drill b. Evaluate the drill and offer recommendations for more effectiveness in the future c. Recognize how to respond to a real disaster in the future d. Write a report on th

ANS: B The nursing students should be prepared to offer a critique of the drill performance and suggest improvements for the next drill—or for an actual disaster. It would be unlikely that the students would be volunteers at the next drill as typically the agencies involved with disaster management are the ones who are coordinating and leading these activities. It is unknown if the student will ever be in the same type of disaster as what they completed the drill for, so their involvement may not change their response in the future. Writing a report and talking about feelings would not be helpful for the agencies to learn what they can do differently if an actual disaster was to occur.

Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital? a. So that the children's families know the public health department cared about them b. So that action could be taken to avoid any such future episodes c. Because the children's parents need to know whom to sue for their medical expenses d. To confirm that the sym

ANS: B The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided. The further investigation of the illness is not to demonstrate caring on the part of the public health department, rather it assists with learning about what factors contributed to the occurrence. It is unlikely that the parents would sue for a hospitalization for severe vomiting and diarrhea. Also, there is no indication that there would be an individual or agency to sue for the symptoms that the child is experiencing. There is no indication as to what caused these symptoms, thus, the nurse would need to do further investigation to determine if they were related to infectious disease or some other contributing factor.

A nurse was the first on the scene of a disaster and saw people with injuries ranging from minor to serious. Some of those with minor injuries were helping others. Which of the following injured persons would the nurse assist first? a. Those with life-threatening head and chest injuries b. Those who have life-threatening abdominal injuries c. Those who have serious injuries of limbs d. Those who are hurt but still mobile and functioning

ANS: B Triage is the process of separating casualties and allocating treatment on the basis of the victims' potentials for survival. The nurse will determine how seriously hurt individuals are and who should get care first, with the first priority being those who have life-threatening injuries but will probably survive if treated quickly. Although the textbook does not address the issue, because of the limited resources in a disaster situation and the fact that only the nurse is currently available to give care to individuals with head or chest injuries that have only a small chance of surviving are not treated. Those who do not have life-threatening injuries and are mobile and functioning are not given priority during the triage process.

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

ANS: B, C When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills. When working with adults emphasis should be placed on previous experience. This is not as important when working with children as they have had more limited experiences. Children are not concerned with long-term consequences, rather they focus on consequences and activities that will occur in the near future (short-term).

Which of the following disasters would implement disaster medical assistance teams (DMATs)? (Select all that apply.) a. Disaster that covers a broad geographic area b. Disaster that is beyond the coping capabilities of the affected state c. Disaster that may result in substantial health and medical problems d. Disaster that may cause a large number of deaths and/or injuries

ANS: B, C, D A presidentially declared disaster is one that requires implementation of disaster medical assistance teams (DMATs) because the disaster exceeds the capabilities of the involved state(s) to provide a timely and effective response. Such a disaster has the potential to cause a substantial number of deaths or injuries; substantial health and medical problems; or significant damage to the economic and physical infrastructure. The disaster may not cover a broad geographic area. The criteria for use of DMATs is that the disaster exceeds the capabilities of the involved state to provide a timely and effective response. This could occur in a small geographic area.

Which of the following describes the purpose of surveillance systems today? (Select all that apply.) a. To obtain data used to fight for increased budgets from taxpayers b. To evaluate the effectiveness of public health programs c. To monitor and reduce the incidence of chronic diseases d. To note and help prevent occupational exposure and diseases

ANS: B, C, D Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. With limited budgets, surveillance systems are important. The taxpayer money should be used in the most effective and efficient ways possible. This involves monitoring the effectiveness of health programming, not asking for increased budgets from taxpayers.

A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.) a. Doctors are feeling rushed as they interact with each patient. b. Emergency departments are notably busier than usual. c. Nurses are calling in ill to the local hospital. d. Pharmacists are discussing the increase in medication purchases.

ANS: B, D Syndromic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. Doctors feeling rushed and nurses calling in ill are not unusual events.

