Exam 3

What was the significance of the 1979 Surgeon General's report? a. It planned the goals and priorities for the entire Veterans Administration medical system. b. It vastly increased funding for health promotion activities. c. It identified the use of tobacco as a cause of lung cancer. d. It created national goals for promoting health and preventing disease

ANS: D The 1979 Surgeon General's report began a focus on preventing disease and promoting health for all Americans. It was a national effort with all levels of government, as well as other interested parties, involved. The 1979 report did not plan goals and priorities for the Veterans Administration medical system; rather it looked at health of all Americans. There was no funding

Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: a. antibody test results are typically negative. b. antibody production by the immune system increases. c. incubation period is prolonged. d. symptoms include myalgias, sore throats, and rash.

ANS: A Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 321

A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Appropriate intervention by the nurse would be to: a. arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. b. contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. c. provide STD prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. d. supply the client with nonsteroidal anti-inflammatory drugs and caution her to call the after-ho

ANS: A Nursing assessment should always include taking a comprehensive sexual history to determine an individual's potential risk for STDs. Each sexual partner is potentially exposed to all the STDs of all the persons with whom their partner has been sexually active. PID is a serious infection involving the fallopian tubes and is the most common complication of gonorrhea, but it may also result from chlamydial infections. Symptoms include fever, abnormal menses, and lower abdominal pain. Symptoms can vary among women. PID can cause ectopic pregnancy, and this should be ruled out in all cases. Stillbirth, premature labor, and infertility are also possible complications. Cognitive Level: Analysis Associated Chapter Objective: 2 & 3 REF: p. 328 & p. 334

The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: a. immunocompromised persons, substance abusers, and those with diabetes. b. individuals previously treated for TB. c. long-term cigarette smokers. d. persons with new-onset asthma or emphysema.

ANS: A Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 332

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. d. Try 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.

ANS: A 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.

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.

ANS: A 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

For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patient's daily prayers. Which of the following is the nurse demonstrating through these actions? a. Accommodation b. Awareness c. Brokering d. Imposition

ANS: A Cultural accommodation involves including aspects of the patient's religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is important—from the patient's perspective, possibly more important than medical treatment. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural imposition is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others.

A nurse is caring for a client of another culture. Which of the following actions would be the most appropriate for the nurse to take? a. Alter personal nonverbal behaviors to reflect the cultural norms of the client. b. Keep all behaviors culturally neutral to avoid misinterpretation. c. Rely on friendly gestures to communicate caring for the client. d. Avoid any pretense of prejudice by treating the client in the same way as any other client

ANS: A Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent are expected to respect other cultures and value diversity. These behaviors tend to provide more responsive care. Nurses should be knowledgeable of other cultures and communicate with the client based on cultural norms. Culturally skillful nurses understand the unique difference among individuals within a given culture and work with those individuals to learn more about their culture and provide culturally sensitive care

At a local hospital, the postpartum care policy requires that nurses observe the mother during infant care to assess the mother's ability to care for the new baby and to promote bonding. A new mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Which of the following actions would be taken by a culturally competent nurse? a. Allow family members to provide the newborn's care and assess the mother's knowledge of child care through discussion. b. Reinforce the importance of bonding and that all good mothers gladly assume these responsibilities. c. Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care. d. State that she must abide by hospital policy because documentation of the mother's ability to give the infant care is required for discharge

ANS: A Culturally competent nursing care focuses on the specific patient, reflects the patient's individual beliefs and values, and is provided with sensitivity. The nurse should accept the cultural norms and behaviors of this client and her family. Thus, the nurse should provide culturally competent care and comply with the client's desire. This should take priority over any judgments the nurse could make about this client or hospital documentation related to infant care by the mother. This respect of culture makes the other options incorrect.

An American nurse says, "I'm not going to change the way I practice nursing based on where the client is from because research shows that Western health care technology and research is best." Which of the following is being demonstrated by the nurse's statement? a. Ethnocentrism b. Prejudice c. Racism d. Stereotyping

ANS: A Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one's own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, "The way we do it is the only right way to provide this care." Prejudice refers to having a deeply held reaction, often negative, about another group or person. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth. Stereotyping occurs when attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences.

