Community Wk 3 Edapt

(4/6) The nurse is assessing for client needs that may be met by local health department services. Which questions should the nurse ask the client? Select all that apply.

"Do you worry about running out of food before you have money to buy more?" "Are your children's vaccinations up to date?" "How do you get to healthcare appointments?" "Is your infant breastfed or formula fed?" "When did you and your children last visit a dentist?" The nurse should ask the client all of the following questions to assess access to food, dental needs, the children's immunization statuses, the infant's feeding method, and transportation needs. ​

A nurse is conducting a blood pressure screening at a health fair and identifies several clients who require referral to a provider. Which client statement indicates a barrier to accessing healthcare?

"I work during the day and the local after‑hours clinic is no longer in operation." Not having hours available during a time when the client is available is a barrier to accessing healthcare.

The nurse is assessing a client's potential exposure to environmental hazards. The client works as a radiology technician. Which assessment questions should the nurse ask? Select all that apply.

"Where do you live?" "Do you wear a lead shield at work?" "Where does your drinking water come from?" "What year was your home built?"

Which are examples of programs or activities to promote health equity? Select all that apply.

A free health care clinic with evening hours Collaboration of local businesses, organizations, and government to improve recreational areas Adapting work policies to include culturally appropriate materials A community garden built to supply fresh produce Conducting assessments of kindergartner's readiness for school

(6/6): The nurse meets with the client for a follow-up six months after the original visit. Indicate whether each finding is improved or if additional follow-up is needed. Home has peeling and chipping paint. Client reports checking the air quality index before doing activities outdoors. Client reports using bottled water for cooking and drinking. Client reports absence of ants in the home.

Additional Follow-up Needed Improved Improved Improved The home was built before 1978 and likely has lead paint. Peeling and chipping paint are problematic and should be addressed.​

Which are examples of issues related to social determinants of health? Select all that apply.

Adequate food supply Exposure to air pollution Lack of handicapped-accessible sidewalks Poor health literacy Racism

(5/6): The nurse is implementing the planned interventions. Which nursing actions are indicated? Select all that apply.

Assess knowledge of education provided Refer the client to resources for well inspection Refer the client to resources for lead inspection Schedule follow-up appointment with client Burning agricultural waste and using pesticides on farm crops are allowed. However, the smoke from burning may cause asthma symptoms. When sprayed, pesticides may cause respiratory problems and can also run into water sources. ​

In which situation does the nurse use the mnemonic, "I PREPARE?"

Assessing for environmental exposure The nurse assesses potential exposures, present work, residence, environmental concerns, past work, and activities. The nurse also provides referrals, resources, and education.

The nurse is caring for a low-income family who needs assistance with healthcare insurance. Which insurance programs are available for clients who qualify? Select all that apply.

Children's Health Insurance Program (CHIP) and Medicaid are insurance programs run by the government. The Supplemental Nutrition Assistance Program (SNAP) and Nutrition Program for Women, Infants, and Children (WIC) are government programs that assist low-income families in getting nutritious food.​ Medicare is available for adults age 65 or older who meet the qualifications and would not apply to a low-income family.

Which are ways that nurses can influence health policy? Select all that apply.

Conduct health policy research Serve on a health department advisory board Write letters to legislators about healthcare issues Vote for candidates who support needed healthy policy Conversations about controversial health policies are not helpful.​

For each assessment question, indicate if it is most related to economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, or social and community context. What is your living situation today?

Economic Stability

In the last 12 months, how often have you worried that your food would run out before you had time to buy more?

Economic Stability

Promoting hiring of a workforce that reflects the population being served

Economic Stability

Which are the categories of social determinants of health? Select all that apply.

Economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context are the five social determinants of health.​

(5/6) Review the case. What actions should the nurse take? Select all that apply.

Educate about symptoms of breast cancer that should be reported Educate on the benefits of healthy weight for hypertension and diabetes Develop a plan with the client to slowly increase physical activity Schedule a follow-up appointment to assess progress Refer the client to a dietitian for assistance in planning healthy eating

The nurse recognizes that there is a significant number of children in the state with special health needs. Which actions by the nurse reflect the essential public health services? Select all that apply.

