Exam V: Chpter 22-28, 31, 32

Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.) a. A 16-year-old who is legally emancipated b. A pregnant adolescent c. An adolescent requiring an emergency appendectomy d. An adolescent whose diagnosis of cancer has a serious prognosis e. A 15-year-old who overdosed on cocaine

A, B, C, E Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the "mature minor doctrine." This allows youths of 15 years and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated. If an adolescent has a diagnosis that has a serious prognosis, parental consent will be needed as this is not a situation that involves emergency care, substance abuse, pregnancy, and birth control.

After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older friend asks the nurse, "I'm really scared of getting cancer. What can I do to avoid that kind of cancer?" Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Avoid smoking or much alcohol. b. Choose poultry or fish as a protein source. c. Eat lots of fruits, vegetables, and fiber every day. d. Try to get at least 8 hours of sleep a night. e. Limit intake of red or processed meat.

A, B, C, E Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer. Getting an adequate amount of sleep will not avoid any risk factors for the development of colorectal cancer

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

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

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

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

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

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

A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money, so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? (Select all that apply.) a. Food insecurity b. Target of peer bullying c. Increased school absences d. Vision problems e. Depression

A, C, E The health problems of homeless children, although similar to those of poor children, often have more serious consequences and are at greatest risk for poor health as a result of poor nutrition, inconsistent health care, high levels of anxiety, and an inability to practice good health behaviors. Homeless children also experience higher rates of school absenteeism, academic failure, depression, and emotional and behavioral maladjustments. It is possible that this child could be bullied; however, there are also children who do not live in poverty who experience bullying as well. Vision issues are generally no more a risk than for the general child population.

A nurse's mother leans forward and says, "My best friend fell the other day and now she's in the hospital. I'm really worried about getting osteoporosis. What do you think I should do?" What should the nurse recommend? (Select all that apply.) a. Ask your doctor for hormone replacement therapy. b. Continue to abstain from alcohol. c. Eat foods high in calcium such as fortified skim milk. d. Eat lots of green leafy vegetables. e. Avoid tobacco products.

B, C, E It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limit in alcohol consumption; and avoidance of smoking. Use of hormone replacement therapy and consumption of green leafy vegetables are not related to decreasing the risk of developing osteoporosis.

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

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

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

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

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

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

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

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

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

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

Which of the following is the best way to ensure good nutrition in newborn infants? a. Breastfeeding only b. Feed them brand-name baby foods c. Feed them only homemade cereals d. Supplement breastfeeding with brand-name formulas

a. Breastfeeding only Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity. Feeding brand-name foods, homemade cereals, and supplementing with formula are not the best ways to ensure good nutrition in infants. Breastfeeding is the best option to ensure good nutrition.

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

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

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

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

A nurse is considering implementing interventions to address an increased interest in health and wellness promotion in the community's older adult population. What intervention should the nurse consider as the priority? Which of the following actions would the nurse most likely take? a. Educate a community group about hypertension control. b. Create a social group for those who have lost a life partner. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

a. Educate a community group about hypertension control. While all options are appropriate interventions, educating the community about hypertension control is the priority since it contributes to the deterioration of health. Administering immunizations, promoting socialization, and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

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

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

Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a. HRT does not prevent heart disease. b. Use of HRT is recommended to prevent osteoporosis. c. When used with complementary therapies, HRT is most effective. d. HRT is a contributing cause of breast cancer.

a. HRT does not prevent heart disease. HRT does not prevent heart disease. To prevent heart disease, women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active. HRT is not recommended to promote osteoporosis. HRT is not a contributing cause of breast cancer. There is no evidence that HRT is most effective when used with complementary therapies.

A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most likely use? a. Life expectancy b. Mortality rate c. Morbidity rate d. Health status

a. Life expectancy Life expectancy is a measure that is often used to gauge the overall health of a population. Health status indicators are the quantitative or qualitative measures used to describe the level of well-being or illness present in a defined population or to describe related attributes or risk factors. Morbidity rate is the frequency that a disease occurs within a population. Mortality rate is the number of deaths in a given area or period. Both morbidity and mortality rates are health status indicators.

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

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

A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth

b. Alcoholism is determined partly by genetic factors. Research demonstrates that genes are responsible for about half of the risk for abuse of alcohol. Multiple genes play a role in a person's risk for the development of alcoholism. Research has not shown that the family environment is the main risk factor for alcoholism. Alcoholism is more common among men than women. Persons who are born with fetal alcohol syndrome are not alcoholics from birth and are likely to have metabolic or other disturbances.

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

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

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

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

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

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

A nurse is caring for a child who has been diagnosed with a chronic health condition. Which of the following conditions would the child most likely have? a. Heart disease b. Down syndrome c. Emphysema d. Arthritis

b. Down syndrome Common chronic conditions seen in children are Down syndrome, spina bifida, cerebral palsy, asthma, ADHD, diabetes, congenital heart disease, cancer, hemophilia, brochopulmonary dysplagia, and AIDS. Heart disease, emphysema, and arthritis are common chronic health conditions of adults, not children

Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up

b. Early detection programs with referral to ongoing access to a care provider Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider. Education for women about breast cancer is not as effective as early detection programs. Screening must be completed which is accomplished through secondary, not primary prevention. Tertiary care does not occur until after diagnosis has occurred, and this is too late.

A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

b. Ensure the individual is educated to make an informed choice about reproduction. The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of preconceptual counseling

A nurse is conducting a screening for type 2 diabetes for children attending a local school. In addition to an elevated BMI, which of the following risk factors should the nurse consider? a. Caucasian descent b. Family history of type 2 diabetes c. Birthweight greater than 9 pounds d. Poverty

b. Family history of type 2 diabetes Screening for type 2 diabetes mellitus is recommended for children with a BMI from the 85th to 95th percentile with two or more for the following risk factors: family history of type 2 diabetes in a first- or second-degree relative; Native American, African American, Latino, Asian American, or Pacific Islander descent; signs of insulin resistance or conditions associated with insulin resistance; or maternal history of diabetes or GDM during the child's gestation. Native American, African American, Latino, Asian American, or Pacific Islander descent is a risk factor, not Caucasian descent. Elevated birthweight and poverty have not been identified by the American Diabetes Association as significant risk factors that indicate the need for additional screening

Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education

b. Harm reduction The harm reduction model is a public health approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. Substance abuse education is only one part of the harm reduction model. Using an approach of punishment and the criminal justice system has not been found to be effective based on research.

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

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

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

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

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

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

Which of the following is of the greatest concern for the nurse who works with high-school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex

b. Motor vehicle accidents Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality among adolescents. Thus, this would be the greatest concern for the nurse working with high-school students. Alcohol use, sports-related injuries, and unprotected sex are not related to the major causes of morbidity and mortality among adolescents. So, although these topics may impact this population, they should not be the priority for the nurse

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

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

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher concerning the child's academic progress? a. Protentional abuse risk b. Possible developmental delays c. Food insecurity d. Susceptibility to infections

b. Possible developmental delays Poverty increases the likelihood of all the options but developmental delays will impact academic progress most severely.

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

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

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

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

A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother's arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home.

b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Fetal alcohol syndrome is a cause of newborn congenital dysfunctions. There is not known tolerance to tobacco smoke. While chewing tobacco doesn't produce smoke, the parents would still be at a considerable health risk from the nicotine.

Which of the following is the most rapidly growing group experiencing poverty? a. Hispanic families b. Women older than 65 c. African-American families d. Single men of all ages

b. Women older than 65 Under the official poverty measure, in 2017, 4.7 million adults ages 65 and older lived in poverty. The rate of increase among seniors increases with age and is higher among women, African Americans, and Hispanics

A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse while demonstrating empathy? a. "I'm so sorry to hear that. Is your mother able to be with you?" b. "It's good that you and the baby are safe from him." c. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" d. "You must hate him for leaving you alone with a new baby!"

c. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. It is inappropriate to assume that the woman wants assistance from her mother. There is no evidence to suggest that the woman or her baby were in danger before he went to prison. Saying "you must hate him" is not appropriate, as it is not the nurse's role to tell the client how she should be feeling

A mother says, "My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and other activities. Do you think I should let him have a car?" Which of the following statements would be the best response by the nurse? a. "Absolutely, it will help him recognize the cost of gas and maintenance." b. "Certainly, most young men want their own car, and peer pressure can be painful." c. "It depends on whether you trust your son to drive safely." d. "No, adolescent males cannot be trusted with an automobile."

c. "It depends on whether you trust your son to drive safely." Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality among adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son. The incorrect responses do not take into account the individual risk factors that the nurse should encourage the mother to consider. The nurse should encourage the mother to think about the risky behaviors specific to this population and how they apply to her son.

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

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

A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a. An advance directive b. A living will c. A durable power of attorney d. A Do-Not-Resuscitate (DNR) order

c. A durable power of attorney Durable power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so. Advance directives is a broad category that includes both living wills and durable power of attorney. A living will allow the client to express wishes regarding the use of medical treatments in the event of a terminal illness. A DNR order is a specific order from a physician not to use cardiopulmonary resuscitation.

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

c. A person who moves from place to place to earn money performing seasonal agricultural work The Office of Migrant Health of the US Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months and who establishes for the purpose of such employment a temporary abode." The emphasis in the definition of migrant farmworkers is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

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

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

Which of the following situations would most likely indicate elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparent's house breaking items. c. A young man repeatedly steals money from his grandmother. d. An elderly person demands that the family come for dinner.

c. A young man repeatedly steals money from his grandmother. Theft or mismanagement of money or resources is an element of abuse. A daughter refusing to visit, children breaking items, and an elderly person demanding that the family come for dinner are not situations that indicate elder abuse. None of these situations should cause alarm for the nurse as they all may normally occur within a family.

Which of the following is the leading cause of disability for adult Americans? a. Accidents b. Arthritis c. Anxiety disorders d. Workplace injuries

c. Anxiety disorders Anxiety disorders are common both in the United States and elsewhere. An alarming 31.1 percent of the adult population will experience an anxiety disorder at some time in their lives (NIMH, 2018). Anxiety disorders may have an early onset and are characterized by recurrent episodes of illness and periods of disability. While the other options can contribute to disability, none are as impactful as anxiety

A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a. Antialcohol program b. Antismoking program c. Careful driving program d. Safe sex program

c. Careful driving program Motor vehicle accidents are the leading cause of death among children and teenagers. The use of tobacco is a leading cause of preventable death among adults, but not among adolescents. Alcohol use and sexually transmitted diseases are not related to common causes of death among teenagers.

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

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

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

c. Directly observing clients with active tuberculosis as they take Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB. Administering skin tests, assessing for signs and symptoms, and interpreting tuberculosis skin test findings are all examples of secondary prevention as these interventions are all focused on screening or the follow-up on a screening test.

A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse

c. Drug dependence Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful.

Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent b. Has not had a PSA test c. Has a father or brother who has had prostate cancer d. Has benign prostatic hypertrophy

c. Has a father or brother who has had prostate cancer Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer. African-American males have a mortality rate from prostate cancer that is nearly twice as high as any other group. The PSA test is not accurate in terms of sensitivity or specificity. This blood test produces many false-positive results because many factors can elevate the PSA. There is no relationship between benign prostatic hypertrophy and the development of prostate cancer

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

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

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

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

A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be most effective? a. Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b. Increase nutrition programs in schools that teach children to make healthy food choices. c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d. Provide after-school and summer camps that focus on diet and exercise

c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant. Changes need to be made at a more direct level, such as by working with the family, to establish a change. Community-level changes may not impact what is happening within the family in regard to diet and exercise.

A nurse is providing nutrition counseling to the parents of a 4-year-old. Which of the following recommendations is the nurse most likely to provide? a. It is recommended that the child consume approximately 10 ounces of grains on a daily basis. b. It is recommended that the child consume approximately four cups of dairy on a daily basis. c. It is recommended that the child consume approximately four cups of fruits and vegetables daily. d. It is recommended that the child consume approximately 10 ounces of protein on a daily basis.

c. It is recommended that the child consume approximately four cups of fruits and vegetables daily. It is recommended that children of 4 to 8 years consume 1-1.5 cups of vegetables and 1-1.5 cups of fruits on a daily basis. It is recommended that children of 4 to 8 years consume 5 ounces of grains on a daily basis. It is recommended that children of 4 to 8 years consume 2-2.5 cups of dairy on a daily basis. It is recommended that children of 4 to 8 years consume 4 ounces of proteins on a daily basis.

If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a. Alcohol b. Guns c. Lack of exercise d. Unprotected sex

c. Lack of exercise Heart disease is the leading cause of death in the United States. Routine physical activity has been found to prevent early death and chronic diseases, including coronary artery disease, stroke, type 2 diabetes mellitus, depression, and some types of cancer. Alcohol, guns, and unprotected sex are not related to common causes of unnecessary death among adults in the United States.

