Exam 2 Comm health

What term is used to refer to the basic science applied to understanding the health effects associated with chemical exposures? a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology

A Toxicology Toxicology is the study of the health effects associated with chemical exposures. Pharmacology is the branch of medicine concerned with the multiple aspects of drugs. Chemistry is the branch of science with deals with the way that matter is composed. Environmental epidemiology is concerned with the discovery of environmental exposures that cause or protect against illness or disease.

Which of the following is generally considered to be nursing's first code of ethics? Nightingale Pledge Code for Professional Nurses Code of Ethics for Nurses Principles of the Ethical Practice of Public Health

A - Nightingale Pledge The Nightingale Pledge is generally considered to be nursing's first code of ethics. After the Nightingale Pledge, the Code for Professional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times, until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements.The Principles of the Ethical Practice of Public Health was approved in 2002.

The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care would drastically reduce the family's resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. c. Talk to the media to see whether a campaign to raise funds for the family can be created. Td. ry to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious.

A - appreciate that the family has made the decision that it feels is best and take no further action if it clear the family has made an informed choice According to Callahan, although the nurse may attempt moral persuasion to change the family's values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family's values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family's decision. Thus, the other answers are not an appropriate action for the nurse to take.

A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first "P"? a. Present work b. Potential exposures c. Personal protective equipment use d. Past work

A - present work Present work is the first "P." Potential exposures are part of the "I"—investigate potential exposures. Personal protective equipment use is not part of the mnemonic. Past work is the second "P.

From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should always be fair, and that everyone should make his or her own decisions? a. With this belief, the needs of society as a whole are ignored. b. Insufficient resources exist to give everyone a fair share. c. This belief leads to a propensity for some people to like to be taken care of. d. Some people think they deserve more than others.

A - with this belief, the needs of society as a whole are ignored All principles of justice focus on the individual, which ignores the needs of society as a whole. The rights of an individual may conflict with the rights of the community as a whole. It is recognized that distribution should be based on what needs and deserves there is considerable disagreement that exists when considering what these terms mean in the context of fairness.

A nurse would identify which as a point source of air pollution? a. A smoke stack b. The number of cars and trucks c. The amount of fossil fuel consumed in a community d. Ground ozone levels

A. A smoke stack Point sources of pollution are identifiable sources of air pollution, such as a smoke stack. Nonpoint sources come from more diffuse exposures, such as from cars and trucks. The amount of fossil fuel that is consumed and ground ozone levels do not identify sources of air pollution

A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? a. Evil eye b. Fallen fontanel c. Fright d. Indigestion

ANS: A A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye. Caida de mollera is known as fallen fontanel, empacho is known as indigestion, and susto is known as fright.

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

ANS: A Accessibility refers to the ability of clients to obtain needed health care services. Only applying for a grant for a mobile clinic can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places. All of these options lead to opportunities for improvement in health, either directly or indirectly, but distributing flyers, refering homeless clients, and soliciting donations does not address the issue of accessibility.

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

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

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

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

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

ANS: A Chronic exposure to pesticides and chemicals may lead to cancer. Memory loss, skin rashes, and headaches are all potential side effects of short term exposure to pesticides and chemicals.

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.

In addition to those barriers faced by many residents in rural areas, what additional barrier to healthcare is a Hispanic migrant farm worker likely to encounter? a.Absence of culturally competent care b.Availability of specialists c.Distance of health care facilities from the place of residence d.High cost of health care

ANS: A For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers. This is an additional barrier that is not faced by other rural residents. Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers, not just migrant workers.

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

ANS: A It is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy. All of these statements are true; however, it is crucial to consider all pregnant teenagers as high-risk obstetric clients. Limited self care, lack of prenatal care, and limited financial resources are all contributors to the potential for all teen pregancies to be considered high risk.

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

ANS: A It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups. If the family is referred to a different provider or agency, it is likely that this follow up will never occur. Only addressing the urinary infection, and not the homeless status of this family, does not provide the comprehensive services that are expected from a public health clinic.

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

ANS: A Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved. Client advocacy refers to actions taken on behalf of another. Because of the variety of actions being taken by the nurse, the nurse is functioning in a larger role than simply advocating for the client. Holistic care addresses providing care for phyicial as well as emotional and spirtiual needs. The nurse is not addressing all of these aspects of care through this coordination. Wrap-around services refers to when comprehensive health services are available and social and economic services are "wrapped around" these services. These services are not being necessarily all being provided by the same clinic.