Educating others about the lack of health services available for children with special health needs* relates to the following essential public health service: Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it.​ Developing partnerships to help identify solutions to increase access to support services* relates to the following essential public health services: Strengthen, support, and mobilize communities and partnerships to improve health.​ Developing policies and plans that support children with special health needs* relates to the following essential public health services: Create, champion, and implement policies, plans, and laws that impact health.​ Advising on a policy-making board to assure the needs of children with special health needs are met* relates to the following essential public health service: Utilize legal and regulatory actions designed to improve and protect public health. Evaluating the effects of implementing programs to support children with special health needs* relates to the following essential public health service: Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement.​

Developing a health literacy program for schools

Education Access and Quality

Do you want help with school or training?

Education Access and Quality

A public health nurse is reviewing the outcomes of an education class about diabetes. The class was held at three different locations, each near public transportation. Which aspect of quality does this finding most support?

Equity Offering the class at three different locations supports the aspect of equity because it was offered in multiple locations with public transportation available nearby. ​

(5/6) Review the client's responses to the nurse's assessment questions. Select whether each nursing action is essential or nonessential. Refer the family to the health department dental clinic. Refer the client to the health department social worker for transportation assistance. Refer the client to an adult class to learn English. Schedule an appointment for the immunization clinic. Enroll the client in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Essential Essential Nonessential Essential Essential The nurse should refer the family to the health department dental clinic, refer the client to the health department social worker for transportation assistance to healthcare appointments, schedule an appointment for the immunization clinic, and enroll the client in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC provides additional food to supplement diets and information on healthy eating for pregnant women, breastfeeding women, non-breastfeeding postpartum women, and infants and children up to age 5 who are at nutritional risk.​

The nurse is caring for a client with a low income who reports that they have missed work because they share a vehicle that is not always available. Which actions should the nurse take? Select all that apply.

Explore other transportation options Assess access to public transportation Provide a bus schedule Refer to social services for a bus pass

Public Healthcare Subsystem:

Federal programs State programs Local programs

The nurse is assessing a 70-year-old client's home using the Healthy Home Checklist. Indicate whether each assessment finding requires additional follow-up or if no follow-up is needed. Home built in 1970​ Hot water heater set at 125ºF Stairs have handrail on right side Smoke detectors located on each floor​ Decorative rugs placed throughout the home

Follow-up Needed Follow-up Needed Follow-up Needed No Followup is needed Follow-up Needed The assessment findings that need to be addressed are that the home was built before 1978 and may contain lead paint, the hot water heater is set higher than the recommended 120ºF, which increases the risk of burns, the stairs only have a handrail on one side rather than both sides, and there are decorative rugs throughout the home that may increase the risk for falls. Considering the age of the client, reducing the risk of falls should be a priority. It is recommended that there be smoke detectors located on each floor of a home.

Which components should the nurse consider when assessing environmental health? Select all that apply.

Food safety Work-related exposures Outdoor air quality Waste management Water quality Healthy homes *and Built Environment (not natural environ)*

Which aspects of social determinants of health are positively impacted by a person having a high-paying job with health insurance? Select all that apply.

Food security Ability to own a home Access to healthcare Choice of location of their home

Health promotion theories and models explain why people may or may not change their behavior. The ___________ suggests that a person's perceived threat of illness combined with their belief in the effectiveness of the recommended action predicts the likelihood of the person making the change. The _____________ focuses on the phases of decision-making. Knowing which stage of change a person is in may be helpful in determining the most effective intervention strategy.

Health Belief Model Transtheoretical Model

Match the health promotion activity with the related Healthy People goal.​ Healthy People Goal: Promote health and safety in community settings.

Health Promotion Activity: A public health department is implementing a community health improvement plan.

Healthy People Goal: Promote healthy and safe home environments.

Health Promotion Activity: An apartment building that prohibits smoking​.

Healthy People Goal: Strengthen the workforce by promoting health and well-being.

Health Promotion Activity: Ensure workers wear hearing protection in jobs where they are exposed to loud noise​.

Healthy People Goal: Improve health by promoting healthy eating and making nutritious foods available.

Health Promotion Activity: Legislation to increase funding to reduce food insecurity and hunger.

In the past 12 months, has lack of reliable transportation kept you from medical appointments?