A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? a. Developing lifestyle improvement programs for women at risk for diabetes b. Presenting lifestyle management presentations at women's conferences c. Monitoring blood glucose levels closely and modifying diet accordingly d. Screening glucose levels of women at risk for development of diabetes

c. Monitoring blood glucose levels closely and modifying diet accordingly Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes. Developing lifestyle improvement programs for women at risk for diabetes is an example of secondary prevention as this group is at risk for developing the problem. Presenting lifestyle management at women's conferences is an example of primary prevention, preventing the disease before it occurs. Screening glucose levels is an example of secondary prevention, as all screening tests are secondary prevention.

Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia is considered to have more medical complications than anorexia.

c. Most women with bulimia are concerned with the shape and weight of their body. Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight; purging is associated with bulimia; and anorexia is considered to have more complications than bulimia

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

c. Pesticide poisoning Because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild symptoms of pesticide poisoning including headache, fatigue, dizziness, nervousness, perspiration, loss of appetite, thirst, eye irritation, and irritation of the nose and throat. Severe poisoning symptoms include fever, intense thirst, vomiting, muscle twitches, convulsions, inability to breathe, and unconsciousness. The work setting of a migrant farmer would lead the nurse to first consider pesticide poisoning as a potential underlying cause of these symptoms. However, some of these symptoms could potentially be present with appendicitis, bacterial gastroenteritis, or a viral illness.

A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when and one is unable to continue drinking? a. If their alcohol consumption is the same size, they'll both pass out about the same time. b. Whoever has food in their stomach will probably vomit and be unable to continue drinking. c. The man will likely win because of an inborn tendency to greater alcohol tolerance. d. The woman will likely win due to the tendency to have more adipose tissue.

c. The man will likely win because of an inborn tendency to greater alcohol tolerance. Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men; thus men have an increased tolerance for alcohol. It is also unlikely that they will both "win" at the same time because the alcohol will likely affect the woman factor than the man. The adipose tissue ratio is not a factor in alcohol tolerance. While vomiting may occur, it will not necessarily affect the ability to continue to consume alcohol.

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

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

Which individual has the greatest risk for becoming a member of the vulnerable population of the local community? a. A male diagnosed with a cardiac issue who recently moved in with his adult child b. A single mother who is studying for a law degree at the local university c. A 50-year-old married female who has worked as a server in local restaurants for her entire adult life d. A single male who has a history that includes a learning disability and a parent diagnosed with type 2 diabetes

d. A single male who has a history that includes a learning disability and a parent diagnosed with type 2 diabetes The WHO, consistent with Healthy People 2030, describes three overall determinants of health to be (1) the social and economic environment, (2) the physical environment, and (3) the person's individual characteristics and behaviors. The WHO also notes that individuals are unlikely to be able to directly control many of the determinants of health, and this is directly related to vulnerability. The seven WHO factors are as follows (WHO, 2015, pp. 1-2): 1. Income and social status: Higher income and social status are associated with better health. 2. Education: Low education is linked with poor health, more stress, and lower self-confidence. 3. Physical environment: Safe water and clean air; healthy workplaces; safer homes, communities, and roads; and good employment and working conditions, especially when the person has more control, all contribute to good health. 4. Social support networks: Family, friends, and community as well as culture, customs, traditions, and beliefs affect health. 5. Genetics, as well as personal behavior and coping skills, affect health. 6. Health services: Access and use of services affect health. 7. Gender: Men and women suffer from different types of diseases at different ages The single male with a history of learning disabilities and a family history of type 2 diabetes has several potential risk factors including those related to his social support network (being single); learning disabilities (effecting education and possible low self-esteem); and a first degree family history of a chronic disease (type 2 diabetes). While the life stories in the remaining options present the individual with risks, none have multiple risks like the male depicted in the correct option.

A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a. Patient Self-Determination Act b. Personal Responsibility and Work Opportunity Reconciliation Act c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA)

d. Family and Medical Leave Act (FMLA) The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member. The Patient Self-Determination Act requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. The Personal Responsibility and Work Opportunity Reconciliation Act is commonly known as "welfare reform." This law created the TANF program. The Temporary Assistance for Needy Families program is a work program that mandates that women heads of households find employment to retain their benefits.

An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice

d. Hospice Hospice would be the best form of care for a person in the last stages of dying. The other options are not specifically designed for persons in the last stages of dying. Home health provides care in the home, but is not specific to meet the needs of the dying patient and his or her family. Assisted living relates to a living situation where the client receives different amenities depending on the level of care needed. This type of living arrangement is not specific to care for the dying patient. Nursing homes provide long-term care and are not specific to care needed for a dying patient.

Which of the following statements best describes why health care of the homeless is so expensive to the community? a. Health conditions of the homeless require increased preventive services. b. Homeless clients typically make more clinic visits for multiple health problems. c. Homeless people are a major source of spread for contagious diseases. d. Most care to homeless people takes place in hospital emergency departments.

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

Which of the following behaviors results in men being less healthy than women? a. Concentration on sports, hunting, and other dangerous recreational choices b. Employment in stressful positions more so than women c. Preference to spend money on priorities other than health care d. Reluctance to visit health care providers

d. Reluctance to visit health care providers A major obstacle to improving men's health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of US men see a doctor, nurse practitioner, or physician assistant compared with 74% of women (AHRQ, 2010). Hobbies, employment, and preference on how to spend money may influence a man's decision to seek medical care. However, these have not been identified as major obstacles in comparison to overall reluctance to seek care.

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

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

A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this agency? (Select all that apply.) a. Delegating power to engage in certain activities such as quarantine b. Enforcing laws and regulations that protect public health c. Filing birth and death certificates whenever these occur within the state d. Monitoring health status of citizens within its geographic boundaries e. Fund and conduct a school eye screening

A, B, D, E State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. These agencies receive funding from federal agencies for the implementation of public health interventions such as the maternal and child health programs. State agencies distribute federal and state funds to the local public health agencies to implement programs and provide oversight and consultation for local public health agencies. State health agencies also delegate some public health powers, such as the power to quarantine, to local health officers. Local departments file birth and death certificates and often ask for volunteers to assist.

Which of the following factors may lead to increased violence? (Select all that apply.) a. Minimal social support b. Feelings of powerlessness c. Violence shown in the media d. Living in a crowded environment e. A history of depression

A, B, C, D Factors that increase violence include seeing violence in daily life or in the media, living in poverty with few opportunities for employment, and feelings of powerlessness. Crowded environments can be a factor but can also lead to banding together for the common good. While social support is a positive factor, an insufficient amount may lead to increased violence. Depression is not necessarily a trigger for violence.

A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following strategies would the nurse suggest the mother implement? (Select all that apply.) a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. d. Encourage her daughter to develop new friendships. e. Encourage her to discuss her dreams for the future.

A, B, C, E Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategies: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic appraisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions. Based on the information provided, there is no reason to suggest the child needs to develop new friendships. Keeping consistent friendships may provide the support the child needs to avoid engaging in these behaviors.

Which of the following describes how occupational health nursing differs from other nursing specialties? (Select all that apply.) a. It is autonomous because the occupational nurse works independently. b. The major focus is on the environment. c. Nurses focus on health promotion and disease prevention. d. Nursing care is given in the community. e. A focus is directed toward restoration of health.

A, B, E Occupational health specialty practice focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment. It involves the prevention of adverse health effects from occupational and environmental hazards. It provides for and delivers occupational and environmental health and safety services to workers, worker populations, and community groups. It is an autonomous specialty, and nurses make independent nursing judgments in providing health care. All nurses should engage in health promotion and disease prevention, and many specialties provide care in the community.

Which of the following activities are included in the Centers for Disease Control and Prevention's school health program? (Select all that apply.) a. Ensuring a healthy school environment b. Assisting teachers with education related to health c. Encouraging nutritious school meals d. Giving immunizations to students, staff, teachers, and their families e. Providing mental health counseling

A, B, C, E The federal government, through the coordination of the Centers for Disease Control and Prevention, developed a plan that school health programs should follow, including health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff, and family/community involvement. Unfortunately, schools cannot afford to give immunizations to everyone who might want such a benefit.

A home health client has been prescribed acetaminophen with codeine every 4 hours for pain following a hip arthroplasty. Which of the following statements made by a nurse to the client's primary health care provider indicates a need for further education on narcotics related to the goals of safe pain management? (Select all that apply.) a. "Please consider decreasing the time interval between doses to every 3 hours so that my client will maintain pain relief." b. "I'm really concerned my client will become addicted to the codeine." c. "Consider prescribing a different medication so that my client will achieve adequate pain relief." d. "My client needs a prescription for PRN medication for 'breakthrough' pain." e. "This medication is expensive; please prescribe something less costly."

A, B, D It would not be appropriate to ask to decrease the time interval in between doses as the increased use of acetaminophen may be damaging to the client's liver and kidneys. There is no evidence that this client is at risk for developing an addiction. Thus, demanding that this medication be discontinued may be a premature action by the nurse. However, the nurse should monitor the patient closely for signs and symptoms of potential addiction. It would be appropriate to ask the primary care provider for an additional medication in the form of a PRN prescription to possibly assist with the client achieving optimal pain relief rather than changing medications entirely. Although it is a factor, the cost of pain medication isn't a consideration when addressing safe pain management interventions.

A nurse is preparing to educate a group of nursing students on cultural perspectives in nursing. The nurse should include that which of the following factors are influenced by an individual's culture? (Select all that apply.) a. Nutritional practices b. Family structure c. Genetics d. Health care interactions e. Views about health and illness

A, B, D, E

A school nurse would like to improve the safety of everyone at the school by creating policies to decrease the likelihood that violence will occur. Which of the following actions would the nurse likely take to minimize risk of school violence? (Select all that apply.) a. Engaging parents in school activities b. Creating a zero tolerance police for weapons on school property c. Encouraging children to participate in the after-school program at a local community center d. Developing mentoring programs for at-risk youth e. Initiating a student hot line for discussing possible violence risks

A, B, D, E Interventions that are aimed at preventing violence from occurring are: engaging parents in school activities that promote connections with their children; fostering communication, problem solving, limit setting, and monitoring of children; supporting/assisting with creating policies of zero tolerance for weapons on school property, including school grounds; and developing mentoring programs for at-risk youth and families. Encouraging students to attend the after-school program at a local community center may assist with the students having additional supervision, but it does not contribute to the students having an increased loyalty or connection to the school. It is important to facilitate student connectedness to the school community.

An occupational health nurse should be aware of which of the following trends in the marketplace? (Select all that apply.) a. A majority of new jobs will be in service-oriented employment. b. Employees will often have longer hours within a compressed work week. c. Jobs are shifting from service to manufacturing. d. Many employees will be older and suffer chronic health problems. e. Reduced job security is common.

A, B, D, E Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. The workforce will become older, including many employees with chronic health problems. The US economy was once based on agriculture, then primarily on manufacturing, and now on highly technological positions. Currently, service-providing positions account for virtually all job growth; soon almost one of every two worker jobs will be in service positions

A nurse is helping a client's family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client's family members would be most effective? (Select all that apply.) a. "Express your belief in him and his ability to change." b. "Point out that his behavior is his choice and his responsibility." c. "Let him know that you understand how much he loves being with his drinking pals." d. "Remind him that entering treatment is better than going to prison." e. "Let him know that he is loved by his family and friends."

A, B, E Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person's own personal Responsibility for any changes made, and give Advice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of self-efficacy. Having the client's family members tell the father that they understand his behavior does not encourage him to realize the need for change. Threatening a future possibility of prison would not provide encouragement to the father and may even challenge him to continue his behavior

A community health nurse is educating the public on the agents of bioterrorism. Which of the following agents should the nurse include in the education? (Select all that apply.) a. Small Pox b. Rotovirus c. Botulism d. Anthrax e. Lyme disease

A, C, D

A nurse is developing a community-based activity aimed at preventing substance abuse in the community. Which of the following interventions would the nurse most likely implement? (Select all that apply.) a. Supporting an increase in the availability of recreational facilities b. Lobbying to state legislators to approve a higher cigarette tax c. Educating all middle school students about the long-term side effects of drugs and alcohol d. Providing general screenings for sustance abuse e. Educating community members on the importance of safe driving practices

A, C, D,

A nurse is developing a community-based activity aimed at preventing substance abuse in the community. Which of the following interventions would the nurse most likely implement? (Select all that apply.) a. Supporting an increase in the availability of recreational facilities b. Lobbying to state legislators to approve a higher cigarette tax c. Educating all middle school students about the long-term side effects of drugs and alcohol d. Providing general screenings for substance abuse e. Identifying community-based resources that deal with substance abuse issues

A, C, D, E Supporting an increase in additional recreational facilities would engage the community members in healthy activities rather than having them potentially turn to substances for relaxation. Providing screenings for substance abuse in the community may assist community members in recognizing the problem sooner. It would be appropriate to educate middle-school students about the long-term side effects of drugs and alcohol since they would be able to understand the information. Early intervention with education is a proven deterrent to substance abuse. Lobbying state legislators for increase in a higher cigarette tax may be beneficial, but this intervention is focused on the state rather than the community where the nurse is working. Identifying local resources where assistance and addition information about substance abuse issues can be found is an appropriate community-based intervention.