A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? a. "I can't visit my husband in the hospital when I'm at work all day. How can I be sure he's all right?" b. "My husband always handled our finances. Now that he's gone, I'll have to learn how to do this." c. "I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our

ANS: C A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. Only the correct response is the person overwhelmed and unable to conceive of how to cope. In incorrect responses, the survivor is considering the problem and trying to learn how to cope or seek resources to cope.

Which of the following families is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b. A man knows that his grandfather, father, and older brother all died of cardiac disease. c. A man is currently unemployed and despairs about finding a position. d. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

ANS: C A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care. A man who says he needs to eat better and exercise more appears to have adequate resources as he is employed. The man who has a family history of cardiac disease is not displaying any known risk factors related to income. The man who has been laid off stil is receiving an income which should assist him in being able to afford the necessary goods and services he needs in the immediate future.

A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse should take? a. Limit the amount of equipment and medications brought into the shelter. b. Determine if the person has a psychological condition requiring special attention. c. Assess if this type of facility is appropriate for the person. d. Provide medical care for persons as if they were in a hospital.

ANS: C Any person who comes to a special needs shelter must be assessed by a nurse to determine whether this type of facility is appropriate. After it has been determined if the facility is appropriate for these people, the nurse can work with them as needed to limit equipment if there is limited space. Assessment of the physical concerns of the people, not the psychological conditions, should be the primary concern of the nurse. The nurse would not be providing medical care at the shelter, rather, the nurse would provide assessments, referrals, assist the client to meet health care needs, keep client records, ensure emergency communications, and provide a safe environment.

A nurse considered copying last month's surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? a. Because such data are legally required b. Because it is still part of the nurse's responsibilities, even if it is a waste of time c. To determine a local baseline rate and immediately notice any chan

ANS: C Disease surveillance generates knowledge of a disease or event outbreak patterns. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks. Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and improve health. Disease surveillance is not part of a legal requirement. There are many useful purposes for surveillance including monitoring for emerging infections and disease trends. The purpose of the monthly surveillance report is not for comparison among communities, rather it is a description of what is happening within the local community.

A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? a. Determine the family's willingness for another home visit b. Establish the purpose of the visit c. Review the family's learning and other accomplishments of the visit d. Review the family record and reason for referral

ANS: C During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The incorrect options listed occur during the pre-visit phase.

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

ANS: C Educators should include participation. Lack of participation is a barrier to learning. Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic. Evaluation occurs at the end of the education, evaluation is not necessarily missing when an educator uses lecture as the primary method of education. The nurse may be able to include experiences as part of the lecture when educating clients. It may be difficult to assess understanding if lecture is the primary method of education; however, the nurse should be able to use nonverbal clues to assess understanding. Also, the use of lecture does not mean that understanding is missing from the process.

A nurse focuses on the care of the individual while viewing the client's family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurse's view represent? a. Client b. Component of society c. Context d. System

ANS: C Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the "family as context" concept, the family serves as either a resource or a stressor to individual health and illness. When family is the the client, the family is placed first, and individuals are second. The family is seen as the sum of individual family members. When family is the system, the focus is on the family as the client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts. When the family is seen as a component of society, it is seen as one of many institutions of society, along with health, education, religious, or financial institutions.

In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System

ANS: C Family structure refers to the organization of the family. This defines the roles and positions of the family members. The family functions refers to the activities and purposes of the family. The family as a system accomplishes activities that serve the individual and society. Family dynamics refers to the interactions and relationships within the family.

A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." Which of the following would be the best action for the nurse to take? a. Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set u

ANS: C Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior. Group support often helps people make needed changes for health that they are unable to accomplish on their own or with the help of just one individual. The role of the employer is not to dictate employee health behaviors, so have a written contract would be inappropriate. The man may already recongize that walking is one of the best health promotion activities he can choose; however, he has expressed that he is lacking motivation. Setting up rewards for himself may be helpful; however, it may not be enough to get him motivated to take action. Group support may help him to get motivated.