Healthcare Access and Quality

Indicate whether each intervention performed by the public health nurse addresses economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, or social and community context: Educating community members about eligibility for and access to entitlement programs such as Medicaid

Healthcare Access and Quality

The nurse is caring for a client diagnosed with type 2 diabetes mellitus five years ago. The client has a family history of type 2 diabetes mellitus, is Hispanic, is overweight, had gestational diabetes 10 years ago, and developed high blood pressure last year. Which type 2 diabetes risk factors increased this client's risk? Select all that apply.

Hispanic Weight Family history History of gestational diabetes *Hypertension is a risk factor for type 2 diabetes mellitus. However, this client did not develop hypertension until after the diagnosis of type 2 diabetes. Exposure to a risk factor must occur before the disease to be a risk factor.​

Case Study: The nurse is caring for a client who reports a recent increase in asthma symptoms. The nurse completes an assessment for environmental exposures. The client reports having increased asthma symptoms after spraying for ants in the home. The client works as a grocery store clerk in a nearby town and lives in a farmhouse built in 1970 with water supplied from a well. A nearby farmer owns cows and also grows corn. The client reports a recent asthma attack after the farmer was burning agricultural waste. (1/6): Which are the top three assessment findings that are most concerning to the nurse?

Home was built in 1970 Water source is a well Report of asthma triggers The client living in a rural area and working as a grocery clerk are not priorities.​

(2/6): For each finding, indicate if it is related to the environmental health factor of air quality, healthy home, or water quality. Each finding may impact more than one environmental health factor. Findings: Use of a well Pesticide sprayed on crops Nearby cow farm Presence of ants Burning of agricultural waste Home built in 1970

Impacts Water Quality: Use of a well, pesticide being sprayed on crops (runoff into the water supply), a home built in the 1970s (lead pipes), and the cow farm (runoff into the water supply) may potentially impact water quality.​ Impacts Healthy Home: Use of a well, the presence of ants, and the home being built before 1978 impact having a healthy home.​ Impacts Air Quality: Pesticide sprayed on crops and the burning of agricultural waste impact air quality.​

(6/6) Review the case. The nurse sees the client one year later for her next breast cancer screening. Indicate whether each assessment finding is improved, unchanged, or declined. Weight is reduced by 10% Mammogram shows area indicative of breast cancer Client reports starting a walking group at church Client reports A1C is lowered Client reports no swelling, redness, or pain in her breasts Blood pressure is decreased

Improved Declined Improved Improved Unchanged Improved

(6/6) The nurse follows up with the family after 6 months. Indicate whether each assessment finding is improved, unchanged, or declined. The parent at home has secured a full-time job. Teenagers have engaged with adult mentors. There has been an increase in gun violence in the neighborhood. Teenagers attend school regularly. One parent is incarcerated.

Improved Improved Declined Improved Unchanged

(5/5): Review the case. The nurse is reviewing data one year later. Indicate whether each outcome is improved, unchanged, or declined. Select only one answer for each row. Homicide rate of teenagers decreased Rates of teenagers returning to juvenile detention decreased The state passed legislation regarding teenage violence Steady rate of high school graduates Death rate of teenagers increased

Improved Improved Improved Unchanged Declined Steady rates of high school graduates indicates no change. An increased rate of teenage death is declined. Since the homicide rate is decreased, other reasoning for the increased death rate should be investigated, such as overdose or suicide. ​

Case Study: (1/6) The nurse is caring for a single parent with three teenaged children. They live urban area with high crime and violence rates. Dad is incarcerated. Mom works multiple part-time jobs and frequently changes jobs. The teenagers been suspended from school several times. The family is currently enrolled in government assistance services to support housing, healthcare insurance, and food needs. What assessment findings indicate the family is at risk for poor health & well-being?

Income Incarcerated parent Employment status Exposure to violence School suspensions

Case Study: The public health nurse working at a local health department is providing care for a mother who speaks only Spanish. The woman has three children: a 4-year-old, a 2-year-old, and a newborn. The family is enrolled in Medicaid. The family income is below the poverty level. The family lives in a rural area with a supportive extended family nearby. The family does not have a vehicle. (1/6) Which findings are concerning to the nurse? Select all that apply.

Income Lives in a rural area Only speaks Spanish Lack of a vehicle Having extended family nearby is not a barrier and often enhances healthcare practices.