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

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

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. The nurse is moody and feels family demands are not really as important as the other members of her family think they are. d. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities.

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.

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

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

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

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

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

ANS: A The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). Most urban adults are more likely to seek care from a medical specialist (allergist or pulmonologist). A pediatrician would provide care specific to children which may or may not be appropriate depending on the age of the resident.

A public health nurse (PHN) working with a family living in poverty is concerned about their exposure to environmental hazards. Which of the following factors should the nurse identify as possibly putting the family at risk? (Select all that apply.) a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education e. Unsafe working conditions

ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Substandard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

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

ANS: A, B, C The boundaries between home and work blur because clients are also neighbors and friends of immediate family members. Nurses are highly regarded by the community and viewed as experts on health and illness. Residents may ask health-related questions and request recommendations whenever they see the nurse. Nurses in rural areas may also be expected to, in general, know something about everything, and this can be a demanding expectation. Some of the challenges are professional isolation, limited opportunities for continuing education, lack of other health personnel or professionals with whom the nurse can interact, heavy workloads, the need to function well in several clinical areas, lack of anonymity, and for some, a restricted social life. Rural people often develop independent and creative ways to cope because of the distance, isolation, and sparse resources they encounter. Because of the sparse resources, rural residents may seek limited preventive care and may only come to the health clinic if their situation is severe.

Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nurse believes that deciding on care rather than cure is the woman's decision and no one else can decide for her. The second nurse says that it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility of cure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn't fair for the family members to expend all their resources on the woman, who is probably going to die anyway. Which of the following conclusions can be drawn from this dispute? (Select all that apply.) a. Ethical principles can conflict with one another. b. The nurses are each using different ethical approaches. c. The first nurse is correct because autonomy demands that the woman decide for herself. d. There is no single accepted approach for resolving such disagreements.

ANS: A, B, D One of the criticisms of using ethical principles is that they can conflict with one another in any given situation. No rule exists for helping resolve such conflicts. Each nurse can apply different ethical principles to reach their own ethical decision. Because there is no one rule to assist with solving an ethical conflict, and ultimately no one right answer, there is not a correct decision that can be made.

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

ANS: A, C The nurse should focus on what data are needed to help the client that day with the problem the client believes is most important. It is important to keep the client's cultural traditions in mind when completing an assessment so that the nurse is able to provide culturally competent care. Because poverty is a primary cause of vulnerability, the nurse should include questions about the client's financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used.

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

ANS: A, C, D Nurses working in rural areas usually have a prestigious status in the community and are viewed as role models. They will be experiencing a different lifestyle in the rural area and should be sensitive to these differences. Also, moving into a community does require the community to be accepting of the outsider which may or may not occur quickly. Nurses working in rural areas typically hae more autonomy because of the larger geographic area that is being served.

Which of the following is the leading cause of disability for Americans 15 to 44 years of age? Accidents Arthritis Major depression Workplace injuries

ANS: C Major depressive depression is the leading cause of disability for Americans between the ages of 15 and 44 years. Accidents, arthritis, and workplace injuries are not the leading causes of disability for Americans between the ages of 15 and 44 years.

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

ANS: A, D About 25% of all US residents live in rural settings. Rural residents are less likely to engage in preventive behavior and they tend to be poorer than their urban counterparts (more than 25% of rural Americans live in or near poverty, and nearly 40% of all rural children are impoverished). Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations.

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

ANS: B A direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth. Teaching about body changes an proper care of babies and parenting would address short-term health outcomes. Monitoring teens to detect early problems in pregnancy addresses a short-term health outcomes as well.

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.

Which of the following populations experiences the highest incidence of poverty? Those between the ages of 18 and 64 Those under the age of 18 Those over the age of 65 Those between the ages of 18 and 25

ANS: B n 2014, the poverty rate for children under 18 was 21.2%, which was higher than all other age groups. In 2014, the poverty rate for people between the ages 18 and 63 was 13.5 percent, and for people over 65 years, the rate was 10 percent. The textbook does not list a specific percent for those between the ages of 18 and 25.