Which of the following activities are addressed by most public health departments on the federal, state, and local levels? (Select all that apply.) a. Collecting and analyzing various health statistics b. Fining any facility that engages in unsafe commercial practices c. Identifying and planning for high-risk populations d. Planning for and responding to emergencies e. Providing health assessments to older adults after a hurricane

A, C, D, E The majority of local, state, and federal public health agencies engage in collecting and analyzing vital statistics, providing health education and information, receiving reports about and investigating and controlling communicable diseases, protecting the environment to reduce the risk to health, providing some health services to particular populations at risk, planning for and responding to natural and human-made disasters and emergencies, identifying public health problems for at-risk and high-risk populations, conducting community assessments to identify community assets and gaps, and partnering with other organizations to develop and implement responses to identified public health concerns. Public health departments do not regulate the practices of businesses; thus, they would not be responsible for fining or terminating businesses.

Which of the following emergency supplies or equipment should a nurse have available in the school health office? (Select all that apply.) a. Cervical spine collars b. Complete emergency kit that fulfills American Hospital Association requirements c. Epinephrine autoinjector kit d. Material for splints e. Supplemental oxygen

A, C, D, E The school nurse needs much equipment to deal with emergencies in the school. Basic necessary equipment includes full oxygen tanks with oxygen masks of different kinds, splints, cervical spine collars, sterile dressings, and an epinephrine autoinjector kit in case a child goes into anaphylactic shock after exposure to an allergen. A hospital-oriented emergency kit would become quickly outdated (medications) and extremely expensive.

A new student's parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the student twice. Which of the following actions should be taken by the nurse to keep the child in school? (Select all that apply.) a. Call the parents or mail another reminder. b. Report the problem to the teacher and the principal. c. Send the child home with a note saying the child cannot return until the immunization record is received. d. Determine whether the family has health care insurance. e. Offer assistance in replacing a lost immunization record

A, D, E There are many problems with children not being immunized or having incomplete vaccination records, especially in families who have moved many times or who may not have a regular physician. The parents may have no idea whether the child has received the required shots. Families may also be without health care insurance to pay for the immunizations, or they may have insurance that does not pay for preventive care. In these cases, they may lack the resources to pay for the immunizations themselves. Therefore, the nurse's role is to be sure parents are aware of the problem, to help them obtain the records if they have been misplaced, and to suggest ways to obtain the injections without charge, even if there is no obvious evidence that lack of funds is the problem. Telling the teacher or principal won't resolve the problem. Sending home a note saying the child cannot return to school does not assist the family with obtaining the immunization for the child which may be a burden for the family or a potential underlying reason why the child has not received the immunization.

A occupational health nurse at an industrial facility is performing an occupational health history the employees. Which of the following information should the nurse ask during the occupational health history? (Select all that apply.) a. Work process b. Past exposures to specific agents c. Past jobs of individuals d. Current job title e. Requirements of various jobs

B, C, D

What did events after September 11, 2001, clearly demonstrate? (Select all that apply.) a. A strong public health structure ready to respond effectively to a crisis b. Public health's need for additional funding and resources c. The unrecognized importance of nurses in lowering health care costs d. Lack of adequate vaccines to meet community's needs e. The need for public education regarding bioterrorism attacks

B, C, D, E The anthrax exposures after 9/11 alerted policymakers to the weakening public health infrastructure required to respond to bioterrorism events. Unprecedented influenza, tetanus, and childhood vaccine shortages and emerging infections competed with bioterrorism activities for resources. The general public was not informed about how immunizations by nurses improved health and lowered health care cost. For public health services to receive adequate funding, it is necessary for the public and the government to be aware of the benefits provided to a community by nurses. These events showed that the public health system needed to be strengthened in order to operate effectively to keep the public safe.

An occupational health nurse is consulting with senior management of a local factory. When discussing work related illness and injury, the nurse should include which of the following as environmental factors? (Select all that apply.) a. Age b. Lighting c. Temperature extremes d. Health status e. Noise

B, C, E

An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information? (Select all that apply.) a. To assess how others have rated the company in relation to employment there b. To compare the prospective employer's injury rate with similar employers' rates c. To learn more about the usual processes and products of the company as well as typical hazards d. To learn how employees feel about their employer e. To identify useful information about the employer

B, C, E All business organizations are classified within the North American Industry Classification System (NAICS) with a numerical code indicating a company's product and, therefore, the possible types of occupational health hazards that may be associated with the processes and materials used by its employees. NAICS codes are used to collect and report data on businesses. For example, illness and injury rates of one company are compared with the rates of other companies of similar size with the same NAICS code to determine whether the company is having an excess of illness or injury. By knowing the NAICS code of a company, a health care professional can access reference books that describe the usual processes, materials, and by products of that kind of company. The NAICS code indicates a company's product, not how others or their employees have rated them as an employer

A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the child turns 16, which of the following actions is the school responsible for? (Select all that apply.) a. None, since the child is no longer eligible for school services b. Continuing to provide needed appropriate education for the child c. Excluding the child from selected extracurricular activities d. Continuing to prepare an updated individualized education plan e. Arranging for reimbursement for services provided

B, D Educational services must be offered by the schools for all disabled children from birth through age 22 years. Children cannot be excluded from activities because of a disability. The school must always develop an individualized education plan for each child and update it at appropriate intervals. Turning 16 does not make a child an adult; thus, the child is still able to receive services of the school and participate in extracurricular activities.

Which of the following best explains why the federal government is beginning to fund school-based health centers? (Select all that apply.) a. These centers help young children avoid becoming addicted to drugs while still in elementary school. b. Attendance and learning are higher in schools with health clinics. c. These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. d. Many children have no other source of health care services. e. To ensure parents are compliant with meeting the health needs of their children

B, D The US government began funding school-based health centers essentially because many schoolchildren may not receive health care services otherwise. These are family-centered, community-based clinics run within the schools. Certainly, avoiding pregnancy and drug addiction are among the goals of school-based health centers, but these are not reasons the government began funding them. Ensuring compliance is not a governmental responsibility in this situation since no federal laws apply.

Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers? (Select all that apply.) a. To fulfill their ethical and moral responsibility b. To avoid the cost of liability suits, workers' compensation, etc. c. To maintain good public relations d. To meet enacted legislated standards e. To avoid significant penalties for noncompliance

B, D, E Legislation at the federal and state levels has had a significant effect on efforts to provide a healthy and safe environment for all workers. OSHA employees have distributed citations to companies that do not meet minimal occupational health and safety standards. Criminal charges have been filed against business owners when preventable work-related deaths have occurred. Another important stimulus for health and safety programs is the desire to avoid the cost of liability and workers' compensation claims and other expenses when employees are injured or killed. Having a healthy and safe environment for workers should provide the public with a positive image of the company; however, this is not a primary reason employers ensuring this type of an environment.

Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace? (Select all that apply.) a. All chemicals are inherently dangerous to humans. b. Chemicals are often used when natural substances are equally effective. c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown. e. It is difficult to accurately predict the reaction of chemical contact

C, D, E Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. A variety of chemicals are found in the body tissues of the general population. Daily, low-level doses of chemicals may be below the exposure standards but may still carry a potentially chronic and perhaps cumulative assault on workers' health. Predicting human responses to such exposures is further complicated because several chemicals are often combined to create a new chemical agent. Human effects may be associated with the interaction of these agents rather than with a single chemical. Another concern about occupational exposure to chemicals is reproductive health effects. Not all chemicals are dangerous; however, less than 0.1% of them have been adequately studied for their effects on humans. There is no evidence to support the statement that chemicals are being used when there are other natural substances available.

A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best assist the client with healing? (Select all that apply.) a. Advocating for increased support for elderly persons b. Eliminating signs and symptoms of disease c. Managing any chronic diseases to prevent complications and delay deterioration d. Maximizing self-care capacity e. Focusing on achieving quality of life

C, D, E With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity. It is probably impossible to eliminate signs and symptoms of the disease with a client who has a chronic disease. Advocating for increased support for elderly persons is not related to assisting the client with healing from the chronic disease.

Education on flu transmission

Primary prevention

Hand washing

Primary prevention

Immunization

Primary prevention

Staying out of crowded areas during flu season

Primary prevention

Screening migrant farm workers for TB

Secondary Prevention

Collecting blood to screen for lead poisoning

Secondary prevention

Screening questionnaire for depression

Secondary prevention

Diabetes Management course

Tertiary prevention

Pulmonary rehab for COPD patients

Tertiary prevention

Push fluids and acetaminophen for febrile patients

Tertiary prevention

The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned that the student will be required to be homeschooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? a. "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." b. "I realize that this will be a difficult adjustment, but homeschooling has improved over recent decades and the Internet will allow your child to connect with friends." c. "Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue." d. "Your child may remain in school as long as he can manage the course requirements and doesn't flunk out."

a. "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." Federal legislation specifies that children cannot be excluded from schools because of a disability. The school must provide health services that each child needs. Legislation further requires the school district's committee on the disabled to develop individualized education plans (IEPs) for children. Federal legislation will support this child continuing in the current school; thus, it would not be necessary to counsel the parents about concerns related to the child needing to be homeschooled. Depending on the diagnosis, special educational needs may need to be addressed for the child through an IEP which may assist the child in being successful in the coursework.

The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an applicant would most likely result in the applicant not being hired? a. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." b. "I prefer to work in teams because no single person has too much responsibility because the burden is shared." c. "Teamwork is better than work done by individuals because teamwork incorporates different perspectives." d. "Whether teamwork is better than work done by individuals depends on the nature of the work being performed."

a. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." An applicant who does not like to work in and with teams would not be appropriate to fill this position. Teamwork is a necessary skill when working as a public health nurse. Working in collaborative partnerships is an essential role of public health nursing. Partnerships and collaboration among groups are much more powerful in making change than the individual client and nurse working alone. Part of the reason is that multiple perspectives are examined in the process of coming to the best solution.

Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder abuse? a. "Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." b. "Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us." c. "She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake." d. "We have to feed Mom baby food now because she has trouble chewing and swallowing regular food."

a. "Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." Giving medication to induce confusion or drowsiness so that the elders will be less troublesome or will need less care is considered a form of elder abuse. Such medication may also make it easier for adult children to control the elder's assets. The incorrect responses are all examples of proper care.

A nurse is helping to triage a group of clients at a mass casualty incident who were involved in an explosion at a local factory. Which of the following clients should the nurse select to be the priority for care? a. A client who has a piece of wood punctured into the chest wall and has an audible hissing so b. A client who has severe head injuries, respiratory rate 6/min, and is unresponsive c. A client who has a simple fracture of the femur, multiple scratches on both legs, and is crying hysterically d. A female who is pregnant at 20 weeks of gestation, has multiple cuts and abrasions, and is walking around

a. A client who has a piece of wood punctured into the chest wall and has an audible hissing so

7. A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? a. A combination of interventions, beginning with changing the environment b. Acupuncture to reduce the nicotine cravings c. Behavior modification through hypnosis d. Nicotine replacement product

a. A combination of interventions, beginning with changing the environment The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker's environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases. Acupuncture, behavior modification, and nicotine replacement products may all assist the client in stopping smoking. However, it has been demonstrated that the most effective method involves a combination of strategies.

A school nurse is administering medications at the school. Which of the following guidelines should be followed? a. A current drug reference should be available in case information is needed. b. The nurse should administer medications brought in from home by the child in a plastic bag. c. Medications cannot be administered without a physician order. d. Narcotics and controlled substances should be kept in a locked cabinet.

a. A current drug reference should be available in case information is needed. A current drug reference should always be available so that it can be consulted for information. The nurse should develop a series of guidelines to help with the legal administration of medications in the school. The prescribed drugs should have the original prescription label on it and be in the original container. There should be a current, signed parental consent form for giving the medication, and the nurse should have a means of contacting a pharmacist to ask questions. A primary care provider's order is not needed to administer the medications. All medications, including narcotics, should be kept in a locked container so that they are not accessible to others.

A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a. A durable power of attorney b. A living will c. An advanced directive d. A Do-Not-Resusciate (DNR) order

a. A durable power of attorney

Which of the following persons is most likely to be assaulted? a. A young man b. A young woman c. An older man d. An older woman

a. A young man Men are far more likely to be assaulted or killed than are women. The greatest risk factor for an individual's victimization by violence is age; youths are at significantly higher risk

A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a. Accidents and iniuries b. AIDS c. Childhood obesity d. Vaccine-preventable diseases

a. Accidents and iniuries

A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect? a. Lack of weight gain and wearing dirty clothes b. Lice in the hair c. Failure of parent to attend parent-teacher conferences d. Bruises in various stages of healing

a. Lack of weight gain and wearing dirty clothes

A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which of the following roles is the nurse preforming? a. Advocate b. Case manager c. Outreach worker d. Primary caregiver

a. Advocate As an advocate, the nurse collects, monitors, and analyzes data and discusses with the client which services are needed and whether the client is an individual, a family, or a group. When using the role of case manager, the nurse assists in providing equal access to health care by identifying and alerting the community to gaps in services available. As an outreach worker, the nurse addresses the multiple needs of high-risk populations. Nurses provide direct client care when using the role of primary caregiver.