A nurse who is explaining to an immigrant client why it is important to take medication states, "The medication takes a couple of weeks to be effective, but then you should feel better." When the client is next seen, no medication has been purchased. Which of the following is the most likely explanation? a. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn't bother with the drug. b. The medication required a trip to the pharmacy, and the client just hadn't had time to obtain the drug yet. c. The medication was too expensive for the client's family. d. The client really hadn't understood why the medication was important

ANS: A If we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time should be the immediate concern of the nurse. It is possible that the client did not have the necessary resource or did not understand the importance of the medication, but the nurse should first investigate the potential cultural disconnect

A client states to the nurse, "I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I have seen no benefits from this legislation." Which of the following statements would be the best reply by the nurse? a. "Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill." b. "It will take years to see any effects from the act because of the delays in implementation of the changes." c. "This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits." d. "The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact."

ANS: A It is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of this law. The goal of the Affordable Care Act was to improve the health of the nation and access care. Several changes to health care have already been made because of this legislation, and more changes will continue in the future. Multiple provisions of the act will affect individuals and families.

Which of the following best describes most Americans' attitude toward immigrants? a. Ambivalence, because there are no clear solutions about how to address their needs. b. Strongly negative, because immigrants take jobs that native-born Americans could have instead. c. Strongly positive, because immigrants bring useful job skills and often join previous family members already in the United States. d. Strong opposition to further immigration, because of the increasing population in the United States.

ANS: A Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions. Because Americans are ambivalent, there is neither a strong negative nor a positive attitude toward immigrants. However, many times immigrants do enter the United States because they have useful job skills or family ties. They are more likely to be low-income workers who work in low-wage, blue-collar jobs and industries.

Which of the following best defines the word politics? a. The art of influencing others b. The outcome of governmental policies c. A provision of power for making decisions d. The result of legislative action

ANS: A Politics is the art of influencing others to accept a specific course of action. Political action results in governmental policies and legislation. The result of legislative action typically is done in the form of laws and policies. The provision of power for making decisions is typically assumed by the government.

When teaching a nutrition class to a student group with a large Latino population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary preventions

ANS: A Primary prevention involves activities such as health teaching to prevent a problem from occurring. Secondary prevention occurs when a nurse completes screenings. Tertiary prevention occurs after a problem has occurred and aims to restore the client to the highest level of functioning as possible

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

ANS: A 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.

A public health agency is planning to implement the electronic health record. (Which is a benefit of this choice)? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. There is no evidence that an electronic health record improves client compliance with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies.

Which of the following activities is completed by the executive branch of the federal government? a. Administration of policy b. Interpretation of policy c. Proposal of policy d. Passage of policy

ANS: A The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws). The judicial branch interprets laws.

A nurse would like to become involved in political action. Which of the following actions would be most appropriate for the nurse to accomplish this goal? (Select all that apply.) a. Become a member of the state nurses association. b. Be friendly with everyone, whether supportive or not of your ideas. c. Focus on being appointed to the state level committees. d. Focus all your efforts on your specialty practice area and your employment site. e. Volunteer to serve on relevant committees.

ANS: A, B A nurse wishing to become politically involved should begin by joining the state nurses association, networking with others involved, and volunteering to serve on committees or in offices. Be friendly and network to increase your knowledge beyond your own workplace or specialty and seek opportunities to share expertise with others. Becoming involved locally is a good opportunity to start becoming involved in political action and allows for networking at the local level. Seeking opportunities beyond one's workplace or specialty area allows the nurse to gain additional knowledge and share expertise in specialty area with others.

A nurse is testifying at a committee meeting about a health bill. Which of the following actions should be taken by the nurse? (Select all that apply.) a. Briefly describe professional education. b. Discuss how the bill affects more than just nurses. c. Include factual data and, if possible, statistical information in visual form. d. Provide written proof of personal and professional qualifications e. Provide information about relevant expertise and related experience.