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.

Which of the following is the most rapidly growing group of homeless? Adolescents Families with children Persons in crisis Single men

ANS: B Families with children are the fastest-growing segment of the homeless population with the highest rates being found in rural areas. Adolescents, persons and crisis, and single men are not the fastest-growing segments of the homeless population.

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

ANS: B Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits. If the wound is not kept clean, it is unlikely that antibiotics will be able to prevent an infection, and the antibiotics will not promote wound healing. Handing out bandaging supplies does not address being able to wash the wound on a regular basis. Monitoring of the wound will not assist in wound healing.

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

ANS: B Men over age 85 are in the highest risk category for suicide. Adolescents under age 20, females 25 to 45 years of ageN, aUnRdSwIomNeGnToBve.r CagOeM65 are all not part of the highest risk category for suicide.

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

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

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

ANS: B People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability. Breakdown of family structures, prejudice, and social isolation may all influence vulnerability to health problems, but have not been identified as a primary cause

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

ANS: B Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Homeless children may have delayed communication, more mental health problems, and histories of abuse. Because the student is attending school, the student should be eligible for free lunches and should be provided adequate food. There is nothing that suggests that this child is unable to see and poverty is not indicative of vision problems. It is possible that this chld is being mistreated, and this may be something to speak with the teacher about; however, developmental delays would be of greater concern to the nurse than mistreatment.

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

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

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

ANS: B Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease. Primary prevention refers to actions taken to prevent the disease from occurring. Tertiary prevention refers to actions taken after the disease has already occurred. A screening test can not be both secondary and tertiary prevention.

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

ANS: B Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care. Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. A bill requiring all persons to pay the same cost for services regardless of income is not feasible. Multiple factors, including the benefits provided by individual health insurance, influence the amount of money individuals pay to receive health care services. A bill for universal health insurance could potentially influence this inequality. Health care providers are obligated to provide care to individuals in an emergency regardless of citizenship in the United States; thus, this bill would not be feasible given current standards. These options would also not support the philosophy of social justice.

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 psychological stress and recommend that he take some time off for a break. c. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time. d. Suspect dehydration and encourage the worker to drink more fluids.

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.

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

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

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

ANS: B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills. Thus, it is most likely that he was unable to meet his basic needs through his current employer. If he had already eaten his meal, it would be unusual to get additional food out of garbarge, rather he should be able to afford to purchase additional food if he was able to purchase his meal. The young adult would most likely not be pulling out half-eaten food if he was looking specifically for a friend's meal. There is no reason to assume that he was part of a fraternity.

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".

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

ANS: B The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual's dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior. When interacting with Mexicann immigrants, as well as some other cultures, establishing general rapport through conversation is expected rather than a direct, focused approach. It would be appropriate for a nurse to develop a therapeutic relationship with the client, not a non-confrontational one.

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 their actions and how they felt during the drill

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 unlikley 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.

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

ANS: B The primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse. Although the nurse might assess for any and all of these options, however, the primary goal of a postpartum visit would be to assess knowledge regarding normal growth and development. A teenager mother's knowledge about her own growth and development and how much assistance she is receiving from her own mother and the baby's father would be secondary concerns.

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.

A nurse is assessing for environmental health risks in the community. Which of the following approaches would be most appropriate for the nurse to use? (Select all that apply.) a. Asking legislators to provide a list of environmental pollutants in the area b. Developing a list of exposures associated with urban, rural, or suburban settings c. Assessing the risk by medium such as air, water, soil, or food d. Dividing the environment into functional locations: home, school, workplace, and community e. Recruiting community members to sign a petition to decrease pollution

ANS: B, C, D Developing a list of exposures associated with urban, rural, or suburban settings, assessing the risk by medium such as air, water, soil, or food, and dividing the environment into functional locations: home, school, workplace, and community are ways a nurse can assess the environment. Asking legislators for a list of pollutants or recruiting community members to sign a petition are not effective means to assess for environmental health risks.

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

ANS: B, D Suggestions for promoting interaction between an adult and a baby include smiling and making eye contact. Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). The mother should be taught to use a distance of 8 to 10 inches from the infant and should not blow on the infant's face. The mother should soothe the baby and try to provide comfort before trying to let the infant "cry it out."