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

a. Advocate/Apply for a grant to fund a mobile clinic to take health care to the clients.

Three female clients were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? a. Alcohol blood level b. Cardiac workup c. Pregnancy test d. STI tests

a. Alcohol blood level Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. Because of the high rate of alcohol involvement in injuries seen in trauma centers, an alcohol blood level would be most important. A cardiac workup, pregnancy test, or STI test would not be the priority.

A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion? a. Anxiety, depression, and exhaustion b. Family turmoil c. Physical illnesses d. Sleeping disorders

a. Anxiety, depression, and exhaustion An estimated 10% of Americans do some form of shift work that has the potential to lead to a variety of psychological and physical problems, including exhaustion, depression, anxiety, and gastrointestinal disturbance. Strategies to minimize the adverse effects of shift work, such as rotating shifts clockwise, are beneficial. Family turmoil, physical illnesses, and sleeping disorders all have the potential to occur. However, there is evidence that anxiety, depression, and exhaustion are the more prevalent physical and psychological problems that are reported

Which of the following best describes the role of nursing in community health? a. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities b. Health care provision offered in primary and secondary institutions or in the client's home c. Provision of health care services in institutions located in the community but outside the hospital d. Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement

a. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities Nursing practice in community health is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of practice is health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole. Healthy People 2020 addresses the role of multiple disciplines in improving the health of the population; thus, it does not use the nursing process or is specific for the nursing profession.

A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor? a. Each sick nurse b. The communicable disease c. The hospital d. The patient

a. Each sick nurse Each worker represents a host within the worker population group. The communicable disease and the patient are considered the agent, the factor associated with the illness or injury. The hospital is part of the physical environment.

A community health nurse is conducting an educational program on various environmental pollutants. The nurse should emphasize that clients who have which of the following disorders are especially vulnerable to ozone effects? a. Asthma b. Hypertension c. Diabetes d. Osteoporosis

a. Asthma

A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a day care center being the first location. What of the following advice should be given to them by their instructor? a. Base the program on the audience's development and maturity. b. Bring (borrow if necessary) a model of the heart to help explain its functioning. c. Focus on entertaining the learners. d. Have lots of handouts to reinforce the lesson.

a. Base the program on the audience's development and maturity. For younger learners, it is important to keep the lesson to no more than 20 minutes in length; to use plenty of examples, pictures, and stuffed animals in the talk; and to remember the developmental stage of the children when teaching them. It will be important for the nurse to assess the developmental level of the audience in order to determine if models or handouts are appropriate to be used. Keeping the presentation short should assist in keeping the learner's attention.

A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services. If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse? a. Call in another nurse to care for this client. b. Explain, from the nurse's perspective, all the reasons that abortion should be made illegal. c. Offer the student a combination of oral contraceptives to induce spontaneous abortion. d. Provide information on alternatives to abortion and give the client information on adoption agencies

a. Call in another nurse to care for this client. This creates an ethical dilemma for the nurse. If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help or the student should be referred to other health providers who can provide the care the student needs. It is important that the nurse be able to keep an open mind when working with this teen, and if that is not possible, another nurse needs to be asked to care for this client. The incorrect options all address the nurse discussing his or her personal beliefs against abortion which may not be therapeutic for the teen.

A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a. Careful driving program b. Antialcohol program c. Antismoking program d. Safe sex program

a. Careful driving program

A nurse is preparing a community health program for adults at risk for cardiovascular disease. Which of the following should the nurse include as a modifiable risk factor? a. Cigarette smoking b. Increasing age c. Diagnosis of diabetes mellitus d.Family history of cardiac disease

a. Cigarette smoking

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a. Community A- with 44 single teenage pregnancies in a city of 500 b. Community B- with 45 single teenage pregnancies in a city of 1000 c. Community C- with 90 single teenage pregnancies in a city of 2000 d. Community D- with 75 single teenage pregnancies in a city of 1500

a. Community A- with 44 single teenage pregnancies in a city of 500

Research has shown that vaping increases an individual's risk for contracting what disease five-fold? a. Covid-19 b. Gingivitis c. Mouth cancer d. Oral herpes

a. Covid-19

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

a. Directly observing clients with active tuberculosis as they take their antitubercular medications

Which of the following factors is causing nursing to change so quickly? a. Economic issues b. Increases in medical and nursing knowledge c. Legislative issues d. Technology changes

a. Economic issues More than any other single factor, the driving force behind nursing changes is the economy and the increase in managed care to decrease or control health care costs in the United States. Changes in technology and knowledge are not influencing the rapid change in nursing knowledge. Legislative issues are not influencing nursing practice.

A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? a. Educate students about injury prevention measures. b. Provide free condoms to sexually active students. c. Screen for signs and symptoms of cancer. d. Invite a guest speaker to talk about living with HIV.

a. Educate students about injury prevention measures. Injuries are the leading cause of death in children and teenagers; therefore, preventive measures should focus on injury prevention. Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety. Providing free condoms to sexually active students would be a secondary prevention intervention as these students are at risk to contract a sexually transmitted disease. Screening for signs and symptoms of cancer is an example of secondary prevention, aimed at early detection. Inviting a guest speaker to speak about HIV would address primary prevention, but it does not address the leading cause of death among children.

Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Harm reduction b. Criminal justice system c. Punishment approach d. Substance abuse education

a. Harm reduction

An elderly person is in the last stages of dying. Which type of care would be best for him? a. Hospice b. Home health c. Assisted living d. Nursing home

a. Hospice

Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB? a. Housekeeping staff b. Medical staff c. Nursing staff d. Ward clerks

a. Housekeeping staff Transmission of tuberculosis (TB) within health care settings has reemerged as a major public health problem. Outbreaks of this type of TB have been reported in hospitals, and some workers have developed active drug-resistant TB. Many workers in these settings are employed as maintenance workers, security guards, aides, or cleaning people, who tend not to be well protected from inadvertent exposures, which include contaminated bed linen in the laundry, soiled equipment, and trash containing contaminated dressings or specimens. Ward clerks have limited contact with acutely ill patients. Medical and nursing staff are more likely to have the proper equipment and education to be well-protected from inadvertent exposures

Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation? a. New workers employed less than 1 year b. Older workers with chronic illnesses c. Older workers with diminished hearing d. Women in their childbearing years

a. New workers employed less than 1 year The population group at greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job. Because of the inherent risks, the nurse should spend extra time with this group to decrease risk. Older workers with more experience are less likely to experience injury even if they have underlying issues of chronic disease. Women of childbearing age are not at any greater risk than the general population of employees.

The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the following would be the best action to take to improve client outcomes? a. Offer daily access to a room with soap, water, and bandages. b. Provide antibiotics to all homeless persons with chronic, non-healing wounds. c. Educate the client on the importance of good nutrition d. Perform regular monitoring of the client's blood pressure.

a. Offer daily access to a room with soap, water, and bandages.

A nurse is trying to identify mental health problems among older adults. Which of the following interventions should the nurse implement initially? a. Organize screening programs offered at senior centers. b. Provide information on mental health resources in the community. c. Teach the elderly to self-monitor for signs and symptoms of depression. d. Teach older clients to focus on their strengths rather than their weaknesses.

a. Organize screening programs offered at senior centers.

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Perform a windshield survey. b. Survey community members. c. Review facility permits and consumer confidence reports. d. Conduct health risk assessments of randomly selected individuals.

a. Perform a windshield survey.

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

a. Pesticide poisoning

Which of the following factors has the largest impact on health disparities among all populations? a. Poverty b. Ethnicity c. Education level d. Lifestyle choices

a. Poverty

The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

a. Primary Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol. Secondary prevention involves screening and intervening with at risk populations. Tertiary prevention aims for rehabilitation and returning to the highest functioning possible.

A public health nurse is assessing an older adult client who lives with a family members. The nurse identifies several bruises in various stages of healing. The client and family member explain that the bruises are a result of clumsiness. However, based on the distribution of the bruises, the nurse suspects abuse. Which of the following actions should the nurse take first? a. Report the findings to a supervisor. b. Document the client's vitals in the chart. c. Provide the client with a crisis hotline number. d. Discuss respite care with the client's family.

a. Report the findings to a supervisor.

A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying to much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? a. Report the incident to child protective services or other appropriate legal authority. b. Abide by the mother's wishes because this information was provided in confidence. c. Arrange for counseling for the boyfriend at the earliest possible availability. d. Encourage the mother to take the child and find alternative housing right away.

a. Report the incident to child protective services or other appropriate legal authority.

A nurse offers homeless clients yearly tuberculosis (TB) screening. Which of the following level of prevention is being used? a. Secondary b. Primary c. Tertiary d. Secondary and tertiary

a. Secondary

An occupational health nurse in the clinic of an industrial plant is developing a guidebook for clinic workers. Which of the following actions should the nurse include as primary prevention? a. Set up an influenza immunization clinic. b. Collaborate with physical therapists to develop programs for injured employees to return to work. c. Screen employees for high blood pressure. d. Conduct a diabetes management education session for employees with diabetes.

a. Set up an influenza immunization clinic.

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

a. Short length of time in the community

A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program for teens. Which of the following is the school nurse most likely trying to prevent? a. Suicide b. Bullying c. Obesity d. Violence

a. Suicide Among teenagers, more than 17 percent have considered suicide and more than 8 percent have actually attempted to take their own lives (Substance Abuse and Mental Health Services Administration). To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses. Bullying may result in adolescents feeling that suicide is the only answer. However, the strategies that the nurse is completing would not necessarily promote a decrease in bullying. The strategies suggested would not impact the prevalence of obesity or the incidence of violence.

The home health nurse is planning his rounds for the day. Which client should the nurse plan to see first? a. The 56 year old client diagnosed with multiple sclerosis who is complaining of a fever and cough b. The 78 year old client diagnosed with congestive heart failure who reports losing 3 pounds. c. The 42 year old client diagnosed with an L-5 spinal cord injury who has developed a stage 4 pressure injury. d. The 80 year old client with a cerebral vascular accident (CVA) who has chronic right-sided paralysis.

a. The 56 year old client diagnosed with multiple sclerosis who is complaining of a fever and cough

An employee in a laboratory drops a flask, resulting in a chemical splash into the employee's eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent? a. The chemical b. The employee c. The flask d. The laboratory

a. The chemical Agents represent potential dangers or risks to the health and safety of workers. However, in the case given, the chemical itself caused the damage. If the flask had broken and glass got into the employee's eye, then the flask would be an agent. However, in the case given, the chemical itself caused the damage. The employee is considered the host and the laboratory is considered part of the environment.

A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 32. Which of the following goals should the nurse include? a. The client will walk for 30 min 5 days a week b. The client will list foods that are high in calcium, which should be avoided c. The client will in crease calorie intake by 200 cal per day. d. The client will replace cigarettes with vaping products.

a. The client will walk for 30 min 5 days a week

Which statement best describes the role of the parish nurse? a. The parish nurse practices holistic healthcare within a faith community b. The parish nurse cares for clients in a religious-based hospital c. The parish nurse practices nursing in a parish clinic. d. The parish nurse is a licensed practical nurse (LPN) who cares for clients in the home

a. The parish nurse practices holistic healthcare within a faith community

A charge nurse is discussing the phases of community response to disaster with nursing staff. Which of the following statements indicates an understanding of the disillusionment phase of disaster response? a. Time has elapsed and a delay in relieving help or failure to receive the promised aid has not occurred, feelings of despair arise. b. Victim bonding, survivor meetings, people being to tell their stories and b c. Nearly everyone feels the need to rush help d. The community has restored some sense of normalcy

a. Time has elapsed and a delay in relieving help or failure to receive the promised aid has not occurred, feelings of despair arise.

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

a. Vulnerable populations

During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client indicates a lack of insight into his violent behavior? a. "I have been taking out my frustrations with work on my girlfriend." b. "I love my girlfriend and didn't want to hurt her; it was an accident." c. "It might be a good idea for me to temporarily leave the house when I feel myself becoming angry." d. "When I drink alcohol, I become more abusive toward my girlfriend."

b. "I love my girlfriend and didn't want to hurt her; it was an accident." Violence is defined as those nonaccidental acts that result in physical or psychological injury. Although this client may now be feeling remorse, at the time the violent act was committed against the girlfriend, the intent was to inflict harm and maintain control. It was not an accident. The incorrect statements indicate an admission of a problem—at least on the surface

Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child? a. "I have stopped using a switch on my child, and I am learning to count to 10 before reacting." b. "I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." c. "I use time-outs when my child acts out or is naughty. Sometimes my child doesn't cope well with this, but I am persistent." d. "When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are."

b. "I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." Emotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. Yelling at a child and threatening loss of love are devastating. Counting to 10 before reacting, using time-outs, and distraction all display positive methods of discipline.