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

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

In which of the following situations would the nurse most likely use an active surveillance system? a. A newspaper wants to know the incidence of asthma in the community. b. A real-time ongoing communication channel is established to monitor a particular symptom. c. Several children become ill with gastrointestinal (GI) upset at one local school. d. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

ANS: C In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. Special surveillance is developed when a particular type of data is sought.

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

ANS: C Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space. Group norms set the standards for the group members' behaviors, attitudes, and perceptions. Task norms are the commitment to return to the central goals of the group. Reality norms occur when members reinforce or challenge and correct their ideas of what is real.

A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a. A broken horizontal line b. An X through a circle c. A solid horizontal line d. A solid vertical line

ANS: C Marriage is indicated by a solid line on a genogram. A broken horizontal line indicates a divorce or separation. An X through a circle or square indicates a death. A solid vertical line indicates offspring and children.

Which of the following older adults is most in need of psychological support? a. The older adult who keeps asking if loans will be available for him to rebuild b. The older adult who keeps asking if he can go back home yet c. The older adult who keeps lamenting the loss of his family photos d. The older adult who keeps talking about how expensive his home theater was and how he will never be able to afford to replace it

ANS: C Older adults react deeply to the loss of personal possessions because of the high sentimental value attached to the items. Family photos are a part of family history and are not replaceable. This type of a loss warrants psychological support. Homes and electronic equipment can be replaced, so the older adult may be able to eventally access loans to rebuild his home and replace his equipment. Because these things are replaceable, it is likely that that the older adult will be able to better cope with these losses than with something that is irreplaceable. Depending on the loss of the older adult, he/she may have a need for relocation rather than returning home.

Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to

ANS: C Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease. The client who is currently unemployed is demonstrating positive health behaviors by actively seeking employment and walking frequently. The client who spends time at the gym and studies the benefits of organic foods is displaying positive health behaviors by being active and wanting to eat healthy. The client who leaves work to pick up the children at 5:00 is displaying healthy behaviors as he/she is bala

Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a. "What helps you to cope with situations involving your wife's cancer?" b. "How has your child's illness affected the behavior of your other children?" c. "Tell me about any illnesses your other family members have." d. "Who do you turn to for support outside your immediate family?"

ANS: C Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health. Asking about coping and support addresses psychological health, not physiological health. Inquiring about the behavior of the other children addresses developmental health.

A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? a. "Did any of the hunters in your family kill a deer this year?" b. "How do you keep your rifles safe from curious children?" c. "Where do you shoot with your handguns?" d. "Where do you keep your rifles locked when it is not hunting season?"

ANS: C Risk reduction is a complex process that requires knowledge of risks and families' perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the family's perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death. Asking about how guns are kept safe or locked up does not address the families perception of the nature of the risk. Asking if any of the hunters killed a deer this year makes the assumption that the family uses the guns for hunting. This perception by the nurse may be inaccurate, it would be more appropriate for the nurse to ask how the guns are used

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

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

What is the purpose of the National Response Framework? a. Create a new branch of government that deals with bioterrorism b. Establish a way for the Red Cross to carry out its mission c. Define roles, responsibilities, and relationships critical to effective emergency preparedness d. Extend presidential power to act quickly upon weapons of mass destruction

ANS: C The National Response Framework, a successor to the National Response Plan, "helps define the roles, responsibilities, and relationships critical to effective emergency planning, preparedness, and response to any emergency or disaster." The NRF serves as a guide for conducting a nationwide all-hazards response that is flexible and adaptable and that links all levels of the government with nongovernmental organizations and the private sector. The U.S. Department of Homeland Security was developed in 2002 to develop and coordinate the implementing of a comprehensive national strategy to secure the United States from terrorist threats or attacks. Eventually, the NRF was developed within this department. The National Response Framework helps to provide a linkage for the Red Cross to other organizations, but does not assist with it carrying out its mission. The NRF does not change presidential power.

A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a teenager comes out and says, ""My mom said she couldn't see you and you should go away." Which of the following actions should be taken by the nurse? a. Demand the teen let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch with the nurse. d. Point out th

ANS: C The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

A nurse has just met a family and is completing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a. Confirm the reason for the appointment. b. Demonstrate cultural awareness. c. Take time to build trust. d. Understand the family dynamics.