Title VIII Nursing Workforce Reauthorization Act supports which aspects of nursing workforce development? Select all that apply.

Increase the number of nurses trained to care for older adults Increase the number of associate and baccalaureate degree nurses Increase diversity of the nursing workforce Increase the number of nursing faculty The funding does not support increasing the number of nursing colleges. ​

Which objectives are examples of social determinants related to healthcare access and quality? Select all that apply.

Increase the proportion of people with dental insurance Increase the proportion of people with a usual primary care provider Increase employment in working-age people: Economic stability Increase the proportion of adults with broadband access to the internet: Neighborhood and built environment Increase the proportion of students who graduate with a regular diploma 4 years after starting 9th grade: Education access and quality

(4/6) Review the case. For each potential nursing intervention, indicate whether the intervention is indicated or contraindicated. Assess the perceived benefits of achieving a healthy weight. Assure client that breast cancer can be prevented if a healthy weight is achieved. Assess readiness for change. Assess additional modifiable risk factors for breast cancer such as alcohol intake. Assess perceived barriers to achieving a healthy weight.

Indicated Contraindicated Indicated Indicated Indicated

The nurse is educating a client with asthma about air quality. Indicate whether each recommendation is indicated or contraindicated. Check the air quality index to determine if you should exercise outside.​ Assign an air quality index level once per week. When the air quality index is over 200, avoid all outside physical activities. Use a rescue inhaler on a high pollution day. Exercise outside when the air quality is good.

Indicated Contraindicated Indicated Indicated Indicated The nurse should recommend the client check the air quality index to determine if they should exercise outside. The air quality index is updated daily for communities, not weekly, and indicates whether people, including those who are sensitive to air pollution, should enjoy regular activities or strenuous activities outside. Air pollution can cause airway inflammation, which may cause an increased need for the administration of rescue inhalers. All people should avoid outside activities when the index is over 200. An index of 0-50 is considered good and safe for all people to enjoy outdoor activities.

(4/5): Review the case. Indicated whether each action is indicated or contraindicated. Select only one answer for each row. Implement programs to connect youth with adult mentors. Provide support when teenagers are transitioning from the juvenile system into the community. Refer teenagers to support for job placement. Implement programs to promote completion of high school. Ensure schools expel students for rule infractions.

Indicated Indicated Indicated Indicated Contraindicateed

(4/6) For each potential nursing intervention, indicate whether the intervention is indicated or contraindicated. Refer teenagers to counseling resources to promote school success Screen for family violence Refer teenagers to resources for access to adult mentors Refer the parent to career counseling resources Refer teenagers to a temporary job agency

Indicated Indicated Indicated Indicated Not indicated The nurse should screen for family violence to ensure everyone's safety. The nurse should refer the teenagers to counseling resources to promote school success and to resources to access adult mentors to help them be successful in completing high school. The nurse should refer the parent to career counseling so the parent might be able to secure more steady employment. ​ The nurse should not refer the teenagers to a temporary job agency; however, it may be helpful to refer them to job training programs.​

A nurse is caring for a client who has adequate health insurance. Which assessment findings contribute to the client having inadequate health? Select all that apply.

Limited transportation Only seeing a physician for health problems Low health literacy Only seeing the dentist when in pain The nurse can intervene to promote preventative care and assist with eliminating barriers.​

Match the example to the correlating political activity. Examples: A nurse presents to legislature about the opioid epidemic and treating dependency. A group supporting financially and working to elect nurse champions to public office. A nurse sending out letters in support of electing someone to office. A nurse serving on a state board of health immunization advisory committee.

Lobbying -Lobbyists typically represent special-interest groups before legislature.​ Political Action Committee - Political action committees are groups that make contributions to candidate's election campaigns. The groups support candidates who they believe to be sympathetic to their interests.​ Campaigning- Nurses can align with candidates and support their campaigns through participating in campaign activities such as assisting with mailings or calling undecided voters near Election Day.​ Change Agent- Nurses can influence public health by contacting legislators, belonging to professional organizations, and serving on advisory boards. ​

A client with an increased risk of heart disease decides to stop smoking to reduce their risk. When the client is in which phase are they most likely successful at smoking cessation?