An upset mother calls the school nurse and says, "How dare you say my child has lice? My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? a. "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." b. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." c. "You may have been traveling. Lice are often found in motels." d. "I'm sure you're correct; one of my volunteers probably made an error. I'll recheck."

b. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life threatening, and the necessary shampoo and other items to treat lice are widely available over the counter. Most school policies are more caring and less exclusionary and allow children with lice to attend school. It is more likely that the student contracted the lice from another student than from traveling to a motel. If the nurse has delegated the responsibility of assessing for lice to a volunteer, the nurse should reassess the findings of the volunteer to confirm that the child has lice before contacting the parent.

Which of the following is the leading cause of children being absent from school because of a chronic illness? a. Allergies b. Asthma c. Diabetes d. Upper respiratory infections

b. Asthma Asthma is one of the leading causes of children being absent from school because of a chronic illness. Upper respiratory infections are an acute problem, not a chronic one. Diabetes and allergies are not leading causes of chronic disease that result in children being absent from school.

A nurse is applying for a public health nurse position at a local health department. Which of the following minimum levels of educational preparation should the nurse have obtained? a. Associate degree in nursing b. Baccalaureate degree in nursing c. Master of science degree in nursing d. Training as a licensed practical nurse

b. Baccalaureate degree in nursing Educational preparation of nurses in community health should be at least a baccalaureate degree. Nurses need this level of education because of the increasing complexity of better care delivery in public health. A licensed practice nurse would need supervision for a registered nurse and would not be able to practice autonomously in this setting. Those registered nurses who have associate degrees are encouraged to seek further degrees because of the increasing complexity of better care delivery in public health. A master's degree would be even more useful, but for many, advanced education may not be feasible.

Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car and wearing a helmet when biking or skateboarding? a. Because children won't know if someone doesn't tell them b. Because injuries are the leading cause of death in children and most injuries are preventable c. Because it is a dangerous world and someone has to warn children about the dangers d. Because teaching is easy and more fun than passing out bandages and documenting care

b. Because injuries are the leading cause of death in children and most injuries are preventable The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers. The nurse is a trustworthy person, but the children may likely have heard this information from someone else. The role of health educator is an appropriate and important role of the school nurse which is the same as the role of the direct caregiver in caring for injured children and documenting care.

Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) d. Mixed alcoholic beverages

b. Caffeine Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications. Beer, cigarettes, and mixed alcoholic beverages are not as culturally acceptable as caffeine, as there are regulations that limit the age that these products can be used.

At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? a. Consultant b. Community outreach c. Counselor d. Researcher

b. Community outreach When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. As a counselor, the school nurse is considered a trustworthy person to whom the children can go if they are in trouble or when they need to talk. As a researcher, the nurse can study outcomes related to school nursing services which may advance the practice of school nursing

Which of the following statements best describes how workers' compensation legislation has changed employer behavior? a. Employers have improved safety of working conditions because safety data is now public information. b. Companies have improved safety of working conditions because workers' compensation insurance premiums are now based on previous claims. c. Employers were legally required to implement safety changes. d. Companies have become more involved in the legislative process

b. Companies have improved safety of working conditions because workers' compensation insurance premiums are now based on previous claims. Workers' compensation acts are important state laws that govern financial compensation of employees who suffer work-related health problems. Each state sets rules for the reimbursement of employees with occupational health problems for medical expenses and lost work time associated with the illness or injury. Workers' compensation claims and the experience-based insurance premiums paid by industry have been important motivators for increasing the health and safety of the workplace. The financial incentive of having reduced claims is much more important to the employer than if the safety data may be available for the public to view. Workers' compensation legislation did not mandate safety changes or cause companies to become more involved with the legislative process.

Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? a. Complementary and alternative therapies b. Computer and technology use c. Psychoanalytical techniques d. Self-defense techniques

b. Computer and technology use In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. Complementary and alternative therapies are already being widely used; most likely the nurse will not be the one providing such care, so it would not be necessary for the nurse to master these skills. Psychoanalytical techniques would not be necessary for the nurse to master as the nurse is able to refer students who require this type of care to appropriate providers. There would not be a need for school nurses to master self-defense techniques.

A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? a. Case manager b. Consultant c. Counselor d. Health educator

b. Consultant The school nurse is the person best able to provide health information to school administrators, teachers, and parent-teacher groups. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The nurse also can recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places. As a case manager, the school nurse helps to coordinate the health care for children with complex health problems. As a counselor, the school nurse is considered a trustworthy person to whom the children can go if they are in trouble or when they need to talk. In the health educator role, the school nurse may be asked to teach children both individually and in the classroom.

A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? a. Continue activities as much as possible as if nothing had happened. b. Continue to assess for shock and stress. c. Help teachers discuss the disaster with their class. d. Maintain school routines and activities.

b. Continue to assess for shock and stress. After a disaster, the school nurse has many responsibilities—for instance, continuing to assess the school community for the presence of shock and stress; encouraging parents to minimize how much their children view the disaster coverage on TV; providing grief counseling; continuing to communicate with the children, parents, and school personnel; and following up with assessment of children for anxiety, depression, regression, and posttraumatic stress disorder. It would not be appropriate for the nurse to ignore that a disaster has occurred or to assume that routines will remain the same; it is important for the nurse to assist the community to cope with the disaster. The nurse may use counselors in the community to assist the children to cope with the disaster as this may not be an appropriate role for the nurse or for the teacher to perform.

Which of the following best describes a principle of care that the nurse should abide by when working with abusive families? a. Confront the abuser and shame him into penitence and a desire to change. b. Demonstrate respect for all family members, including the abuser. c. Exclude the abuser from family meetings because the abuser is the one creating problems. d. Notify the abuser's clergyman, boss, and others who can exert pressure for change.

b. Demonstrate respect for all family members, including the abuser. Principles of giving care to families who are experiencing violence include the following: intolerance for violence; respect and caring for all family members; safety as the first priority; absolute honesty; and empowerment. Confrontation and exclusion would not be therapeutic techniques for the nurse to implement. Notification of others would violate HIPAA laws, as the nurse should be keeping this information confidential.

The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which of the following should be the first action that is taken by the nurse? a. Arrange for the couple to attend marital counseling. b. Develop a plan for the wife's escape if the violence starts again. c. Teach the client how to avoid initiating her husband's anger. d. Work with the client on development of self-esteem.

b. Develop a plan for the wife's escape if the violence starts again. Unfortunately, abuse tends to escalate in frequency and severity over time, and the man's remorse tends to lessen. A nurse encountering severe abuse needs to consider the safety of the woman and her children as the priority. The woman will need an order of protection and help in getting to a safe place. At the very least, the woman must design a carefully thought-out plan for escape and arrange for someone to call the police if another violent episode occurs. Although marital counseling may be useful at an early stage of abuse, it is generally contraindicated at all other stages because of the risk to the woman's safety. After first developing an escape plan, it may be beneficial for the nurse to speak with the woman more about potential triggers for the husband's abuse as well as her own self-esteem and how that may be influencing the continuation of the relationship.

Which of the following is the underlying science or area of study on which public health is based? a. Biostatistics b. Epidemiology c. Medicine d. Social sciences

b. Epidemiology It works across many disciplines and is based on the scientific core of epidemiology. Public health uses biostatistics in its practice. It is not a branch of medicine; it is an organized community approach designed to prevent disease, promote health, and protect populations. Public health is not based on the social sciences, which is the study of society and relationships

Which of the following best describes services that are offered at a school-based health center? a. Employee care at a discounted cost at the school b. Family-centered care for preK-12 grade students c. Sex education, birth control, family planning, and care throughout pregnancy d. Referral and networking with other health care services in the community

b. Family-centered care for preK-12 grade students These are family-centered, community-based clinics that are run within school, often in low-income populations. These centers provide primary care services to students of preK-12 and may offer expanded health services, including mental health and dental care. The intention of school-based health centers is to provide care specific to preK-12 grade students, not employees. These clinics provide a variety of services, depending on the clinic. Based on the size and services of the clinic, they may not provide family planning services, referral, or networking with other health care services.

Which of the following is the most likely reason for a man to rape a woman? a. Because the woman was asking for it b. For power and control c. Provoked by the woman's dress and behavior d. Sexual pleasure and release

b. For power and control The underlying issues of rape are hostility, power, and control. Sexual desire is not an underlying issue of rape, nor is provocative dress and behavior. Rape occurs because of power and control, not because the woman is asking for it.

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. Medicare b. Medicaid c. An emergency department d. A managed care organization

b. Medicaid

Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment.

b. Methadone blocks the effects of heroin and reduces the craving. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long acting and effective when taken orally, it does not produce a "high," it is inexpensive, and it has few known side effects. The main effect of this medication is that it decreases the craving for heroin; it is not a drug that clients come to prefer nor does it prevent further dependence on drugs

Which of the following is an accurate concern about the marijuana? a. Strength of most available marijuana is weaker than in the past. b. Paranoia is a known side effect of marijuana use. c. Marijuana has no effect on a fetus. d. Psychological and physiological dependence are seldom experience with marijuana use.

b. Paranoia is a known side effect of marijuana use. Marijuana's diverse reactions include anxiety, disorientation, and paranoia. The risks of marijuana are not being discussed as much as in the past. Today's marijuana is stronger than ever before, and people can become addicted. The Substance Abuse and Mental Health Services Administration (SAMHSA) says "approximately 1 in 10 people who use marijuana will become addicted." The rate increases to 1 in 6 if the youth is under age 18. Marijuana use has known effects on fetal development.

A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following actions is the nurse most likely taking? a. Identifying and treating clients in a sexually transmitted disease clinic b. Partnering with schoolteachers to teach and observe handwashing techniques in elementary school children c. Providing case management services that link clients with communicable diseases to health care and community support services d. Performing directly observed therapy (DOT) for clients with active tuberculosis

b. Partnering with schoolteachers to teach and observe handwashing techniques in elementary school children An example of primary prevention is to educate day care centers, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases. The goal of primary prevention is to prevent the disease from occurring. Identifying and treating clients are part of secondary prevention, as screening is being completed to determine at the earliest stage possible who has the disease. Providing case management services for those with communicable disease and performing DOT therapy with clients are both examples of tertiary prevention as the populations that the nurse is working with both already have the disease. Through tertiary prevention, the nurse is working to restore their health to the highest level possible.

The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented? a. Both secondary and tertiary prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

b. Primary prevention Delivery of primary prevention services to employees is directed toward promoting health and averting a problem. Primary prevention is attempting to avoid harm through protecting measures, in this case reducing ear damage due to high noise levels and eye damage from flying particles or fluids. Secondary prevention involves screening for the disease or detecting the disease at the earliest stage possible. Tertiary prevention aims at rehabilitation and restoring the client to the highest possible level of functioning

A nurse is working at a local health department. Which of the following would most likely be completed by this agency? a. Enforcement of laws and regulations related to public health nationwide b. Provide leadership in planning community health screenings c. Providing experts in various specialties to answer questions and respond as needed d. Surveying the state's public health needs

b. Provide leadership in planning community health screenings Local public health agencies provide and disseminate health information, provide leadership in health planning, provide essential public health and environmental services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community. Enforcing laws and regulations related to public health nationwide, providing experts in various specialties, and surveying the state's public health needs would all occur at the state level.

The school nurse has arranged for volunteers to help assess each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

b. Secondary Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers. Primary prevention involves providing education before a problem or disease occurs. Tertiary prevention aims at rehabilitation after the disease or problem has occurred and intends to get the client to the highest possible level of functioning.

A school health nurse is conducting drug screening to detect drug use by students before serious problems develop. Which of the following levels of prevention does this action represent? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary and secondary prevention

b. Secondary prevention One means of secondary prevention is to institute early detection (screening) programs in schools, workplace, and other areas in which people gather to determine the presence of substance abuse. Primary prevention involves education before a problem occurs. Tertiary prevention occurs after the problem has occurred and aims to assist the client to the highest level of functioning. It is not likely for a single intervention to be both primary and secondary in prevention foci.

An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Tertiary care prevention

b. Secondary prevention Secondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible moment in its course and elimination or modification of the hazard-producing situation. Primary prevention would occur to prevent the injury from occurring, such as teaching the employees about how to protect themselves from exposure to hazardous gases. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the exposure to the hazardous gas.