ANS: C The family assessment process is interactive. As the nurse is evaluating the family, the family is evaluating the nurse. Too much disclosure during the early contacts between the family and nurse may scare the family away. The nurse should slow the process down, and take time to build trust. Components of building trust with the family would include confirming the reason for the appointment so that the family knows the nature of the visit and demonstrating cultural awareness during interactions. As the nurse completes the family assessment, the nurse will note the dynamics of the family; understanding the family dynamics is not important before engaging in self-disclosure.

A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a. Family systems b. Bioecological systems c. Family developmental d. Family nursing

ANS: C The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. In the family systems theory, families are considered social systems, composed of a set of organized, complex, interacting elements. The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family nursing theory is an evolving synthesis of the scholarship from three different traditions: family social science, family therapy, and nursing.

Which of the following organizations would direct nurses' response to a countywide disaster? a. American Red Cross b. Centers for Disease Control and Prevention c. Emergency Management Agency d. The local public health department

ANS: C The first level of disaster response occurs at the local level with the mobilization of responders such as the fire department, law enforcement, public health, and emergency services. If the disaster stretches local resources, the county or city emergency management agency (EMA) will coordinate activities through an emergency operations center (EOC). Generally, local responders within a county sign a regional or statewide mutual aid agreement to allow the sharing of needed personnel, equipment, services, and supplies. The American Red Cross may assist with disaster relief efforts, but this would not be the agency that would direct the response by nurses. The Centers for Disease Control and Prevention is a national agency and would most likely not be involved with a county-wide disaster. The local public health department may be involved in responding to the disaster, but this would not be the organization that is responsible for leading the response.

A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a. Assess the family and the home setting for both strengths and problems. b. Determine the family's expectations of a home visit. c. Establish rapport between the nurse and the family. d. Engage in extended social interaction as would be expected from any guest.

ANS: C The initial home visit includes the nurse's self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client's expectations. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. Building rapport between the nurse and family should occur as the nurse is determining the family's expectations, as well assessing the family and home setting.

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

ANS: C The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned. Because breast self-examination is a psychomotor skill, the emphasis should be placed on the learner having the ability to perform the skill after the conference. The most important aspect should be the time for practice in this situation, and not on the time for questions. The nurse would not need to explain to the audience why culturally appropriate images are acceptable, rather these should have been incorporated into the session. Having printed materials is important so that the learner has a reference after leaving the conference.

A community health nurse has invited several agencies in the community to a meeting to discuss the disaster plan for the community. Which of the following best describes the purpose of this meeting? a. To increase stability in the community b. To improve overall community functioning c. To manage response to disasters in the community d. To enhance communication among agencies in the community

ANS: C The level of community preparedness for a disaster is only as good as the people and organizations in the community make it. Although natural disasters cannot be prevented, much can be done to minimize further increases in accidents, death, and destruction after impact. A concise, realistic, and well-rehearsed disaster plan is essential for managing the response to disaster. Open, clear, and ongoing communication among involved workers and organizations is critical. A disaster planning meeting among community agencies would not impact the stability or functioning of the community. The communication among the agencies that are present may be improved; however, the group is meeting for a specific purpose so the overall communication may not change, and there may be agencies that are not represented at the meeting.

A nurse asks a family member, "What has changed between you and your spouse since your child's head injury?" Which of the following focuses of the family is the nurse assessing? a. The context b. The client c. A system d. A component of society

ANS: C When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions. When family is the the client, the family is placed first, and individuals are second. The family is seen as the sum of individual family members. When the family is seen as a component of society, it is seen as one of many institutions of society, along with health, education, religious, or financial institutions. When family is the context, the individual is placed first and the family second. In the "family as context" concept, the family serves as either a resource or a stressor to individual health and illness.