ANS: A, B, C, E Language must be simple and carefully chosen to convey information to listeners and to avoid professional jargon. The nurse must share a bit of personal education, experience, and expertise to be seen as a credible source, but written proof of credentials is not necessary unless specifically requested. The testimony must go beyond just nursing's interest and include accurate, credible data. The data must be accurate and credible which may not be the case when getting names from the media.

Which of the following activities is the responsibilities of the Centers for Disease Control and Prevention (CDC)? (Select all that apply.) a. Conduct research to enhance disease prevention. b. Detect and investigate infectious disease problems. c. Develop public health policies. d. Publish national goals for promoting health and preventing disease. e. Serves as an advocate of public health polices

ANS: A, B, C, E The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. To monitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, and develop and advocate sound public health policies and other prevention strategies. The safety and health of the workplace is the specific responsibility of OSHA. The CDC cannot write or pass legislation. The USDHHS published national health goals in Healthy People 2020.

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

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.

A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore, a cultural assessment should be attempted. Which of the following questions should the nurse ask? (Select all that apply.) a. "Can you tell me where your family is from?" b. "Do you practice a particular religious faith?" c. "What other countries have you lived in?" d. "Is there anything special we need to know about your food preferences?" e. "What do you think is causing your health problem?"

ANS: A, B, D, E In a general cultural assessment, nurses ask clients about their ethnic background, language, education, religious affiliation, dietary practices, family relationships, hospital experiences, occupation and socioeconomic status, cultural beliefs, and language. Nurses want to also ask about the client's perception of the health issue and what caused it and how it should be treated as well as the results they expect from the care they get. Such basic data help nurses understand the client from the client's point of view and recognize what is unique about the person, thus avoiding stereotyping. Knowing the other countries that the client has lived in may be helpful; however, necessary information about the client's culture should be able to be collected through broad questions about the client's culture.

Which of the following best describes the importance of the World Health Organization (WHO) to the United States? (Select all that apply.) a. Provides daily information on disease occurrences. b. Establishes international standards for antibiotics and vaccines. c. Creates international legislation regarding international cooperation. d. Supports national programs to fight disease when asked to do so. e. Monitors for adverse drug reactions.

ANS: A, B, D, E Some WHO services that benefit all countries (including the United States) are providing day-to-day information service on the occurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoring adverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can request assistance with strengthening the delivery of health services, supporting national programs to fight disease, and training health workers—which the United States does not. WHO can suggest but cannot legislate to individual countries.

What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Foreign-born immigrant population is increasing. b. Hispanics are the largest minority group population. c. Leading causes of death are from infectious diseases. d. Mortality for both genders in all age groups declined. e. Unintentional injuries are among the top 10 causes of death.

ANS: A, B, D, E The nation's foreign-born population is growing, and it is projected that from now until 2050 the largest population growth will be due to immigrants and their children. Although African Americans used to be the largest minority group, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined. The leading causes of death have changed from infectious diseases to chronic and degenerative diseases with unintentional injuries being among the top 10.

A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state's citizens c. Employing and supervising school health nurses d. Establishing and maintaining child immunization clinics e. Providing education regarding established health codes

ANS: A, B, E State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in areas such as ongoing assessment of health needs. Employing and supervising school health nurses occur at the local level, and many times within a specific school. Provision of child immunization clinics occurs at the local level.

Which of the following statements is accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. People often spend a considerable amount of their own money on complementary therapies. d. The gap between the richest and poorest is widening. e. The composition of families and living patterns are changing

ANS: A, C, D, E Several social trends that influence health care include changing lifestyles, a growing appreciation of the quality of life, the changing composition of families and living patterns, changing household incomes, and a revised definition of quality health care. People often spend a considerable amount of their own money for these types of therapies because few are covered by insurance. It is obvious that the gap between the richest and poorest is widening because of the percent wage increase in the higher income levels. Americans spend considerable money on health care, nutrition, and fitness, because health is seen as an irreplaceable commodity. To be healthy, people must take care of themselves

A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection

ANS: A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them. Cognitive Level: Synthesis Associated Chapter Objective: 2, 3, 5, & 6 REF: p. 330

Which of the following provides evidence that the US health care system is in crisis? (Select all that apply.) a. Health insurance is an expensive benefit for employers to provide. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors. e. Consumers want lower costs and high-quality health care without limits.