A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary preventions

b. Secondary prevention Tracing individuals exposed to a client with a sexually transmitted disease is secondary prevention because the nurse is attempting to find those exposed and screen them. Once the exposed persons have been located, screening is another secondary prevention activity. Through tertiary prevention, the nurse is working to restore their health to the highest level possible. If the nurse were to provide direct care to the clients with sexually transmitted diseases, this would be an example of tertiary prevention. The goal of primary prevention is to prevent the disease from occurring. Thus, when providing primary prevention, the nurse could provide free condoms for sexually active persons or provide education about ways to prevent the transmission of these diseases.

Which client may be able to safely detoxify and manage their withdrawal symptoms with only minimal medical supervision? a. A 50-year-old who uses diazepam to "manage my anxiety" b. The 30-year-old reporting a "weekend cocaine habit" c. A 60-year-old who takes a secobarbital "most nights to help me sleep" d. A 70-year-old who usually drinks "3-4 beers in the evening"

b. The 30-year-old reporting a "weekend cocaine habit" Stimulants, e.g., cocaine or opiates, may produce withdrawal symptoms that are uncomfortable but not life threatening. Detoxification from these drugs does not require direct medical supervision, but medical management of the withdrawal symptoms increases the comfort level. On the other hand, drugs such as alcohol, benzodiazepines, e.g., diazepam, and barbiturates, e.g., secobarbital, can produce life-threatening withdrawal symptoms. These clients should be under close medical supervision during detoxification and should receive medical management of the withdrawal symptoms to ensure a safe withdrawal.

Which statement is an example of community-oriented, population-focused nursing? a. The nurse cares for an older adult client who had a kidney transplant and who lives in the community. b. The nurse develops an educational program for type 2 diabetes in the community. c. The nurse refers a client with Cushing's syndrome to the registered dietician. d. The nurse provides the client with chronic kidney disease with educational pamphlets.

b. The nurse develops an educational program for type 2 diabetes in the community.

Which of the following best describes the mission of OSHA? a. To create an inspection system to avoid preventable loss of life b. To ensure safe and healthful working conditions c. To establish rules for employee safety d. To share factory illness and injury rates with the public

b. To ensure safe and healthful working conditions The Occupational Safety and Health Act of 1970 had as its purpose to ensure "safe and healthful working conditions for working men and women." OSHA enforces occupational health standards; its mission is not to have an inspection system. Safe and healthful working conditions are ensured because of the standards that have been enforced by OSHA. OSHA does maintain a databased of work-related injuries, illnesses, and death, but its mission is not to share this information with the public

An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change? a. To prevent injury b. To limit disability c. To provide primary prevention d. To provide tertiary prevention

b. To limit disability Interventions aimed at disability limitation are intended to prevent further harm or deterioration, and they include referral for counseling and treatment of an employee with an emotional or mental health problem whose work performance has deteriorated and removal of workers from heavy metal exposure who manifest neurological symptoms. The repetitive work with handling heavy metal may have already caused harm or previous injury to this employee. Thus, the goal is to limit disability rather than to prevent injury. Primary prevention would occur to prevent the injury from occurring, such as teaching safe lifting or operation of the equipment. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to any incident or injury.

The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? a. "I'll get the names to you and the involved teachers immediately." b. "Let me get the parents' consent, and then I'll get you the names." c. "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." d. "Why don't we coordinate a school-wide program on preventing accidents instead?"

c. "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." The school nurse is responsible for maintaining school health office policies, including privacy and safety of health records. When a rumor is involved, it is always wise to check its accuracy. If a child was indeed hurt, the nurse needs to make sure both children involved receive (or have already received) appropriate care. The nurse must follow the HIPAA privacy rules while also ensuring the safety of children at school. The question about having a school-wide program may be appropriate, but this behavior was apparently purposeful, not accidental.

A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities. Which of the following parents in attendance would be most at risk for abusing his or her own child? a. A new mother who has joined a parents' support group b. A father who is overwhelmed and exhausted by overtime work c. A depressed father who was laid off from work and is missing his work colleagues d. A mother who is missing her career challenges and friends but enjoying being home with her baby

c. A depressed father who was laid off from work and is missing his work colleagues Parents with low social support, a tendency toward depression, multiple stress factors, and a history of abuse are at risk for abusing their own children. Abusive parents often have unrealistic expectations of a child's developmental abilities. A new mother who has joined a parents' support group is displaying positive coping behaviors. Although a mother is missing her career challenges, she is finding enjoyment in being home with her child which displays that she has a positive emotional health. A father who is overwhelmed and exhausted is at risk for abusing his children; however, he is not displaying as many risk factors and stressors as the father who is depressed, laid off from work, and missing his colleagues.

Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? a. Tell all staff to call 911 if the nurse is not in the building. b. Arrange to always be available, even if only by phone. c. Create and share an emergency plan with all teachers and staff. d. Wear a pager so that the nurse can come as soon as humanly possible

c. Create and share an emergency plan with all teachers and staff. It is recommended that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed. Depending on the emergency, it may or may not be appropriate to call 911; thus, having an emergency plan in place is a more appropriate response. It is impossible for the nurse to be available at all times. Depending on where the nurse is and what other roles the nurse is fulfilling, it may not be possible for the nurse to respond quickly to an emergency

Which of the following federal agencies is most influential in public health activities? a. The Agency for Healthcare, Research, and Quality b. Centers for Disease Control and Prevention c. Department of Health and Human Services d. Food and Drug Administration

c. Department of Health and Human Services The US Department of Health and Human Services (USDHHS) and the Environmental Protection Agency (EPA) are the federal agencies that most influence public health activities at the state and local levels. The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration are all pieces of the broader USDHHS.

In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families? a. Acute care inpatient settings b. Community clinics and physicians' offices c. Emergency departments and psychiatric units d. In homes during home health visits

c. Emergency departments and psychiatric units Nonfatal violence in the health care worker's workplace is a serious problem that seems to be underreported. Much of the study of health care worker violence has been in psychiatric settings and emergency departments. Violence is not reported in as high of an incidence in acute care settings, community clinics, or in client homes in comparison to emergency departments and psychiatric units.

Which of the following would most likely be one of the first steps taken in employer disaster planning? a. All employees are invited to attend sessions on disaster planning. b. Employers stress the importance of disaster drills and encourage active participation. c. Exhaustive inventory of chemicals and industrial hazards is completed. d. Written disaster plans are distributed to each employee and each worksite.

c. Exhaustive inventory of chemicals and industrial hazards is completed. The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of company and community. The nurse is often a key person on the disaster planning team. The potential for disaster must be identified; this is best achieved by completing an exhaustive chemical and hazard inventory of the workplace. The MSDSs and plant blueprints are critical for correctly identifying substances and work areas that may be hazardous. Worksite surveys are the first step to completing this inventory. After potential hazards have been identified, it would be appropriate for the other events to occur. This would include providing employee education, circulating a written disaster plan, and encouraging participation in disaster planning drills

Which of the following activities are expectations for a school health nurse? a. Ensuring that children with health problems are accepted by their peers b. Driving children home if parents can't pick them up c. Giving emergency care in the school or during school events d. Giving medications as needed if children are ill

c. Giving emergency care in the school or during school events School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school; keeping track of the state-required vaccinations that children have received; carrying out the required screening of the children based on state law; and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics. It would not be appropriate for the school nurse to provide transportation services to the students attending the school.

Which of the following interventions regarding worker safety would be the least effective? a. Using job rotation and workplace monitoring b. Designing equipment so that employee exposure to hazards is minimized c. Having employees use safety measures and personal protective equipment d. Designing the environment to encourage employees to follow workplace procedures

c. Having employees use safety measures and personal protective equipment Personal protective control is the last resort and requires the worker to actively engage in strategies for protection such as use of gloves, masks, and gowns to prevent blood/body fluid exposure. Various control strategies are used to eliminate or reduce exposure and hence risk. Engineering controls can reduce worker exposure by modifying the exposure source. Administrative controls reduce exposure through job rotation, workplace monitoring, and employee training and education. External controls—the way equipment is built or manufacturing processes are established—are controllable and much more effective than asking a great many individuals to engage in behaviors that they may not want to do (such as using personal protective equipment). Humans are much less programmable than external controls.

A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most likely displayed? a. He has threatened harm to his school peers. b. He is between the ages 15 and 19. c. He is depressed and has a history of being sexually abused. d. He has been accused of abusing an animal.

c. He is depressed and has a history of being sexually abused. Leading risk factors for suicide are depression and other mental disorders or substance-abuse disorders. Other risk factors (that are not as common as the leading risk factors) include prior suicide attempt, family history of suicide, mental disorder, substance abuse or violence, firearms in the home, incarceration, and exposure to the suicidal behavior of others (family, peers, or figures in the media). Children who threaten to harm others or who abuse an animal are more likely to hurt others than themselves.

A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect? a. Bruises in various stages of healing b. Failure of parent to attend parent-teacher conferences or return teacher phone calls c. Lack of weight gain and wearing dirty clothes d. Lice in the hair

c. Lack of weight gain and wearing dirty clothes Physical neglect refers to failure to provide adequate food, clothing, shelter, hygiene, or necessary medical care; emotional neglect refers to the omission of basic nurturing, acceptance, and caring essential for health development. Lice are a common problem among schoolchildren, and the presence of lice does not indicate neglect. Failure to attend parent-teacher conferences should not be construed as neglect, because various reasons, such as employment requirements, may prevent parents who care from attending. Bruising is a sign of physical abuse rather than neglect.

A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking? a. Encouraging others to interfere when they see children hit or hurt in a public place b. Referring caregivers to community respite centers if abuse is beginning to occur c. Lobbying for passage of legislation to outlaw physical punishment in schools d. Screening each pregnant woman privately for intimate partner abuse

c. Lobbying for passage of legislation to outlaw physical punishment in schools Primary prevention involves action before damage has occurred. The other options are all screening for abuse or reactions to abuse that has already taken place. Encouraging others to interfere when they see children hit or hurt in a public place and referring caregivers to community respite if abuse is beginning to occur are examples of tertiary prevention because the abuse is already occurring. Screening pregnant women for intimate partner abuse is secondary prevention as it is a screening aimed at early detection of the problem.

Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community? a. Community health clinics b. Federal health agencies c. Local health agencies d. State health agencies

c. Local health agencies Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health; they do not provide essential public health programs to the community. Federal health agencies develop regulations that implement policies formulated by Congress. Community health clinics may provide essential public health programs to the community but are not responsible for implementing and enforcing local, state, and federal public health codes and ordinances.

Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? a. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. b. Most nurses prefer to be employed in hospitals giving direct care. c. Most school districts are unable to afford a nurse in every school. d. School districts and taxpayers see no need for nurses in schools.

c. Most school districts are unable to afford a nurse in every school. The Healthy People 2030 Objective AH-R08 recommends an increase in the proportion of secondary schools with a full-time registered nurse (US Department of Health and Human Services, 2020). But such a recommendation is expensive and not a possibility for all school districts presently. School districts may see that the need for nurses is important but may have insufficient funds to be able to afford to pay for their services. There is not a national requirement that school nurses must have baccalaureate preparation or school nurse certification. Preference of employers by nurses does not impact why school nurses are unable to ensure that adequate care if provided.

Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early 20th century? a. PHNs contributed without receiving any salary for doing so. b. PHNs created new settings where health care could be given. c. PHNs gave care to powerless groups. d. PHNs worked outside any organized health care system.

c. PHNs gave care to powerless groups. During this period, public health nurses worked with populations and in settings that were not of interest to other health care disciplines or groups. Much public health service was delivered to the poor and to women and children, who did not have political power or voice. Public health nurses were employed by agencies and received pay for the work that they did. In the early 20th century, new settings where health care could be delivered were not developed. Public health nurses worked with a variety of partners to begin to include reproductive health, chronic disease prevention, and injury prevention activities.

Which of the following is a common factor typically found in those who abuse others? a. Fear and belief that others are "out to get them" b. Poor self-esteem and unawareness of alternatives c. Previous observations of violent behaviors to manage conflict d. Difficulty keeping commitments

c. Previous observations of violent behaviors to manage conflict People who become involved in violence typically had previous exposure to some form of violence. Abusers were often beaten when they were children, or they witnessed siblings or one of their parents being beaten. They learned that violence is a way to manage conflict. The incorrect responses are not commonly found among those who typically abuse others.

A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most likely being completed? a. Disseminating information about mental health to community organizations b. Partnering with school health nurses for early identification of children who have evidence of mental health problems c. Providing case management services that link clients with serious mental illnesses to mental health and community support services d. Screening high-risk clients for the presence of mental disorders

c. Providing case management services that link clients with serious mental illnesses to mental health and community support services An example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services. Tertiary prevention aims to restore those with the disease to the highest level of functioning possible. Disseminating information about mental health is an example of primary prevention as the nurse is aiming to prevent a problem before it occurs. Partnering for early identification of children and screening high-risk clients are examples of secondary prevention. Secondary prevention occurs when the nurse conducts screenings and tries to identify diseases at the earliest possible stage.