The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.) a. Analyze educational health programs offered to the public last year. b. Congratulate the public health staff on the success of their asthma awareness program. c. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma. d. Review

ANS: C, D Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? Confirming the data by comparing it to other sources would be the priority. After this has been completed, the next steps would be for the nurse to look at the health programming and community awareness education that has taken place. It would be premature to look at the programming if the initial data obtained is not accurate.

In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) a. Conferring appropriate social status b. Educating the younger members c. Ensuring physical and mental health d. Fostering interpersonal relationships and support

ANS: C, D Today, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health. Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, conferring social status.

During which phase of the home visit does the nurse document what was accomplished? a. Previsit phase b. In-home phase c. Termination phase d. Postvisit phase

ANS: D A major task of the post-visit phase is documenting the visit and the services provided. Major tasks of the pre-visit phase are to initiate contact with the family and schedule the home visit. During the in-home phase, the nurse-client relationship is established. During the termination phase the visit is reviewed with the family and plan for future visits is made.

A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, "My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag." Which of the following best describes the group purpose that is being served by the teenager's statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking a

ANS: D A task function is anything a member does that deliberately contributes to the group's purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenager's statement shared information about a good resource for the group. Maintenance functions help members affirm, accept, and support one another, resolve conflicts, and create social and environmental comfort. The teenagers comment does not support a maintenance function of the group, rather it focuses on a task function by contributing to the group's purpose.

A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? a. Apply for emergency financial assistance on the family's behalf. b. Arrange for community members to assist with child care. c. Invite the mother to join a cancer support group. d. Teach the family how to navigate the health care system.

ANS: D Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

A nurse is working with a community during the preparedness stage of disaster management. Which of the following events would the nurse anticipate occurring? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

ANS: D Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security is part of the mitigation phase. Individuals should make plans for the provision of their pets through their own personal disaster planning; this would not be part of the community disaster planning. It would not be appropriate or feasible for the nurse to purchase personal protective equipment for all citizens.

A nurse learns about a huge disaster a few states away. Which of the following actions by the nurse would be most helpful in this situation? a. Donating to any charity that is assisting the victims b. Driving over to the area and volunteering to assist c. Sending clothes and food to the area for distribution d. Training to become a Red Cross disaster volunteer

ANS: D Disaster workers must know what kinds of populations they are attempting to assist. Thus, formal training related to disaster management and response would be important for the nurse to complete. Without having formal training and having official sponsorship, volunteers may not be able to be used. Lack of information or inaccurate information regarding the scope of the disaster and its initial effects can contribute to the misuse of resources. Often too many volunteers who lack official sponsorship convene at the site of disaster and are disappointed when their help cannot be used. Similarly, well-meaning people may send clothes and food to disaster sites. The unneeded contributions of food and clothing add to the stress of coping with the disaster, particularly if refrigeration and storage are not available. Although contributing to an organization like the American Red Cross is to be encouraged and commended, many fraudulent scam charities may pop up claiming to collect funds

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

ANS: D During the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. The response explaining that "the purpose is to have a safe place" both recognizes what was said and clarifies the purpose of the group. The statements of "Don't share anything until you're comfortable" and "No one will require you to do anything. . ." are supportive, but they does not recognize the phase of development of the group. The statement "I understand . . ." offers the client empathy but does not reinforce the purpose fo the group.

Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy

ANS: D Government actions that have a direct or indirect effect on families are called family policy. The range of social policy decisions that affect families is vast, such as health care access and coverage, low-income housing, Social Security, welfare, food stamps, pension plans, affirmative action, and education. Family planning is only one example of family policy that can have a direct or indirect effect on families. Family funding may occur through programs administered by the government, but these programs are developed from family policy. Family policy is broader than only addressing legislative action.

A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities

ANS: D Health risk appraisal refers to the process of assessing the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environmental risk, and behavioral risk. Incorrect Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

ANS: D Limited communication or certain families members dominating the conversation can be suggestive of problems within the family. Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.