Maintenance Once the client has reached the maintenance phase, they are most likely to sustain smoking cessation because they have already stopped the behavior for more than 6 months. During the precontemplation, contemplation, and preparation phases, the client continues to smoke. During the action phase, the client has stopped smoking for less than 6 months and is more at risk for relapse than once in the maintenance phase. ​

The nurse needs to be aware of programs available to assist with financing healthcare needs. Indicate whether each client is eligible for Medicare, Medicaid, or the Children's Health Insurance Program. Each client may be eligible for more than one insurance program. A 75-year-old whose income is below the poverty line A child of a low-income family who does not qualify for Medicaid A pregnant woman whose income is below the poverty line A child from a family whose income is below the poverty line

Medicare and Medicaid Children's Health Insurance Program Medicaid Medicaid

Indicate whether each risk factor is modifiable or nonmodifiable.​ Smoking status Family history of disease Race Gender Diet Activity level Alcohol intake

Modifiable Nonmodifiable Nonmodifiable Nonmodifiable Modifiable Modifiable Modifiable

(6/6): The nurse evaluates the client six months after the initial visit. Indicate whether each finding is improved or if additional follow-up is needed. Infant weight gain is below average 4-year-old had two cavities filled All children are up-to-date with immunizations Client has attended all appointments with the health department Client participated in breastfeeding counseling

Needs Additional F/U Improved Improved Improved Improved

Collaborating with a church group to develop a resource list for transportation assistance

Neighborhood and Built Environment

(2/6) Review the case. For each finding, indicate if the finding is a modifiable or nonmodifiable risk factor for breast cancer. Female 55 years old Family history of breast cancer Diet Sedentary lifestyle

Nonmodifiable Nonmodifiable Nonmodifiable Modifiable Modifiable

The nurse at a health department receives a call that a family has become ill with diarrhea and vomiting after swimming in a local lake. What actions should the nurse take? Select all that apply.

Notify the state health department Recommend supportive care for vomiting and diarrhea It is not within the role of the public health nurse to close the beach. Protocols for testing water for contamination at beaches are determined by the state health departments and are unlikely to be done daily.

Healthy People Objective: Reduce the number of days people are exposed to unhealthy air

Nursing Intervention: Educate clients about the Air Quality Index

Healthy People Objective: Reduce diseases and deaths related to heat

Nursing Intervention: Educate parents to place a child's item, such as a diaper bag, in the front passenger seat when driving with children in a vehicle to prevent forgotten baby syndrome

Healthy People Objective: Increase trips to work made by mass transit

Nursing Intervention: Provide clients with bus route information

Healthy People Objective: Reduce exposure to lead

Nursing Intervention: Refer clients for home assessment if built before 1978

The public health nurse provides clients with environmental health education and referrals. Match the nursing intervention with the Healthy People objective the intervention supports. Healthy People Objective: Increase the proportion of people whose water supply meets safe drinking water act regulations

Nursing Intervention: Refer clients with wells to resources for maintenance and testing

(3/5) Review the case. Which actions should the nurse take when planning interventions to address the problem? Select all that apply.

Plan potential educational programs with local schools. Identify strategies to prevent violence with community leaders. Collaborate with community leaders to identify available resources. Collaborate with juvenile detention centers to develop early intervention programs. Develop a formal public health response plan of action. Holding a public forum to educate people about the problems and plans to address the violence may be included in the formal plan. The public forum would be held during the implementation phase.​

What are barriers to health policy development and implementation? Select all that apply.

Political barriers to getting a public health issue on the health board agenda Lack of dedicated funding for public health programs Public's lack of understanding about a policy issue Policies should be developed based on research and those that promote equitable distribution of services.​Nurses can influence health policy development and implementation through education, advocating for health needs of the public, assisting with planning, and leading implementation.​

The nurse is working with a group of clients to increase their physical activity levels. The group has developed a plan to meet three times a week at a local walking trail. The clients are in which phase of making a change?