An occupational health nurse is removing a foreign body from a patient's eye. Which of the following levels of prevention is being implemented? a. Injury prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

c. Secondary prevention The nurse is engaging in secondary prevention when providing treatment for the injury. This does not meet the criteria for injury prevention because the injury has already occurred. Primary prevention would occur to prevent the injury from occurring, such as teaching the employee about use of protective eyewear. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the foreign body from developing.

A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which of the following levels of prevention is being used by the nurse? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

c. Tertiary Tertiary prevention includes caring for children with long-term health needs, including asthma and disabling conditions. The nurse is teaching disease management (i.e., when to use an inhaler). Primary prevention involves providing education before a problem or disease occurs. Secondary prevention addresses screening and early detection of the disease or problem.

A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

c. Tertiary prevention Many teenage girls who are pregnant attend school; therefore, the school nurse may provide ongoing care to the mother. Although this may appear to be secondary prevention, it is tertiary prevention because adolescent pregnancies are considered to be high risk. Primary prevention involves providing education before a problem or disease occurs. Secondary prevention addresses screening and early detection of the disease or problem. Because the teenager is already pregnant, the nurse is addressing how to assist the teen to achieve the highest level of functioning possible (tertiary prevention).

A nurse advises a client diagnosed with HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

c. Tertiary prevention Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability. Primary prevention and health promotion both address the use of interventions before the disease occurs and to reduce the risk of developing the disease. Secondary prevention is aimed at detecting the disease early through screening programs and early intervention for at-risk individuals.

Which of the following is the top risk factor for intimate partner homicide? a. There is a gun in the house. b. The husband has made threats against wife before. c. The wife has previously reported being physically abused. d. The woman's young daughter also lives with them.

c. The wife has previously reported being physically abused. The top risk factor for intimate partner homicide (IPH) is previous domestic violence. Other risk factors are access to guns, estrangement, threats to kill or threats with a weapon, nonfatal strangulation, and a stepchild in the home if the victim is a female; however, these are not the top risk factor.

A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic's clients. Which of the following best explains why the nurse is collecting this data? a. This data will be useful in a research study the nurse is conducting. b. This data will provide evidence of clinic resources being wasted on minor health problems. c. This data will help identify patterns in the risk factors associated with a particular subgroup. d. This data can be used to show trends that can be included in the next grant proposal for further funding

c. This data will help identify patterns in the risk factors associated with a particular subgroup. When health data are considered collectively, the nurse may determine some patterns in risk factors associated with the occurrence of particular injuries and illnesses in a total population of clients. There is no mention of consent, so the nurse should not be collating research data. Grants for funding typically require current client data rather than trends.

Which of the following statements best explains the primary reason why violence is so high among young male parents? a. Men tend to be more violent than women. b. They are young and thus lack maturity. c. Unemployment is higher in this population. d. Violent tendencies are transferred genetically along racial lines

c. Unemployment is higher in this population. Most analyses conclude that the differential rates of violence in the United States have more to do with economic realities, such as poverty, unemployment, and overcrowding, than with race. Although violence among men may be higher than among women, this question specifically addresses "young men." Economic realities are more indicative of this rate of violence than age and maturity. Violence is a learned behavior; it is not transferred genetically along racial lines.

A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, "I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal." Which of the following would be most appropriate response from the nurse? a. "I'm so glad you're beginning to recognize the need to control your blood sugar." b. "Now you just have to make sure you don't give that habit up!" c. "Sounds like you're not ready to really plan your eating yet." d. "That is great. You've started to take action and make changes."

d. "That is great. You've started to take action and make changes." There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. The client prepares for action by learning to recognize the importance of eating and needed changes. Therefore, the nurse should encourage and recognize that the client has begun serious change. This comment by the client demonstrates readiness to take action and needs to be encouraged by the nurse. The incorrect responses are not encouraging replies that would promote the client to continue to move forward with these actions.

A nurse is completing a health history on a client during a routine physical examination. Which of the following questions, which is often omitted, should be asked by the nurse? a. "How is your family doing?" b. "What problems have you been having?" c. "What health concerns do you have today?" d. "Where do you work and what do you do there?"

d. "Where do you work and what do you do there?" The question often omitted is, "Where do you work and what do you do there?" The occupational health history is an indispensable component of the health assessment of individuals. Because work is a part of life for most people, including an occupational health history in all routine nursing assessments is essential. All of these questions are appropriate during a routine physical examination. However, it is likely that the nurse asks about family, current problems, and current health concerns to clients on a routine basis.

A nurse is interviewing a person who has stated on their entry health form that they are retired. Which of the following is the most crucial question for the nurse to ask? a. "Have you had any problems since leaving your employment?" b. "How do you spend your time now?" c. "What has retirement been like for you?" d. "Where were you previously employed and what did you do there?"

d. "Where were you previously employed and what did you do there?" The most crucial question is, "Where were you previously employed and what did you do there?" The occupational health history is an indispensable component of the health assessment. All persons should be questioned about their employment history. To describe only a current status of "retired" may lead to the omission of needed data. Even for retired persons, the nurse must ask about employment history, because many problems take years to manifest in signs and symptoms. All of these questions are appropriate during a routine physical examination for a person who has retired because they relate to current problems, recreation, and mental health. However, they are not as crucial as asking for additional information about employment history. The client's answer to this question may alert to potential problems that the nurse should focus on.

Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years? a. Advances in hospital care and procedures b. Advances in medicine and medical research c. Advances in nursing practice d. Advances in public health

d. Advances in public health A person born today can expect to live 30 years longer than someone born in 1900. Medical care accounts for 5 years of that increase, but public health is responsible for the additional 25 years, through prevention efforts brought about by changes in social policies, community actions, and individual and group behavior changes. Advances in medical care only accounts for 5 of the additional 30 years that longevity has increased. Hospital and nursing care are not specifically noted when discussing the increase in life span.

Research as shown that vaping increases an individual's risk of contracting what disease five-fold? a. Gingivitis b. Mouth cancer c. Oral herpes d. COVID-19

d. COVID-19 Vaping increases the risk of contracting COVID-19. This is due to the fact that e-cigarettes affect the lungs and immune system, and that makes the user more susceptible to the virus. The seriousness is increased when teens or other uses share the e-cigarettes. Research has found that people who vaped and smoked were five times more likely to develop COVID-19. The other options are potential risks but have not been shown to be so directly associated with vaping

Which of the following is the primary reason that large companies are becoming more involved in their employees' personal health and well-being? a. It is an ethical and moral responsibility. b. It improves public relations within the community. c. It allows managers to better understand their employees. d. It provides a cost savings to the company

d. It provides a cost savings to the company A significant increase in the number of health promotion and employee assistance programs offered has occurred. Health promotion programs focus on lifestyle choices that cause risks to health such as obesity or smoking. Employee assistance programs are designed to address personal problems (e.g., marital/family issues, substance abuse, financial difficulties) that affect the employee's productivity. Such efforts are cost effective for businesses. Becoming more involved in employees' health and well-being would most likely not change the relationship between the manager and the employee. This also would not change the public relations in the community. Becoming more involved is the right thing for companies to do; however, the main motive behind this shift is to save the company money

A school nurse stops a student in the hall and expresses concern that, "Your eyes look rather red and dry." The student yawns and denies eye problems but does mention having gained 15 pounds since smoking "special cigarettes." Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana

d. Marijuana Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. Side effects of crack cocaine and ice methamphetamine are similar and include increased breathing, rapid heart rate, high blood pressure, and increased body temperature. Tobacco use is associated with many chronic diseases but a person smoking tobacco would not necessarily display the student's symptoms.

A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? a. Ask the student if abuse has occurred. b. Call in the named student and ask him to remove his shirt. c. Discuss the conversation with the student's parents. d. Notify the legal authorities.

d. Notify the legal authorities. When the nurse identifies a child, who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school's principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.

Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? a. Teacher shortages have required nurses to be increasingly involved in teaching life skills. b. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. c. States are requiring nurses to screen and to teach life skills. d. Nurses have been enlisted in this role to help reduce risk factors for future health problems in schoolchildren.

d. Nurses have been enlisted in this role to help reduce risk factors for future health problems in schoolchildren. Nurses fulfilling the health educator role assist in teaching children both individually and in the classroom. This teaching should assist in helping reduce the risk factors among children in the future. Potential teacher shortages have not impacted the role of the school nurse as a health educator. Use of the role of health educator has not changed the need for school nurses in the school setting. There are not state requirements for required school screening or teaching life skills.

At a county board meeting, a nurse reports statistics related to the increasing problem of substance abuse in the county. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? a. Help prevent obesity and boredom. b. Offer alternatives to being "on the streets." c. Prevent children from getting in trouble before their parents get home from work. d. Promote healthy lifestyles with physical activity.

d. Promote healthy lifestyles with physical activity. The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors. The purpose of the nurse requesting this funding is to address the problem of substance abuse, not obesity. This program may offer an alternative to children and keep them safe and off the streets; however, the primary objective is to address the overall healthy lifestyle of these youth.

Which of the following should be the focus for programming in the community related to communicable diseases proposed by Healthy People 2030? a. Encouraging community members to engage in healthy behaviors b. Identifying high-risk sexual behaviors among community members c. Monitoring the sexual activity of adolescents d. Providing information about the hazards of multiple sexual partners

d. Providing information about the hazards of multiple sexual partners Healthy People 2030 lists communicable disease as an area of focus including levels of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the public health nurse providing information on the hazards of multiple sexual partners and street drug use. Encouraging "healthy behaviors" is not specific to the prevention of communicable diseases. Monitoring the sexual activity of adolescents only addresses one segment of the population, and monitoring does not provide an active intervention for the nurse to complete to influence the problem. Identification of high-risk behaviors is part of the assessment of the community and may assist the nurse in knowing what programs to develop, but this would not assist in decreasing the rates of communicable disease.

The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe? a. Comfort level of the PPE b. Effectiveness of the nurse's teaching c. Knowledge level of the employee d. Psychosocial norms of the setting

d. Psychosocial norms of the setting The employee will only be safe if the employee uses the PPE. If the employee doesn't use the PPE or uses only part of the equipment, then the employee will be at risk. The primary determination of whether the PPE is used correctly and used all the time is the psychosocial norms of the setting. If others are careless in PPE use, then such carelessness is the norm. If everyone is extremely careful to use their PPE, then that is the norm in that setting. Through education, employees have the knowledge and skills available to correctly use PPE. The educational session should also make the employees comfortable with its use. The use of PPE does not depend on the effectiveness of the teaching, rather the employees' choice to correctly put into practice the knowledge and skills that they have received.

A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? a. Abide by the mother's wishes because this information was provided in confidence. b. Arrange for counseling for the boyfriend at the earliest possible availability. c. Encourage the mother to take the child and find alternate housing right away. d. Report the incident to child protective services or other appropriate legal authority.

d. Report the incident to child protective services or other appropriate legal authority. Nurses are mandatory reporters of child abuse, even when only suspected, in all states. The incorrect options put the child's welfare at risk, including encouraging the mother to seek alternatives, since encouraging an action will not ensure that it will happen.

A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse? a. The daughter's inability to do well in school b. Intimacy problems with the daughter's boyfriend c. The mother's abuse of the daughter over a long period of time d. Sexual abuse by the father

d. Sexual abuse by the father Nurses must be aware of the incidence, signs and symptoms, and psychological and physical trauma of incest. Symptoms include headaches, as well as other physiological problems. Children often try to avoid or escape the abusive behavior. Intimacy problems with her boyfriend, abuse by the mother, and the daughter's inability to do well in school could all be potential reasons why the daughter ran away. However, the nurse's primary concern should be the potential for sexual abuse because of the behaviors that are being displayed by the daughter.

Which of the following is a core competency required of public health nurses? a. Knowledge in the use of high-technology diagnostics b. Knowledge of the implementation of electronic medical records c. Skill in the physical assessment of complex clients d. Skill in developing policy and planning programs

d. Skill in developing policy and planning programs The core public health competencies are divided into the following eight domains: (1) analytic assessment skills; (2) basic public health sciences skills; (3) cultural competency skills; (4) communication skills; (5) community dimensions of practice skills; (6) financial planning and management skills; (7) leadership and systems thinking skills; (8) policy development/program planning skills. The incorrect competencies are better suited for tertiary facilities such as hospitals.

A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would most likely have a positive effect? a. Being assertive and taking control of decisions because family members cannot be expected to have this ability b. Focusing attention on family weaknesses that need to be fixed before healing can begin c. Pointing out things that victims should do differently to avoid antagonizing the abuser d. Soliciting ideas from the family regarding what they feel will improve their situation

d. Soliciting ideas from the family regarding what they feel will improve their situation To empower the family, the nurse needs to recognize and capitalize on the violent family's strengths and to guide the family in recognizing and dealing with its problems. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach. Families often can generate many of their own solutions—in fact, the family's own solutions tend to be more culturally suitable and individualized than those the nurse generates.