A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity? a. To ensure that local causes of death are consistent with national causes of death b. To confirm that no local health problems are beginning c. To evaluate effectiveness of health promotion programs d. To obtain mortality data for the local area

ANS: D Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports, such as death certificates, are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. It is not necessary that the local causes of death are consistent with national causes, rather it is important the nurse be aware of the major causes of mortality in the community so that the needs of the community can be addressed. Mortality data can occasionally be used to evaluate the effectiveness of health promotion programs, but this would not be the primary purpose of reviewing death certificates. Other data can be used to detect the start of local health problems. Analyzing death certificates as the only means of examining local health problems would provide the nurse with data that is not current.

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

ANS: D Not only should learners receive feedback, but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified. Obtaining feedback only at one point in time during the program does not give the nurse enough feedback as to what is happening throughout the presentation. In order for the educator to modify the teaching process and better meet the learner's needs, evaluation data should be obtained at multiple points in time.

The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the man's married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the "family"? a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even tho

ANS: D Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A "family" may range from the traditional nuclear model with extended family to such "postmodern" family structures as single-parent families, single families, same-gender families, and families consisting of friends. The incorrect answers have the nurse determining who is and who is not part of a family. This is not an appropriate action for the nurse to take, rather the nurse should let the client describe and define his/her family.

A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurse's commitment to the family and enter the home quickly. d. Drive away and no

ANS: D Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit. The home health nurse should be educated about what to do in this situation before it occurs and should not need to call the agency to ask for their advice when faced with this situation. The priority would be to leave the situation before calling the family. The nurse should not place him/herself in a potentially violent situation by choosing to enter the home.

A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss

ANS: D The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job. The Health Insurance Portability and Accountabilty Act (HIPAA) allows for familys to retain health insurance after resigning from employment. HIPAA prevents family information from being shared with colleagues unless they have a need to know based on the care they are providing for the family. The provision of Medicaid is not part of the Family Medical Leave legislation.

The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. "How many children do you have, and who is the father of each?" b. "Is there a register of families who are members of this commune?" c. "Tell me about your significant other." d. "Who are the members of your and your child's

ANS: D The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning. Asking who the father of each child is does not help define the family; the client needs to define the family. Knowing if there is or is not a register of families on the commune does not help the client define her own family. The client may or may not include the significant other in her definition of a family, so this may not assist in making this determination.

A nurse is employed by the American Red Cross and is frequently assigned to fly to a disaster zone. Which of the following should the nurse's family members have readily available? a. Gloves, mask, and other personal protective equipment b. A copy of the nurse's professional license c. A 5-day supply of water d. A disaster/emergency plan

ANS: D The nurse and the nurse's family are best protected by having the skills and knowledge to cope with a disaster, including details such as where families will reunite in the event of an emergency. The nurse should have his/her own copy of the professional license. It is recommended that a 3-day supply of water (1 gallon per person per day) be part of an emergency planning kit. Gloves, mask, and other personal protective equipment are recommended for the professional nurse to have available as an emergency supply.

Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental b. Exosystems c. Bioecological systems d. Family systems

ANS: D The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory. In this theory, the emphasis is on the whole rather than on individuals. Families are viewed from both a subsystem and supra-system approach. The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle. The bio-ecological systems theory describes how environments and systems outside of the family influence the development of a child over time. The definition of exosystems is found within the bio-ecological systems theory; these are the external environments that have an indirect influence on the family.

Which aspect of a biological agent is probably the most frightening to those exposed? a. Infectivity b. Invasiveness c. Pathogenicity d. Virulence

ANS: D Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease.

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

Before learning can take place, you need to gain the learner's attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally. Asking the students why they are being so rude would not be a professional response by the nurse. The nurse should take responsibility for gaining the attention of the audience and not expect the instructor to do so. Gaining the students can best be accomplished by telling the students why it is important rather than telling a joke.

Which of the following best describes the use of genomic health care? a. Assists with understanding family relationships b. Assists with determining familial health risks c. Useful in learning about environmental risk factors d. Useful in detecting risk for developing cancer

Genomic health care can give health care providers the tools that they need to use a person's unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a person's risks for the same diseases that other family members experienced.

Which of the following best describes a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The incorrect responses are not normative life events.