ANS: A, C, E Consumers want lower costs and high-quality health care without limits and with an improved ability to choose providers and services of their choice while employers are typically the purchasers of health care; they want to be able to obtain basic health care plans at reasonable costs for their employees. Many employers have seen their profits diminish as they put more money into providing adequate health care coverage for employees. Nurses working long hours pose a serious threat to patient safety because fatigue slows reaction time, saps energy, and diminishes attention to detail. The Institute of Medicine's (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. The report makes it clear that the majority of medical errors today were not produced by provider negligence, lack of education, or lack of training.

An undocumented immigrant comes to a primary care provider's office to receive care. Which of the following services can the client receive? (Select all that apply.) a. Treatment for tuberculosis b. Treatment for type 2 diabetes c. Immunization for polio d. Physical examination e. Sutures for a laceration

ANS: A, C, E Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. They are eligible only for emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches. Undocumented immigrants are not eligible to receive treatment for chronic diseases such as type 2 diabetes or physical examinations.

A nurse is visiting a state legislator to encourage the legislator to vote for a particular health bill that the state nurses association has endorsed. Which of the following actions would be most important for the nurse to complete? (Select all that apply.) a. Encourage the legislator or staff to ask relevant questions. b. Be friendly and engage in small talk so that rapport can be established. c. Be aware that legislators are well informed; don't insult the legislator by stating information that is obvious. d. Have a handout that summarizes all the major points in support of the bill.

ANS: A, D Legislators might not be well informed about every issue, so they need and want important information. The nurse should allow time for questions or clarifications of information shared and have the material on a handout for the legislator's convenience. It is also helpful to invite the legislator to attend nursing conferences or meetings where health issues will be discussed. The nurse should not waste time with small talk but briefly present his or her stand, emphasizing other nurses who support the bill, because numbers count. Legislators might not be well informed about every issue, so they need and want important information that the nurse can provide.

A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: a. acute hepatitis B is self-limiting. b. hepatitis A outbreaks commonly occur in facilities where staff change diapers. c. hepatitis C is a "silent stalker." d. individuals with chronic liver disease are at greater risk for hepatitis A.

ANS: B Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic. Cognitive Level: Analysis Associated Chapter Objective: 2 & 4 REF: p. 330

Many behaviors place any individual—regardless of age, gender, ethnicity, or other characteristics—at greater risk for STDs. The nurse should include primary prevention interventions in all client encounters through the discussion of: a. partner notification. b. safer sex. c. standard precautions. d. STD testing.

ANS: B Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters. Cognitive Level: Application Associated Chapter Objective: 5 & 6 REF: p. 336

A nurse is assigned to teach clients STD prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use. Cognitive Level: Analysis Associated Chapter Objective: 5 & 6 REF: p. 330

A nurse is assigned to teach clients STI prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STIs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use.

A patient who identifies as Buddhist enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which of the following considerations was omitted by the nurse? a. The patient should not be served any food until a primary care provider's order is obtained. b. The patient's Buddhist faith probably requires a vegetarian diet. c. The patient may be too frightened about the tests to want to eat very much. d. The patient may have diabetes or be allergic to some foods.

ANS: B Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don't eat meat. The nurse should be aware of the cultural considerations that should be made for Buddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that these considerations can be made. The nature of the test determines the fasting requirements; no order is needed. Whether the client is diabetic or allergic to some foods should be determined upon admission

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.

ANS: B 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 cannot 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.

A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of law will the nurse refer? a. Common law b. Constitutional law c. Legislation and regulation d. Judicial law

ANS: B Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry. State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfare of their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe on individual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. The community's rights are deemed more important than the individual's rights when there is a threat to the health of the public. Judicial law, based on court and jury decisions, and the principles of common law (precedent, justice, fairness, respect for an individual's autonomy, and self-determination) are both used by court's as the basis to make a decision and do not relate to having the right to isolate a patient. Legislation is law that comes from the legislative branches of the government and regulations are specific statements of law related to defining or implanting individual pieces of legislation. Neither are as important in this case as the constitutional law of the police power of the states in regards to isolation of a patient.