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: BTriage 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, seriously hurt 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 best describes a health professional shortage area (HPSA)? a. An area with inadequate health care facilities for residents b.An isolated area of underserved populations within an urban region c.A region with insufficient numbers of health care providers d.A rural region of the United States with a population density of less than 10,000

ANS: C An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties. The incorrect responses do not fit the definition of a HPSA.

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

ANS: C Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence. It is important for the staff member to obtain an interpreter after learning that a client does not speak English, so this statement does not indicate the need for addtioanl education. Addressing multiple concerns within one visit is also appropriate, and does not indicate the need for additional staff education. Also, it is important for the staff member to recognize the importance of working around work schedules; thus, this action is appropriate and does not indicate the need for additional staff education.

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

ANS: C Because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild psychological and behavioral deficits such as memory loss, difficulty with concentration, and mood changes, abdominal pain, nausea, vomiting, diarrhea, headache, malaise, skin rashes, and eye irritation. The work setting of a migrant farmer would lead the nurse to first consider pesticide poisoining as a potential underlying cause of these symptoms. However, some of these symptoms could potentially be present with appendicitis, bacterial gastroenteritis, or a viral illness.

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

ANS: C Children 12 to 13 years of age can work on a farm with the parents' consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family's economic survival. This child may be at risk for this occurring again because the family needs the income that is generated by the child's employment. The child is most likely working and not going outside to play. In order for this child to work, the parents also were working on the same farm with them, but again need this child's income for survival.

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

ANS: C Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act. Distributing literature is an ineffective intervention as community members would need to read the literature that has been provided. Based on the growth and development of youth, they are unlikely to be able to truly understand the larger scope of youth violence. Recommending increased funding for prosecution and jail does not provide any measure to prevent the problem from occurring.

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

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

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 eventually 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.

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

ANS: C Poverty also increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. These children may also be hungry and fatigued and experience dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children may have delayed communication, more mental health problems, and histories of abuse. The priority of the nurse should be to address the potential absenteeism. Being clumsy is not related to living in poverty. Receiving screenings, such as a vision screening, is many times not a priority for those living in poverty. However, this would not be the key concern of the nurse. It is possible that this child could be bullied; however, there are also children who do not live in poverty who experience bullying as well.

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

ANS: C Pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus, being homeless is the most dangerous sign of those listed. Elevated blood pressure, positive STD test, and seeking prenatal care late in the pregnancy are all concerns for the nurse. However, most concerning would be homelessness, as homelessness presents many challenges for the women during and after the pregnancy.

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

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

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

ANS: C Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB. Administration of skin tests, assessing for signs and symptoms, and interpreting tuberculosis skin test findings are all examples of secondary prevention as these interventions are all focused on screening or the follow up on a screening test.

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.

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

ANS: C The Office of Migrant Health of the U.S. Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode." The emphasis in the definition of migrant farmworkers is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

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

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

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 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.

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 for the victims.

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

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

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

ANS: D Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore, health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics. It is likely that most homeless people do not seek preventive care, thus, it is not that they require increased services, but they are less likely to seek these preventive services. Homeless clients are likely to not be seen in the clinic setting. Homeless people may spread contagious diseases, but this does not explain why providing health care to this population is expensive.

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

ANS: D Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. In order to respond therapeutically to the mother, the nurse should not use the words absolutely (which implies that there may not be a problem with the son at all) or crazy (which is not a positive word to describe the son's behavior).

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

ANS: D Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain. Most migrant farmworkers are legal residents or U.S. citizens, not illegal immigrants. If the clinic personnel provide culturally competent care, they should not be biased or look down on this family when providing care. They should not be at any greater risk to have their belongings be stolen than on any other day when they leave their home.

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

ANS: D Tertiary prevention involves actions taken when a person already has a condition so that complications and worsening of the condition are avoided. Thus, treating a client with exposure is tertiary prevention. Observing farmers for evidence of unsafe handling of pesticides is an example of secondary prevention as the nurse is assessing to detect a problem at the earliest stage possible. Primary prevention occurs when the nurse aims to prevent the problem form occurring which is accomplished when the nurse teaches about safe handling of pesticides and recognition of signs and symptoms of pesticide poisoning.