Preparation The clients are in the preparation phase because they have not yet begun to take action. In the precontemplation phase, the clients would not have a plan for making changes. During the contemplation phase, the clients would be weighing the pros and cons of increasing their physical activity levels. Motivation is not a part of the transtheoretical model.​

Indicate whether each client is eligible for primary, secondary, or tertiary prevention services through their insurance program. Each client may be eligible for more than one level of prevention services.​ A 16-year-old who is enrolled in Children's Health Insurance Program (CHIP) A 70-year-old who is enrolled in Medicare Parts A, B, C, and D A 15-year-old who is enrolled in Medicaid

Primary, Secondary, AND Tertiary Prevention Services FOR ALL CLIENTS Medicaid, Medicare (Parts A, B, C, D), and Children's Health Insurance Program (CHIP) provide all levels of prevention services. ​

Indicate whether each healthcare service provided is considered a private healthcare or public healthcare subsystem. Services: Healthcare provided by St. Jude for a child with cancer Healthcare provided at a Veteran's Affairs outpatient clinic Healthcare provided at a correctional facility Healthcare provided in a cardiology office

Private Public Public Private Private healthcare services are provided through individual practices, specialty groups, an integrated health maintenance model, community health centers, or voluntary agencies. Healthcare provided by St. Jude or in a cardiology office is considered private healthcare.​ Local, state, and federal government laws and regulations direct the establishment, implementation, and evaluation of public health programs and various health services. Healthcare provided at a correctional facility is managed through a local health department program. Healthcare provided at a Veteran's Affairs facility is managed through a federal program. ​

Place the policy process steps in order from first to last.

Problem identification Policy analysis Strategy and policy development Policy enactment Policy implementation During problem identification, the problem is clarified in terms of the effect on public health and framed in a way that lends itself to policy solutions. ​ During policy analysis, different policy options are identified and researched to determine the most effective, efficient, and feasible options. ​ During strategy and policy development, the strategies for implementation and engaging stakeholders are identified. ​ During policy enactment, procedures are followed to get the policy enacted or passed. ​ During policy implementation, the policy is executed and monitored.​

A health care facility experienced an increase in medication errors involving clients after transfer of care. Place the actions in the order they should be performed.

Problem identification: 1- The workgroup identified there was no standard process for medication reconciliation. Policy analysis: 2- An evidence-based medication reconciliation toolkit was identified by the workgroup.​ Strategy and policy development: 3- A medication reconciliation policy was drafted with input from unit councils and information technology regarding integration with the electronic health record. ​ Policy enactment: 4- The medication reconciliation policy was approved through shared governance.​ Policy implementation: 5- Nursing staff utilized the medication reconciliation process during transitions of care and charts were monitored for compliance.​

(4/6): The nurse plans interventions to address the environmental risk factors. For each potential nursing intervention, indicate whether it is recommended or not recommended. Educate about how to check the air quality index prior to exercising outside. Educate about preventing ants without pesticides by making sure food is always cleaned up and trash is covered. Recommend that the client request an increase in asthma medication dosages. Recommend that the well be assessed for proper maintenance and testing of well water. Recommend that the home be checked for sources of lead (paint, pipes, etc.).

Recommended Recommended Not Recommended Recommended Recommended The nurse should not recommend the client requesting an increase in asthma medication dosages. Instead, the nurse should first educate the client about how to avoid triggers.

Collaborating with community partners to develop parenting programs.

Social and Community Context

How often do you feel lonely or isolated from those around you?

Social and Community Context

(2/6) Indicate whether each assessment finding is related to economic stability, education access and quality, neighborhood and built environment, or social and community context. Incarcerated parent Exposure to violence Income Employment status School suspensions

Social and Community Context Neighborhood and Built Environment Economic Stability Economic Stability Education Access and Quality

Indicate whether each service related to public healthcare is delivered by the local, state, or federal subsystem.​ Services: Manage licensing of nurses Collaborate with the World Health Organization Follow up on reports of communicable disease outbreaks Manage healthcare services for veterans Inspect restaurants for food safety

State Federal Local Federal Local Federal-level programs manage healthcare services for veterans and collaborate with worldwide health organizations, such as the World Health Organization.​ State-level programs manage the licensing of nurses.​ Local health departments manage inspections of restaurants for food safety and follow up on reports of communicable disease outbreaks.

The public health nurse received several phone calls from clients experiencing sudden symptoms of abdominal pain, diarrhea, and fever after eating at a local restaurant. Which actions by the restaurant cooking staff could have contributed to the illnesses? Select all that apply.