A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurse's community. b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures.

ANS: B Cultural awareness requires self-examination and an in-depth exploration of one's own beliefs and values as they influence behavior. Cultural awareness is the first element in the model of cultural competence. Following the development of cultural awareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethnic groups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The fourth construct essential to this model is cultural encounter, which is the process that permits nurses to seek opportunities to engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group.

A nurse states, "The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs." What does this statement reflect in relation to culture? a. Awareness b. Blindness c. Knowledge d. Preservation

ANS: B Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural knowledge is information about organizational elements of diverse cultures and ethnic groups; emphasis is on learning about the client's worldview from an emic (native) perspective. Cultural preservation means that the nurse supports and facilitates the use of scientifically supported cultural practices from a person's culture along with those from the biomedical health care system.

Minority nurses represented about 30.1 percent of the RN population. What is this an example of? a. Projection b. Disparity c. Racism d. A sentinel event

ANS: B Disparities are racial or ethnic differences in the quality of health care or representation of a faction of the population, not based on access or clinical needs, preferences, or appropriateness of an intervention. Projection is an estimate or forecast of a future situation based on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that one's own race is superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the patient.

Earlier in the week, a nurse carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose although the patient denies taking more than the label indicated. Which of the following is the most likely explanation? a. The patient was taking more mediation in the hope of getting well faster. b. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. c. The patient truly did not understand and thought the dose being taken was correct. d. The patient had a unique response to the medication and should have a smaller dose ordered.

ANS: B For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients. It is unlikely that the patient was taking too much medication, taking the incorrect dose, or having a unique reaction to the medication. Rather the nurse should first interview the patient about use of folk medicine which may interact with the prescribed medication regimen.

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

ANS: B 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 does managed care (MC) attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary-care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers who agree to comply with the care approaches established through a case management approach, not through a point of service list of individual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve different populations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather a case management approach is used to control costs

Which of the following statements best describes the law in relation to clinical practice by nursing students? a. Students are considered certified until licensure is obtained. b. Students are expected to meet the same standard of care as the professional nurse. c. Students are not legally liable for errors because they practice under the license of their instructor. d. Students have a scope of practice determined by the nurse practice act.

ANS: B Nursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Students are expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similar circumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act, they also cannot perform the tasks and responsibilities of the licensed practitioner within the scope of practice until they have received adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the student's level of education.

A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse take to influence the bill's implications? a. Exercise veto power by calling for petitions from health care agencies. b. Contact the regulatory agency and participate in public hearings. c. Call members of congress to request that they rescind the legislation that was passed. d. Discuss the change in services with the administrators at the hospital.

ANS: B Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying against a bill because it shapes the final implementation of the law. Health care agencies do not have the ability to veto a bill. After a bill has been passed, it is too late to contact members of congress. Calling the hospital will not change the implications of the bill. Contact must be made with the regulatory agency in order to influence how the law is regulated.

Which statement best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals, families, and the community. Health care is made available to them with their full participation and is provided at a cost that the community and country can afford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, not primary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitative services. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted all citizens of the world to live socially and economically productive lives.

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

ANS: B 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.

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers' complaints and general unhappiness d. Increased pressure to decrease overlap in services

ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both important factors to consider; however, this is not the reason why increased collaboration has occurred. There has not been an increase in taxpayer complaints or unhappiness that has caused these changes to occur.

A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the client to in order to receive care? a. Managed care b. Community health center c. Emergency department d. Physician office

ANS: B There is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide a broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and dentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people of all ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specific network of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergency departments and physician offices are not the best place for an individual without health insurance to receive care. Both are expensive and do not provide the necessary resources for the individual to possibly receive health insurance

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."

ANS: B 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 affect 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.

Which of the following describes the significance of the passage of The Public Health Threats and Emergencies Act? (Select all that apply.) a. It funded ongoing activities of the public health system. b. It led to improved water quality and food safety guidelines. c. It included funding for public health activities. d. It validated that the public health system was prepared for terrorism. e. Expanded the role of Secretary of HHS to include aspects of public health emergencies.