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

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

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

ANS: D Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations and do not appropriately fit the definition of "aggregates". Resilience refers to the ability to resist poor health outcomes, not to succumb to them.

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

ANS: DMany agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care). Because of the major costs associated with providing care to this population and risks related to reimbursement, it would not be in the best interest of the agency to want to eagerly apply to provide care to this group.

According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a. $16,020 b. $24,300 c. $32,580 d. $40,890

B According to the Federal Register in January 2016, for a family of four, the poverty level— defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $24,300. According to theFederal Register in January 2016, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $16,020 for a family of two, $32,580 for a family of 6, and $40,890 for a family of 8.

Why is it important for a nurse to have knowledge of environmental health and the effects of chemical, biological, and radiological materials? a. They are a major cause of global warming. b. They are often found in the air, water, and products we use. c. They are frequently linked to the development of chronic illnesses. d. They are products that nurses work with daily

B They are often found in the air, water, and products we use Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use. These are not a major cause of global warming. They are not frequently linked to the development of chronic illnesses. These are not products that nurses work with daily.

When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Identifying areas with an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community

B identifying areas with an increased incidence of lead poisoning The use of a GIS allows the PHN to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness. An electronic health record (EHR) would be the most appropriate place to record client data from a foot clinic. Evaluation of effectiveness of a farm safety program would need to be done through some type of assessment or evaluation method—GIS would not be useful to collect this data. GIS is not a scheduling system and would not be helpful when scheduling health promotion programs in the community

When researching pesticides, the nurse looks at the "family" of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity

B Actions and associated risks Chemicals are grouped so it's possible to understand the actions and risks associated with each group. Although some common health risks exist within these families of chemicals, the possible health risks for each chemical should be evaluated individually when a potential human exposure exists

A new nurse states to a nursing colleague, "But why do I have to be involved in politics? I just want to be the very best clinical nurse I can." Which of the following would be the best response from the nursing colleague? a. "As long as you pay your membership fee to the American Nurses Association, you have participated in the profession's political endeavors." b. "Political action is the way you try to fulfill your ethical responsibilities to clients." c. "You're absolutely right; if you are good clinically, you have fulfilled your obligation." d. "When you've completed your clinical orientation, then you'll have time to be involved in politics."

B - "Political action is the way you try to fulfill your ethical responsibilities to clients." To be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action to ensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked access to quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as the mechanism to effect social justice and reform regarding homelessness, violence, and stigmatization. Nurses need to be involved in the political process in more ways than only being a dues paying member to the American Nurses Association. Clinical practice is not the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse. Nurses must make a conscious effort to be involved in political action.

A nurse wants to find more information about indoor air quality. Which of the following websites would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. "Right to Know" NURSINGTB.COM d. The Occupational Safety and Health Administration (OSHA)

B - American Lung Association Indoor air quality is a growing public health concern in office buildings, schools, and homes and is reflected in the alarming rise in asthma incidence in the United States, particularly among children. Sources of information about indoor air quality include the EPA and the American Lung Association. The NIH is part of the U.S. Department of Health and Human Services (USDHHS) and is responsible for health and biomedical research. "Right to Know" is part of a workplace safety legislation. OSHA regulates safety in factories and businesses

What is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water

B - Animal waste from wildlife Nonpoint sources come from more diffuse exposures to pollution. Animal waste is the only diffuse exposure given. The others are considered point sources; point sources are individual, identifiable sources such as smoke stacks.

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

B,C Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis, as well as exposure to high levels of lead. Cholera and malaria are not illnesses associated with the migrant farmer population.

A nurse fulfills the environmental health competency of "assessment and referral." Which of the following actions has the nurse most likely completed? a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

C Completing an environmental health history Assessment and referral states that all nurses should be able to successfully complete an environmental health history, recognize the potential environmental hazards and sentinel illnesses, and make appropriate referrals for conditions with probable environmental causes. Advocating for public policy changes is part of advocacy. Understanding policy framework and legislation is part of legislation and regulation. Describing the scientific principles of environmental health is part of basic knowledge and concepts

Which example contains the components necessary to form an epidemiologic triangle? a.Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature

C Trichloroethylene, water, infants The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil, etc.). The other examples do not contain an agent, host, and environment