Storing raw meat with raw vegetables Using the same knife to cut raw meat and cheese Thawing meat at room temperature Raw meat should be stored separately from other foods. Knives and cutting boards should be sanitized after use with raw meat. Meat should be thawed in the refrigerator, in cold water, or in the microwave and then cooked immediately.​

Which actions by the public health nurse are considered advocacy on behalf of families living in poverty? Select all that apply.

Supporting local anti-poverty groups Collaborating with local agencies to promote resources available to those in poverty Initiating public discussion of the impact of poverty on health Building a solid evidence-base of data related to poverty to support the need for change Presenting the issue of family poverty at professional organization meetings All are considered acts of advocacy on behalf of families living in poverty. These are examples of collaboration, using knowledge of the issues to inform others, communication, and building relationships. ​

The nurse is caring for a client whose mother has type 2 diabetes. Which recommendations should the nurse make? Select all that apply.

Take the stairs instead of the elevator Schedule walking dates with friends Keep fresh fruits and vegetables available Review nutritional information when dining out Use a fitness tracker to track steps

The public health nurse is evaluating nutrition services provided by a local health department. Which components should the nurse examine to evaluate the quality of the care services? Select all that apply.

Timeliness Effectiveness Equity Client-centered Efficiency Safety Effectiveness: providing services to those who will benefit​ Timeliness: reducing waits and harmful delays in providing and receiving care​ Client‑centered: ensuring client values guide decision‑making​ Equity: providing equal care without discriminating against gender, race, sexual orientation, or socioeconomic status​ Safety: avoiding injuries to clients from the care intended to help them​ Efficiency: avoiding waste in supplies, ideas, or energy​

(3/6) ​The client/family is at risk of which complications? Select all that apply.

Unnecessary illness Discrimination Lack of understanding of healthcare instructions Poor nutrition The low socioeconomic status, language barriers, geographic isolation, and lack of personal transportation place the client/family at risk for poor nutrition, unnecessary illness, discrimination, and lack of understanding of healthcare instructions.​ The client indicated having a supportive family nearby.​

(1/6) Which are the top 3 assessment findings the nurse is concerned about? Select all that apply.

Weight Never having a mammogram before Family history of breast cancer Mammogram screening generally begins at the age of 50.​ The breast assessment and employment status are not concerning.

Which questions should the nurse ask a client when assessing economic stability? Select all that apply.

When assessing economic stability, the nurse asks questions related to the key issues of poverty, employment, food security, and stable housing, such as: ​ "In the last 12 months, has your electric, gas, oil, or water company threatened to shut off services?" "Are you able to eat three healthy meals a day?" "How often do you feel you do not have enough money to pay your bills?" "Are you worried that in the next two months you may not have stable housing?" The question "How often does anyone threaten to harm you?" is related to the neighborhood and built environment.​

A public health nurse assessed the following factors. Which factors place the family at risk of exposure to environmental hazards? Select all that apply.

Working in a low paying manufacturing job Food supply supplemented by food bank Living near a plastic and rubber manufacturer Living in an old, overcrowded apartment building

(3/6): ​The client is at risk of which top three complications?

Worsening of asthma symptoms Lead poisoning Contamination of Water The client is most at risk for lead poisoning from the lead pipes, water contamination from farm runoff, and worsening of asthma symptoms from pesticide use and burning of agricultural waste.​

(3/6) ​Review the case. The nurse should address the client's ___________ and _____________.

access to health care diet

(2/6) The client is at risk for inadequate ____________________ due to ______________ , __________________ , and ________________________.

access to healthcare language barriers lack of transportation potential attitudes of healthcare personnel The client reports having adequate health insurance through Medicaid and a supportive family. There is no indication of lack of healthcare providers, inconvenient hours, or social isolation.​

The nurse is caring for a client who smokes and recognizes their risk of cancer related to continuing smoking. The likelihood that the client will quit smoking is based on the client perceiving that the ____________ outweigh the __________. The nurse should focus on _______________.

benefits barriers strategies to promote successful smoking cessation

Case Study: The public health nurse is reviewing data regarding a city in the county the nurse is assigned. The average annual income is $70,000. The community has a significant number of families living in poverty. The nurse notes a significant increase in the death rate among teenagers and a slightly increased death rate of older adults. Vital statistics revealed the leading cause of death was homicide. The teenage pregnancy rates are steady. The high school graduation rates are steady. The rates of reports to Child Protective Services for neglect and abuse are increasing. The incidence of alcohol and drug use among minors has steadily increased. (1/6): Youth who experience ___________ are at risk for ___________ .