ANS: B, C The Public Health Threats and Emergencies Act was the first federal law to comprehensively address the public health system's preparedness for bioterrorism and other infectious disease outbreaks and signaled the beginning of renewed interest in public health as the protector for entire communities. The focus of this law was to address emerging threats to the public's health and authorize the Secretary of HHS to take appropriate response actions during a public health emergency, including investigations, treatment, and prevention. A focus was the improvement of water quality and food safety. It did not support the ongoing activities of public health. It did not validate the public health system was prepared for terrorism.

A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency would want to achieve accreditation? (Select all that apply.) a. To improve health programming and services b. To improve community relationships c. To improve performance and quality d. To improve management e. To decrease cost of health care

ANS: B, C, D The purpose of accreditation for public health departments is to assist and identify quality health department performance and quality, and it develops leadership, improve management, and improve community relationships. Neither the improvement of health care programming and services nor minimizing health care costs is a reason why a public health agency would want to achieve accreditation

A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STDs. b. cures for each of the STDs identified. c. risk of skin-to-skin contact in transmitting the identified STDs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur. Cognitive Level: Synthesis Associated Chapter Objective: 4, 5, & 6 REF: pp. 325-328

A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STIs. b. cures for each of the STIs identified. c. risk of skin-to-skin contact in transmitting the identified STIs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STIs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur.

A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Which of the following interpreters would be the most appropriate in this situation? a. A Bosnian male who is certified as a medical interpreter b. A female from the client's community c. A female who does not know the client d. The client's 20-year-old daughter

ANS: C Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpreter for females. This client has specifically requested a female provider; therefore, one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client

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.

ANS: C 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 of the following agencies has the most influence on the health and welfare of US citizens? a. Agency for Healthcare Research and Quality (AHRQ) b. Centers for Disease Control and Prevention (CDC) c. US Department of Health and Human Services (USDHHS) d. World Health Organization (WHO)

ANS: C As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO's policy-making body provides policy options and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid through the Centers for Medicare and Medicaid Services (CMS).

The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is "hot" and he believes that penicillin, a "hot" medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the client's prescription is changed to a different yet equally effective antibiotic? a. Cultural awareness b. Cultural brokering c. Cultural knowledge d. Cultural skill

ANS: C Cultural knowledge is information about organizational elements of diverse cultures and ethnic groups; emphasis is on learning about the client's worldview from an emic (native) perspective. Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioner's need to prescribe an effective antibiotic. Cultural awareness is the self-examination and in-depth exploration of one's own biases, stereotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients.

An immigrant who takes metamizole (banned in the United States) for pain may experience life-threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural re-patterning? a. Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b. Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. d. Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.

ANS: C Cultural re-patterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them. Completing a cultural assessment involves learning more about the client's culture but does not address the need to consider changing or modifying cultural practices. In order to complete cultural re-patterning, the nurse has to take an action to resolve this potential problem.

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.

ANS: C 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.

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? a. Appropriate, because the supervisor is responsible for the nurse's choices. b. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn't considered. 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.

ANS: C 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.

Which statement best describes the cost of health care in the United States? a. Health care costs are kept low, and the indicators of health are among the best worldwide. b. Health care costs are low which has resulted in poor health outcomes. c. Health care costs are the highest in the world, but the indicators of health are not the best worldwide. d. Health care costs and indicators of health are the highest in the world.

ANS: C Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic product, the indicators of what constitutes good health do not document that Americans are really getting their money's worth. Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor in comparison to other countries who spend less money on health care.

A nurse is explaining the health care system in the United States to a group of health care providers visiting from South America. How would the nurse best describe the current health care system? a. "It is a logical, rational approach to meeting expressed needs while still trying to control costs." b. "It is a centralized system that provides care in hospitals." c. "It is divided primarily into two components: private health care and public health care." d. "It is the best in the world with outstanding research and high-technology care available to all."