A nurse working at the individual level to reduce pollution in the environment would most likely be involved in what activity? a. Providing a tax incentive to factories that do not pollute b. Making laws related to allowed levels of pollution in the area c. Recycling paper, glass, cans, and plastic d. Moving to an area with less pollution

C - recycling paper, glass, cans and plastic Nurses can reduce pollution by doing their part, which can include choosing to recycle paper, glass, cans, and plastic. Providing a tax incentive and creating laws would not be completed at the individual level to reduce pollution in the environment. Moving to an area with less pollution would not help to improve the problem

What statement accurately describes the characteristics of epidemiology? a. It is a science that studies the poisonous effects of chemicals. b. It explains the association between learning disabilities and exposure to lead-based paint at the cellular level. c. It helps nurses understand the strength of the association between exposure and health effects. d. It is a method for tracking the prevalence of health outcomes

C it helps nurses understand the strength of the association between exposure and health effects Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects. Toxicology is the science that studies the poisonous effects of chemicals. Environmental surveillance provides data with which to track and analyze the incidence and prevalence of health outcomes. Epidemiology does not examine causes at the cellular level.

A nurse didn't know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn't seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse's actions? Appropriate, because the supervisor is responsible for the nurse's choices Intelligent, because the supervisor has access to resource persons (clergy, physicians, administratorNs) wRho ImigGht kBno.wCofMoptions the nurse hadn't considered USNT c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices

C - Justified because this provides and opportunity to discuss the issue but the nurse maintains responsibility for the decision Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. The supervisor is not responsible for the nurse's choices, the nurse must maintain responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have similar knowledge as the supervisor.

How are ethics and public policies similar? a. Both are abstract principles that often differ in actual practice. b. Both are best achieved by persons in high political office who can effect change. c. Both strive for the public good. d. Both use general principles in making decisions.

C - both strive for the public good An important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. Ethics involves the application of specific principles when making decisions. There is nothing that supports that ethics and public policies are better achieved by those in high political office.

Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act

C - clean water act The Clean Water Act sets basic structure for regulating pollutants to United States waters. The Safe Drinking Water Act authorized the EPA to establish safe standards of purity and required all owners or operators of public water systems to comply with primary standards. The Toxic Substance Control Act gives the EPA the ability to track the 75,000 industrial chemicals currently produced or imported into the United States. The Pollution Prevention Act focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials.

Employees working with hazardous chemicals have the "Right to Know" about the chemicals they are working with through the creation of which resource? a. Material Safety Data Sheet (MSDS) b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency (EPA)

C - hazard communication standard The Hazard Communication Standard requires employers to maintain a list of all hazardous chemicals that are used on site. Each of the chemicals should have an associated chemical information sheet known as an MSDS, which is written by the chemical manufacturer. Consumer Confidence Reports summarize the results of the annual testing of the public water supply. The EPA sets forth policies, regulations, and public laws for the safety of the environment and the population.

A nurse is completing the first phase of a risk assessment. Which of the following questions would the nurse most likely try to answer? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

C - is the chemical known to be associated with a negative health effect? The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans): Is the chemical known to be associated with a negative health effect? The second step is determining if the chemical has been released into the environment: Has the chemical been released into the environment? The third step is estimating how much and by which route of entry the chemical might enter the human body: How much and by which route of entry can the chemical enter the body? The final step considers the previous steps: What is the prediction for potential harm?

What is the greatest single source of air pollution in the United States? a. Waste incineration b. Power plants c. Motor vehicles d. Molds

C - motor vehicles Mobile sources such as cars and trucks are the greatest single source of air pollution in the United States. Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality

What is the first step the nurse would take when addressing the problem of air pollution in the community? a. Setting standards b. Monitoring c. Permitting d. Compliance

C - permitting Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water. Environmental standards may describe a permitted level of emissions, a maximum containment level, an action level for environmental cleanup, or a risk-based calculation. Monitoring is an ongoing process after an action has happened. Compliance refers to the processes for ensuring that permit/standard/regulatory requirements are met.

A city sets the standard of an acceptable level of emissions or a maximum contaminant level allowed for factories. Which concept is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard

D - Environmental standard An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed. Although this does help to control pollution, environmental standard is best applied in this example. Setting a standard for emissions does not impact waste minimization or land use planning.