both witness and experience violence committing violent acts Youth who are exposed to violence, child abuse, and neglect are more at risk for engaging in violence. Substance use, low levels of school attendance, involvement with delinquent peers, and lack of appropriate supervision also increase the risk of violent behavior. ​

Indicate whether each agency or program is part of the private or public healthcare subsystem. Private Healthcare Subsystem:

consists of: Non-profit agencies Profit agencies Voluntary agencies

(2/5): ​The nurse is most concerned about the death rates of _______________ followed by the ________________.

death rates of teenagers leading cause of death being homicide Interventions to prevent violence and homicide will reduce the death rate of teenagers.​ Increased rates of teenage death by homicide are more severe than teen pregnancy, alcohol and drug use, poverty, and the death rate of the elderly. ​

(5/6) When referring the family to resources, the nurse should first ensure that the family has ______________ and ________________.

food security housing security Although the family is enrolled in government assistance programs, the nurse should still follow Maslow's hierarchy and ensure the family has access to basic needs such as food and housing.

A nurse supporting legislation to provide health care through Medicaid to undocumented children promotes _________________ . A nurse supporting legislation to allow advanced practice nurses to practice at the full extent of their licensure promotes _______________ .

health equality healthcare access

The Affordable Care Act, also known as the Health Care Reform Act, made significant changes to _______________ and helped shift the focus of health care from __________________ to ____________________ .

healthcare insurance treatment of illness health promotion and wellness

(3/6) The priority nursing diagnosis for the family is _________________ related to inadequate resources and situational crisis, as evidenced by the incarcerated parent​, exposure to violence​, income​, and employment status.

ineffective coping

Health __________ is enabling people to increase their control over and improve their health. Health __________ is when everyone has an opportunity to achieve their full health potential. Health ___________ is a difference in health that is related to a social, economic, and/or environmental disadvantage.

promotion equity disparity

People should avoid outdoor activities when the air quality index is high because it indicates less healthy air quality and can cause negative health effects. Poor outdoor air quality negatively impacts the __________________ system and can cause ________________.

respiratory airway inflammation

Review the case below. Click to select the findings that are concerning to the nurse. The public health nurse is reviewing data regarding a city in the county the nurse is assigned. The average annual income is $70,000. The community has a significant number of families living in poverty. The nurse notes a significant increase in the death rate among teenagers and a slightly increased death rate of older adults. Vital statistics revealed the leading cause of death was homicide. The teenage pregnancy rates are steady. The high school graduation rates are steady. The rates of reports to Child Protective Services for neglect and abuse are increasing. The incidence of alcohol and drug use among minors has steadily increased.

the number of families living in poverty the significant increase in the death rate among teenagers with a leading cause of death being homicide the increased reports of neglect and abuse the increased incidence of alcohol and drug use ​ The nurse is not concerned about the annual income or the steady teenage pregnancy rates.

Highlight the information that indicates barriers to the client accessing healthcare.​ A public health nurse is caring for a 65-year-old client with cancer. The client is from an Amish community that uses a health trust to pay for healthcare and does not obtain health insurance. The Amish leaders decided that the cost of the care needed for this client would be too much of a burden on the community. The client lives in a rural area and is without transportation. The community owns a shared cellular phone.

​Belonging to an Amish community*- which may present a cultural barrier​. Not having health insurance*-because the community uses a health trust instead​. The cost of the care is a burden to the community*- indicating the client cannot pay for healthcare services. Living in a rural area*- is geographically isolated. Not having transportation*- no access to healthcare facilities​. A shared community cellular phone*- makes it very difficult for the client to make appointments for healthcare and/or services; therefore this a barrier to healthcare access. The client's age and diagnosis are not barriers to accessing healthcare services.​

The nurse is caring for a client in a primary care facility. Which assessment findings reported by the client are related to social determinants of health? Select all that apply.

​occasionally running out of food difficulty making rent payments a great amount of smog in their community discrimination in the workplace The client reporting not taking prescribed hypertension medication is an individual risk factor.