ANS: C Health care in the United States consists of a private or personal care system and a public health system, with overlap between the two. The United States health care system is one of the most expensive systems in the world that does not do a good job at controlling costs. Care is provided through an enormous range of facilities and providers, including hospitals, physicians' and dentists' offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clinics. Although there is great research and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health care disparities exist among multiple populations making this system not available to all.

Who is responsible for determining the scope of practice for registered nurses? a. American Nurses Association b. Federal legislators c. State legislators d. US Department of Health and Human Services

ANS: C Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse practice act is governed by legislators in each state. The American Nurses Association, US Department of Health and Human Services, and federal government do not determine the scope of practice for nurses; this responsibility is the role of state governments. The US Department of Health and Human Services is the agency most heavily involved with the health and welfare of US citizens.

A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a. When the bill is first assigned to a committee. b. When the bill is discussed and debated within the committee. c. When the bill moves out of committee to be heard by the entire Senate. d. When the bill passes the Senate and moves to the House of Representatives.

ANS: C Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this senator, who will then be in a position to act on it. To contact the senator when the bill is first assigned to the committee or is being discussed and debated within the committee is too early to effectively influence the individual senators. The nurse would not want to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.

Which of the following statements best describes why the federal government has become involved in health care? a. The states asked the federal level to become involved. b. Because of rising costs to the states, the federal budget needed to be used to pay for necessary services. c. The Constitution gives the federal government the power to promote the general welfare. d. This step was necessary to standardize care on a national level

ANS: C One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution, that such federal governmental action was within the powers of Congress to promote the general welfare. According to Article I, Section 8 of the US Constitution Congress has multiple roles in relation to health care: provide for the general welfare, regulate commerce among the states, raise funds to support the military, and provide spending power. Thus, Congress was within its role to become involved in health care and was not asked to do so by the states or used to standardize care on the national level

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.

ANS: C 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.

Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for professional negligence? a. "Because the health care workers didn't turn my mother every 2 hours, she developed bedsores." b. "I received permanent nerve damage because they would not remove a cast that was too tight." c. "My daughter wasn't given a call light, and for a whole shift no one checked on her condition." d. "They amputated the wrong leg during surgery."

ANS: C Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an injury, except for "My daughter wasn't given a call light, and for a whole shift no one checked on her condition," in which case the care was substandard but no injury resulted. The incorrect responses all specify an injury whereas professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury.

A client is crying softly and saying, "What did I do to deserve this punishment, Lord?" Which of the following responses by the nurse would be the most appropriate? a. "God doesn't punish people. You're sick just because of bad luck." b. "I can call the hospital chaplain to help you talk about these feelings." c. "What can I do to be helpful to you right now?" d. "Would you like to confess your sins and repent so this illness will go away?"

ANS: C Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the client's religious faith group, an open-ended response showing caring is the most appropriate statement. The most therapeutic response from the nurse is an open-ended question. This allows the client to share information and not feel like his or her actions are being judged by the nurse. Also, this allows the nurse to not give advice or offer false information to the client.

Which of the following laws established programs for provision of health services for women and children and supported community-oriented nursing practice? a. Early Periodic Screening and Developmental Testing (EPSDT) Initiative b. Healthy People 2000 Initiative c. Sheppard-Towner Act d. State Child Health Improvement Act (SCHIP)

ANS: C The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children and made nurses available to provide these services in the community setting. Within the Sheppard-Towner Act was a provision to start the EPSDT initiative. SCHIP provides insurance for children and families who cannot otherwise afford health insurance. Healthy People 2000 focuses on promoting health and preventing disease for all Americans.

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.

ANS: C 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 taxpayer 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

ANS: C 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.

A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following branches of the government is the nurse working? a. Constitutional branch of government b. Executive branch of government c. Legislative branch of government d. Judicial branch of government

ANS: C The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies problems and proposes and then debates, passes, and modifies laws to address those problems. There is not a constitutional branch of the government. The executive branch administers and regulates policy. The judicial branch interprets laws.

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

ANS: C The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Based upon this understanding, none of the other options correctly describes the nurse's statement.