Which of the following is the most common disabling condition when measured by days away from work? a. Bruises b. Cuts and lacerations c. Mental illnesses d. Sprains and strains

d. Sprains and strains In 2014, sprains, strains, and tears were by far the most frequent disabling conditions, accounting for 420,870 days-away-from-work cases and an incidence rate of 38.9 cases per 10,000 full-time workers (Bureau of Labor Statistics, 2015d). Bruises, cuts and lacerations, and mental illness are not among the most common disabling conditions that are reported.

A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant organisms. Which of the following actions would be most appropriate for the nurse to implement? a. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. b. Notify the Centers for Disease Control regarding any unusual signs and symptoms related to a communicable illness. c. Reinforce the importance of receiving vaccinations according to recommended schedules. d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections.

d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections. The widespread, often inappropriate, use of antimicrobial drugs has resulted in loss of effectiveness for some infections. Clients and health care providers are responsible for the inappropriate use of antibiotics. The nurse can influence this trend by objecting to inappropriate use of antibiotics by providers and by educating individuals, families, health care providers, and the community about the dangers of misuse and overuse of antibiotics. Lobbying for increased use of antibiotics would not assist in decreasing the number of drug-resistant organisms. Notifying the Centers for Disease Control or increasing the percentage of children who are vaccinated will not affect the increased development of drug-resistant organisms.

The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion? a. To provide an example to other employees to ensure future cooperation with safety measures b. To enforce an economic penalty for not obeying nurse's instructions regarding safety measures c. To ensure that all employees keep their positions during an economic downturn d. To continue employment and income with limited duty as a rehabilitation effort after an injury

d. To continue employment and income with limited duty as a rehabilitation effort after an injury Rehabilitation strategies such as return-to-work programs after a heart attack or limited duty programs after a cumulative trauma injury are examples of tertiary prevention. Tertiary prevention is intended to restore health as fully as possible and assist individuals to achieve their maximum level of functioning. The method described is focusing on an effective method of rehabilitation. Rehabilitation strategies are not used as a form of punishment to employees or to ensure employment for all workers

An IV drug abuser admits to the nurse he has no desire to stop using drugs, so rather than lecture the individual on the dangers of drug addiction, the nurse provides information how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases

d. Tertiary prevention to reduce the transmission of blood-borne diseases Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. This client is already using IV drugs, thus, the nurse will be intervening at the tertiary level of prevention. Secondary and primary prevention strategies would not be appropriate when working with this client who already has a known problem.

A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his or her practice? a. Decisions are made at the federal level, disseminated at the state level, and carried out at the community level. b. Health of populations is only as good as the health of individuals that live and work in the community. c. Oversight of community health departments is the most important function. d. The interaction of the local-state-federal partnership is critical to success.

d. The interaction of the local-state-federal partnership is critical to success. In the United States, the local-state-federal partnership includes federal agencies, the state and territorial public health agencies, and the local public health agencies. Their effective interaction is critical to the effective use of both financial and personnel resources to address the health of populations. Nurses working in all of these agencies work together to identify, develop, and implement interventions that will improve and maintain the nation's health. Decisions can be made and implemented at the federal, state, and local levels. The health of individuals and populations is influenced by the health policies that are in place. The state agency may provide some oversight of local health departments, but that is not its primary purpose.

In which of the following scenarios is a family member enabling an individual to continue to abuse alcohol? a. The husband asks the nurse to explain why his wife's continued drinking is dangerous. b. The son threatens to leave home because he finds the father's behavior embarrassing. c. The teenage daughter of an alcoholic turns to a favorite teacher for emotional support. d. The wife tells her husband's boss that her husband is sick when he is actually inebriated.

d. The wife tells her husband's boss that her husband is sick when he is actually inebriated. Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. When someone lies for the abuser, the individual is enabling the abusing behavior to continue. The other options do not demonstrate the behavior of enabling, since none are shielding the abuser from experiencing the consequences of the addiction.

An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace? a. Find employment in physical labor; at least your body will be in good condition. b. Professional positions are the safest choice for employment. c. White collar positions provide the least risk for injury. d. There is no "safe" occupation or profession.

d. There is no "safe" occupation or profession. Most adults spend about one-third of their time at work. No work is completely risk free. Every single industry grapples with serious hazards related to work.

As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse? a. To document employee efficiency and effectiveness at their jobs b. To look for evidence of personal protective equipment being torn or destroyed c. To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day d. To observe effectiveness of safety education and equipment

d. To observe effectiveness of safety education and equipment The nurse may conduct an assessment of the workplace itself, which is known as a worksite walk-through or survey. Direct observation allows the nurse to learn about the work processes and the materials; the requirements of various jobs; the presence of actual or potential hazards; and the work practices of employees. Such information is directly useful in planning programs, assessing their effectiveness, and reinforcing safety with individuals who have been seen behaving in a less than safe manner. It is not within the scope of the occupational health nurse's role to document employee efficiency and effectiveness. The nurse may observe how PPE is being used or if employees are taking care of themselves while on the job; however, this is not the main purpose of a worksite walk-through assessment.

A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while being raped? a. Confusion b. Satisfaction c. Sexual release d. Victimization

d. Victimization During the act of rape, survivors are often hit, kicked, stabbed, and severely beaten. It is this violence, as well as the violation of the sense of self, that most traumatizes the person because of the fear for her life and her feelings of helplessness, lack of control, victimization, and vulnerability. Because of the violence associated with rape, it is highly unlikely that the victim will report satisfaction or sexual release. The woman may be confused about what to do next, but it is more likely that the trauma will cause feelings of helplessness which could contribute to the confusion.

Which of the following statements is the best explanation as to why some countries are more violent than others? a. Civilized societies are less violent than primitive societies. b. Geographical differences are the primary factor. c. Population differences are the main determinant—for example, having more males than females. d. Violence is a learned behavior controlled or allowed by social norms.

d. Violence is a learned behavior controlled or allowed by social norms. Some societies are basically nonviolent, and for them violence is not a significant health problem. Violence is a learned behavior, and social norms can keep violence at low levels or even eliminate it. The learned culture of the society is the best indicator for violence, not the differentiation between civilized or primitive, geographic location, or population differences among males and females.

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

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

A nurse is preparing to use the I PREPARE mnemonic to assess a client's potential environmental exposures, which of the following should the nurse ask when assessing for the first "P"? a. What do you like to do for fun? b. What year was your home built? c. What industries are near where you live? d. What do you currently do for work?

d. What do you currently do for work?

A school nurse is planning health promotion and disease prevention activities for the upcoming school year. Which of the following activities would be considered tertiary prevention? a. Educating classes on the importance of hand washing b. Routinely checking students for pediculosis throughout the year c. Implementing age-appropriate injury prevention programs d. Working with a dietitian to determine carbohydrate counts for students who have diabetes

d. Working with a dietitian to determine carbohydrate counts for students who have diabetes

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

B, C, E Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB) and hepatitis, as well as exposure to high levels of lead from pesticides. Diabetes is common among this population as well. Malaria is not an illness associated with the migrant farmer population.

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

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

Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager

a. A 1-year-old Children in their first year of life have the highest rate of victimization at 26.7 per 1000 children. A 6-year-old, 9-year-old, and teenager are not at high risk for being abused because they are older

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

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

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

b. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around." Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy. Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care.

Which of the following clients is most likely to experience a high incidence of poverty? a. A 65-year-old woman b. A 14-year-old male c. A 79-year-old male d. A 19-year-old female

b. A 14-year-old male While gender is not relevant, the poverty rate for children under 18 years of age was 16.2 percent, and the poverty rate for people aged 65 and older was 9.7 percen

A nurse is providing preconceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a. Iron b. Calcium c. Folic acid d. Vitamin C

c. Folic acid Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects. A recommendation was made that women capable of or planning a pregnancy take 400 mcg of folic acid daily (USDHHS, 2010). Iron, calcium, and vitamin C are not used as routine prenatal supplements.

A nurse has just met the parents of a 10-year-old child who has been diagnosed with a congenital heart defect. When interviewing the parents, which of the following would be a priority question for the nurse to ask? a. What are the learning needs of your child? b. What does your child eat on a typical day? c. Does your child have a good peer support network? d. Does your child have a medical home?

d. Does your child have a medical home? The use of a medical home, in which one provider or clinic has all of the child's records, is important for this population. Communication among all providers who are working with this child is essential in order for the child to achieve optimal health and functioning. Learning needs, nutritional needs, and peer relationships are important for a 10-year-old child. However, without having the coordination and consistency of a medical home to coordinate medical care, these other things may be insignificant.

Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty

d. Poverty Poverty is a strong and underlying current factor that affects all special groups. Ethnicity, education level, and lifestyle choices do not have as large of an impact on health disparities than income level related to poverty.

. Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to "just say no" when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d. The fact that tobacco smoking causes more premature deaths than any other behavior

d. The fact that tobacco smoking causes more premature deaths than any other behavior The most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. Because the students are engaging in tobacco use, this is the most important topic to address with them at this time. If the students were not engaging in this behavior, the other topics of commonly used drugs on campus, just "saying no", and overcoming peer pressure may have been just as appropriate.

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

d. They weren't getting paid for that day, and continued employment is never certain. Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain. Most migrant farmworkers are legal residents or US citizens, not illegal immigrants. If the clinic personnel provide culturally competent care, they should not be biased or look down on this family when providing care. They should not be at any greater risk to have their belongings be stolen than on any other day when they leave their home

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

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

Toward whom is the TLC model targeted? a. Caregivers of older persons with health problems b. Community organizations that offer services for the elderly c. Elderly clients with health problems d. Nurses who care for older clients

a. Caregivers of older persons with health problems The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management. The TLC model is not focused on community organizations, elderly clients, or nurses, rather it focuses on caregivers and relieving caregiver burden.

A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a. Accidents and injuries b. AIDS c. Childhood obesity d. Vaccine-preventable diseases

a. Accidents and injuries Injuries are the number one cause of death among children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable. Obesity, although a significant problem, is not a common cause of death in children. AIDS and vaccine-preventable diseases are not common causes of death among children.

According to the Federal Register, which of the following is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter, and clothing needed to preserve health)? a. $16,020 b. $26,200 c. $36,580 d. $40,890

b. $26,200 As of 2020 for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $26,200.

Which of the following clients is most at risk for suicide involving firearms? a. A 15-year-old female b. A 20-year-old male c. A 56-year-old female d. A 36-year-old male

b. A 20-year-old male Suicide was the second leading cause of death for youth ages 10-24. Males take their lives about four times more often than do females, yet females are more likely to have suicidal thoughts than males are. Firearms are the most common method of suicide among males and poisoning among females

A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse does not yet know the community, which of the following programs would be good to plan first? a. Alcohol and tobacco cessation programs b. Cancer screening programs c. Cardiac health education programs d. Exercise for life programs

c. Cardiac health education programs Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurse's second focus

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

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

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

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

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

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

Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.) a. Assess schools and day care centers for environmental "friendliness." b. Share nutritional information with all students in the school. c. Develop home and environmental assessment guides. d. Teach all school personnel how to use rescue inhalers. e. Work with community developing clear air policies.

A, C, E Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day care centers for lack of asthma triggers. Sharing nutritional information is not related to the care of asthma patients. It is not necessary that all school personnel know how to use rescue inhalers, rather those who are in direct contact with the child with asthma.

Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) a. 40% of rural children live in poverty. b. People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c. Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d. The cost of healthcare is strain on rural families. e. Accessibility to healthcare is limited.

A, D, E Nearly 40% of all rural children are impoverished. Poverty and inaccessibility to health care is a major problem for rural communities. Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations.

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

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

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

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

A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a. Adult day health b. Home health c. Long-term care d. Senior center

a. Adult day health Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision. Typically, individuals return home to their caregivers at night. Adult day health serves as more of a medical model than the senior center. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems, and help would not be available.

A 13-year-old resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? a. Advanced nurse practitioner b. Allergist c. Pediatrician d. Pulmonologist

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

A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? a. Establish lifestyle improvement programs through local youth organizations. b. Evaluate the food intake of a group of children for a 48-hour period. c. Provide education programs to overweight expectant parents. d. Evaluate the body mass index of children at regularly scheduled well-child examinations.

a. Establish lifestyle improvement programs through local youth organizations. Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children.

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

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

A nurse is trying to identify the risk for mental health problems among older adults. Which of the following interventions should the nurse implement initially? a. Provide information on mental health resources in the community. b. Teach the elderly to self-monitor for signs and symptoms of depression. c. Organize screening programs offered at senior centers. d. Teach older clients to focus on their strengths rather than their weaknesses.

c. Organize screening programs offered at senior centers. Early detection and intervention for mental health problems can be increased if persons seeking primary care are assessed for mental health problems. Nurses are in an ideal position to assess and detect mental health problems. They conduct comprehensive biopsychosocial assessments as part of screening programs. While the other options are not inappropriate, they do not help identify mental illness in the older adult population.