A facility is inspected after it has obtained a permit. The inspection is completed for the purpose of observing whether the plans submitted in the permit application are being implemented as approved. Which of the following environmental protection strategies is being applied? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring

D - environmental monitoring Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved. Permitting is an important step in controlling pollution. Waste minimization and land use planning are activities aimed at prevention of pollution.

How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients

D Observing signs and symptoms in clients Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. Extrapolation by toxicologists and biomonitoring are modern methods. Completing a chemistry course does not show how to identify these possible relationships

Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principles

D - upholding ethical principles In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandates or doing what is best for the community or family.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "The whole family is being affected and will fall apart if they don't focus on their family's needs first before anything else." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

D - utilitarianism By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision making. Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

A physician refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the physician merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is the physician using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics

D - virtue ethics Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is paternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn from his experience and possibly develop into a drug-free person. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. When decisions are based on outcomes or consequences it is known as consequentialism. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions.

roles for nurses in climate change

mitigation (prevention) response

ethical issues

moral challenges facing all HCPs question of rightness and wrongness ebola tracking

veracity

moral obligation to tell the truth

utilitarianism

moral value of action determined by overall benefit

Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency (EPA). d. Many Americans live in areas that do not meet current national air quality standards.

Nurses should be able to assess risks and advocate for policies that support healthy environments Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments. Toxicologists do not often consult nurses about environmental pollutants. Pollutant exposures are not routinely reported by nurses. Although there may be problems with air quality standards in the United States, this would not be the primary reason why nurses should understand environmental health

I PREPARE

investigate potential exposure present work residence environmental concern past work activities referrals + resources educate

Which of the following is considered the most important goal in nursing today? a. Adapting to technological advances such as electronic medical records b. Demonstrating caring as the basis of nursing practice c. Distinguishing nursing care from medical care d. Seeking evidence-based outcomes to demonstrate nursing's contribution to care

b - demonstrating caring as the basis of nursing practice Since the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing practice. Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationship between the patient and the care provider. The primary goal of nursing is not to adapt to technological advances, distinguish nursing from medical care, or seek evidence based outcomes; rather, the goal of nursing is to implement caring which has been the moral ideal of nursing for many years.

With which of the following ethical approaches are Gilligan and Noddings associated? a. Distributive justice approach b.Feminine ethic c.Principlism approach d.Virtue ethics

b - feminine ethic Gilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality of responsibility in relationships that emphasize connection and caring as a moral imperative. Distributive justice (fair distribution of the benefits and burdens of society), principlism (relying on ethical principles for decision making), and virtue ethics (seeking to enable persons to flourish as human beings) were not developed by Gilligan and Noddings.

How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions? a. Ask community leaders for their opinion of the interventions. b. Examine the morbidity and mortality rate of the community. c. Reassess the community to determine whether obvious needs have been met. d. Systematically survey community residents regarding their perception.

b. examine the morbidity and mortality rate of the community The end products of appropriate advocacy are decreased morbidity and mortality. In other words, if advocacy has been effective, public health problems will be decreased. Effectiveness can not be assessed accurately by asking community leaders for their opinions, reassessing the community, or surveying community members regarding their perception; data must be collected to determine results.

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

c - Emergency Management Agency (EMA) 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 man entered the emergency department bleeding profusely and screaming, "I've got to see a doctor right now! I've got a right to see a doctor! I'm hurt. You have to take care of me!" Which of the following premises would ethically justify such a demand for immediate attention? a. All hospitals receive federal money and all capable employed adults pay taxes, so all adults have a right to what their tax money has purchased. b. Saving an individual's life improves society and upholds tradition. c. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. d. The man has a property right to his own body, and the government is responsible to ensure that property rights are protected.

c - Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society—and that the government's role is to ensure this happens, at least on a basic level. Therefore, the man has a right to emergency care. Hospital funding and use of tax payer money does not demonstrate the use of an ethical principle. Saving an individual's life may or may not improve society. There is not an ethical principle that states that the man has a property right to his own body.

Which of the following is the first and most crucial step in a generic ethical decision-making process? A. Assess the context or environment in which the decision must be made. b. Consider the various ethical principles or theories. c. Identify the ethical issues and dilemmas. d. Make a decision and act on it.

c - identify the ethical issues and dilemmas The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all relevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6) make the decision and take action, and (7) evaluate the decision and action.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "But it doesn't have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn't that be fair?" Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

c - principlism The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethics and looks at the relationship and respoinsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make.