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

ANS: C 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 responsibility 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

ANS: C 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 to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make

A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia about 10 years ago. The nurse's next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a. Covert intentional prejudice b. Covert unintentional prejudice c. Overt intentional prejudice d. Overt unintentional prejudice

ANS: C The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client. Covert prejudice involves subtle or passive acts of prejudice. This can occur intentionally or unintentionally. In this case, the actions of the nurse were intentional, which means it was an overt behavior. Overt prejudice includes any action that intends to give unequal treatment to an individual or group. Given the scenario, it appears that the action of the nurse was intentional, not unintentional.

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. "Let's go through these medications and see which ones we can delete." b. "You can get these medicines at this clinic for free." c. "Let's see if we can get some help from Medicare to help you pay for these medications." d. "These medications are important. Do your best to pay for them."

ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figure it out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before looking into receiving the medications for free as there may be other barriers which limit the abilities to get these medications at a discounted cost

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur. Cognitive Level: Application Associated Chapter Objective: 4 & 5 REF: p. 335

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STI transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STIs. Adolescents are particularly at risk. Not all STIs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur.

A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the nurse make about this population? a. They have difficulty accessing health care due to a shortage of primary-care providers. b. They most likely receive health insurance through Medicare. c. They are unable to access health care due to the implementation of the Affordable Care Act. d. They have access to affordable health care insurance

ANS: D Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only 2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly different in Massachusetts than in other areas of the country. Low-income populations are eligible for Medicaid services, not Medicare. The program in Massachusetts became a model for the Affordable Care Act.

A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: a. HIV test results counseling. b. needle exchange. c. partner notification. d. instruction in standard precautions.

ANS: D Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected. Cognitive Level: Application Associated Chapter Objective: 1, 5 & 6 REF: p. 339

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.

ANS: D 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.

A nurse is determining which health care services must be offered at a local public health clinic. Which factor is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations from Healthy People 2020 d. Services mandated by the state government

ANS: D At the local level, health departments provide care that is mandated by state and federal regulations. Data available from the most recent community assessment, suggestions from community members about need, and recommendations from Healthy People 2020 could all be used. However, funding for these types of programs may not be available. The services that are mandated by the state government will be funded and allow the clinic to be able to provide these services.

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

ANS: D 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 responsibility 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 Spanish-speaking family comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English-Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, "No hablo Español" (I don't speak Spanish). d. Obtain an interpreter to translate.

ANS: D Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client's language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for the client—attempting communication using a book, stating that he or she does not speak English, and arranging for a referral do not address the priority action of finding an interpreter.

A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client's history. He stopped doing this around specific clients after being told that they were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a. Cultural accommodation b. Cultural imposition c. Cultural re-patterning d. Cultural skill

ANS: D Cultural skill is the effective integration of cultural knowledge and awareness to meet client needs—in this case, the clients need to not be offended by having the bottom of the nurse's foot or shoe in view of the client's face. The nurse using cultural skill makes sure that nonverbal communication techniques take into consideration the client's use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing one's values on others. Cultural re-patterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.

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

ANS: D 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

A health care worker tells a nurse, "It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them." Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping

ANS: D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food. Cultural imposition is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others. Ethnocentrism is a type of cultural prejudice at the population level which involves the belief that one's own group determines the standards for behavior by which all other groups should be judged. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth.

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

ANS: D 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. Setting 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.

A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the following factors should the nurse emphasize? a. Providing disease investigation training b. Providing research opportunities c. Providing leadership experiences d. Providing salaries commensurate with responsibilities

ANS: D Through the input of the Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP), the Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to support the public health nurse role are competitive salaries commensurate with responsibilities, experience in health promotion and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health disparities. The Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP) did not emphasize the importance of providing disease investigation training, research opportunities, or leadership experiences.

A health care provider 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 provider 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 being using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics

ANS: D 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.

The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and requires. Which of the following effects will this change have on nurses in this state? a. None, because they are just helpful guidelines for maximum safety. b. None, because they just give specifics that may change over time. c. Major, because prudent nurses would follow such regulations. d. Major, because these rules and regulations have the effect of law and must be obeyed.

ANS: D When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations. Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They are laws that must be followed, not guidelines.