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It's not up to us; it's the family's decision. They know what is best for them." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

c - principlism The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values and goals. Therefore, the nurse is using principlism—that is, basic principles are the basis of the nurse's actions. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make

The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following approaches should the nurse use in personally deciding what is right? a. Do whatever will not get the nurse in trouble with employer. b. Do whatever is supported by an ethical expert, such as the hospital chaplain. c. Do whatever the nurse would recommend to anyone in a similar situation. d. Do whatever the nurse supervisor would feel comfortable reporting to administration.

c - whatever the nurse would recommend to anyone in a similar situation One of the rules in deontological decision making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly. In the same way, principlism suggests the nurse examine the context and make the decision that can be morally justified within that context. In order to apply the deontological ethics decision process the nurse must first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine their own personal motives, and then determine whether the proposed actions can be generalized. Doing whatever will not get the nurse in trouble, whatever is supported by an ethical expert, or whatever the nurse supervisor feels comfortable with is not an appropriate way to make an ethical decision.

Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It is a wife's responsibility to care for an ill husband." Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism

c deontological ethics The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions.

How can ethics be applied to public health nursing practice? a. Ethics and actual nursing practice are not related. b. Knowing ethics allows nurse to recognize the source of most problems. c. Ethics is constantly involved in nurses' clinical decisions. d. Although ethics is important, political and legal responsibilities are more important in practice.

c. Ethics is constantly involved in nurses' clinical decisions. Ethical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation, conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of public health nursing as nurses attempt to meet the needs of the community. Ethical principles are applied in nursing practice on a regular basis and assist with problem solving. The use of ethics does not allow the nurse to recognize the source of most problems. The used of ethics is more important than political and legal responsibilities in practice.

deontology

conclude action is right or wrong itself, regardless of goof that may come from it afhering to moral duty instead of consequences

A public health nurse (PHN) is organizing a multidisciplinary team to address the issue of water pollution in the community. Which group of professionals would be invited to address this issue? a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists

d Geologists, meteorologists, and chemists Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists. The other professionals are not experts in the area of water pollution in the community

A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the wife's diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse's most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family's current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family's well-being

d - interviewing the family concerning their perspective of the threat to the family's well being The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family's cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures the family, rather than the individual, is the unit of primary concern. Sett.ing up a surgical appointment immediately would not be an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has cancer. Assessing the family's current living situation would not be the first concern of the nurse; the first concern should focus on the family's well-being. After assessing the family's well-being, the next action of the nurse may be to educate the family about the treatment and prognosis of breast cancer.

Which of the following would confirm that the nurse's advocacy has been truly successful or effective? a. Audiences agree with the nurse who is serving as advocate. b. Legislators discuss appropriate legislation to better allocate resources. c. People verbalize that the disenfranchised should be better treated. d. Systematic social changes are made to improve quality of life.

d. Systematic social changes are made to improve quality of life. Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community live to reduce death and disability and improve quality of life in the community. Only when systematic social changes are made to improve quality of life can advocacy be considered truly effective. Systematic change encompasses the complete role of the nurse as an advocate. Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations may have different views than the nurse. Advocacy goes beyond only working with legislators to allocate resources. Serving those who are disenfranchised is only one part of the advocacy role.

ECHO program

environmental influences on child health outcomes Upper + lower airway obesity pre, peri, postnatal outcomes Neurodevelopment ugly obese pregnant naval

waste disposal

incineration water discharge landfilling or burying soil

radon

odorless, colorless, radioactive gas 2nd leading cause of lung disease breathing outdoors, buidlings, homes, eating, drinking

ethical dilemmas

puzzling moral problems in which justified reasons for both doing ot not doing something

mold

sensitive ppl - nasal stuffy, eye irritation, wheezing, skin irritationn, possible severe allergic reaction w/ chronic illness - pneumonia and lung infections

social determinants of health

social/economic environment persons individual characteristics + behaviors physical environment

radon 2 main home sources

soil - highest risk for associated lung CA water - can cause stomach CA w/ ingestion, lung CA with showering