N416 Communities Exam 3 Quiz

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21. A nurse eagerly explained to a long-term disabled male client the most recent relevant research related to his care. The client, rather than express appreciation, said, "I prefer to have my care given this way." The nurse explained that research suggested an alternative approach was more clinically effective, but the client said, "I am more comfortable during the day if my care is given this way." Which action should be taken by the nurse? a. Accept that the client knows what works best b. Ask the nursing supervisor to review the research with the client c. Give evidence-based care according to current research findings d. Negotiate a compromise between patient preferences and research-based approach to care

: A A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. The nurse must ask the client what works best for him or her and what goals the client is pursuing. Research is based on probabilities of effectiveness with large groups, but individuals may have a different unique reaction to any intervention.

6. Which group would most need adult daycare services? a. Caregivers who work all day b. Elderly who are bored staying home alone c. Elderly in whom Alzheimer's has been diagnosed d. Older men who want an opportunity to meet older women e. Older women who want to engage in arts and crafts activities

: A Adult daycare provides a safe and supportive environment during the day for adults who cannot or choose not to stay alone. This service is often needed by caregivers who work during regular hours or need respite.

8. "I don't understand," a woman said. "I know I'm eligible for Medicare part A and it's free. Part B isn't free. When will I ever use it?" Which would be the most appropriate response by the nurse? a. "Part A is only for hospital bills. Most care is given on an outpatient basis. Part B pays a large portion of those costs." b. "Part A is a benefit because you paid into Social Security for more than 10 years. In comparison, part B is optional if you want that additional insurance." c. "Part B is easy to pay for; they take the cost out of your Social Security check each month." d. "Researchers have found that people don't waste health care resources if they have to pay a bit for them."

: A All the responses are true, although the woman may not care about research findings. Further, she may well prefer the money from her Social Security benefit to be paid to her rather than go for additional insurance. However, the reason the woman needs to know why she should pay for part B is that so much care today is given on an outpatient basis, including diagnostic procedures, physicals, speech and occupational therapy, ambulances, durable medical equipment, and some home health care services.

13. Which is the most common reason for visual impairment in older adults? a. Cataracts b. Glaucoma c. Macular degeneration d. Presbyopia

: A Among older adults, the three most common pathological eye conditions are cataracts, macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally clear lens of the eye. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with near vision, generally occurs in the 40s.

12. Which is the most prevalent type of substance use problem among male and female veterans? a. Binge drinking b. Overuse of prescription drugs c. Marijuana use d. Use of smokeless tobacco

: A Binge drinking and cigarette smoking are the most prevalent types of substance use problems among male and female veterans, affecting about 11% of the veteran population, with disorders more common among males younger than 25 years of age. Substance use disorders (SUDs) involve a pattern of use of alcohol, tobacco, and illegal and prescription drugs that results in marked distress and/or impairment (American Psychiatric Association [APA], 2013).

17. A nurse explained that the elderly are twice as likely to die in a home fire as younger persons and therefore suggested some safety measures. Which strategy would most likely have been suggested by the nurse? a. Have smoke detectors installed in the house b. Invite a family member to sleep in the house at night c. Practice escaping quickly from the house in case of an emergency d. Program your phone so the fire department can be reached by pushing only one button

: A Community health nurses making home visits can assess their elderly client's home for fire risk and teach fire safety, including the importance of home smoke detectors and fire extinguishers. Inviting family members to spend the night, practicing a quick escape, and programming one's phone for the fire department are irrelevant if a smoke detector is not installed to alert the elderly client that there is a fire in the home.

3. Which statement regarding developmental disabilities is accurate? a. Those with developmental disabilities exhibit limitations before 18 years of age. b. Those with developmental disabilities see improvement in their functional ability as they age. c. Developmental disabilities are diagnosed before 1 year of age. d. Developmental disabilities result in a physical handicap.

: A Developmental disabilities encompass those conditions that are manifested by limitation before the legal age of adulthood, which is 18. This includes issues that limit or present challenges to the performance of activities of daily living (ADLs). Developmental disabilities encompass those lifelong conditions that are chronic in nature and may incorporate either or both intellectual and physical disabilities. Developmental disabilities can be diagnosed at any point in time during childhood. A handicap is not a characteristic of a person, but rather a description of the relationship between the person and the environment; a handicap results when a person with an impairment cannot fulfill a normal life role in society on a macro level of analysis.

10. "My health problems are too much to handle," said an elderly woman at her annual clinical checkup. "What's most important for me to do?" Which would be the most appropriate response by the nurse? a. "Focus on eating properly and staying active." b. "Get the shingles immunization along with your flu shot this year." c. "Keep active mentally—do you do crossword puzzles or Sudoku puzzles?" d. "Stay involved with others. Do you ever go to the senior citizens center?"

: A Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. As the woman was already getting an annual checkup, the nurse should stress nutrition and exercise.

5. In the supermarket checkout, a young woman complained to her friend, "Old people think we taxpayers should pay for them to be in a nursing home. Seems like a waste of money." Which would be the most appropriate response by the nurse? a. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" b. "Those old people built our society; we owe it to them to support them now." c. "Would it be better to put each person to sleep when they reach a certain age such as 80 years?" d. "You know, you'll get old someday too. Won't you want someone to take care of you when you can't anymore?"

: A In 2013, 93% of the Medicare population aged 65 years and older resided in traditional community settings. Three percent resided in community housing with at least one service available, and approximately 4% resided in long-term-care facilities. The other responses do not support a therapeutic response by the nurse in this situation.

18. An elderly gentleman was shoveling his snow when you arrived for a home visit. You notice that when he comes inside he is very pale, is shivering, and seems a bit confused. His skin is very cold when you touch it. Which action would be most appropriate for the nurse to take first? a. Apply warm moist towels to his head, neck, chest, and groin b. Give him hot coffee with sugar to drink c. Have him get in a tub of very hot water immediately d. Call 911

: A Initial management is to prevent further loss of heat. Rewarming of the core temperature at a safe, slow rate is important to avoid lethal side effects. The reason for rewarming the core first is to prevent vasodilation that would place the individual in ventricular fibrillation. Measures that can be taken are: (1) remove the individual from the cold area as soon as possible; (2) add more clothing, especially to the head (e.g., use a hat or scarf); (3) provide a warm sweetened drink (no coffee or tea); and (4) apply mild heat to the head, neck, chest, and groin areas using hot water bottles or warm moist towels. Medical help is imperative, and hospitalization may be needed depending on the stage of hypothermia.

18. Which best describes the prevalence of autism in the United States? a. The prevalence of autism has increased in the past decade. b. The prevalence of autism has decreased in the past decade. c. The prevalence of autism has remained stable in the past decade. d. Because the etiology is unknown, it is difficult to determine the prevalence of autism.

: A It has been estimated that about 1 in 88 children (or slightly more than 1.1%) have autism. Alarmingly, between 2000 and 2010, autism's prevalence increased 119%, with estimates at 1 in 68 births. Autism has no known etiology, but more frequently occurs among older parents.

3. A woman said, "I've never been retired before. I didn't plan it but it's OK. I'm still doing what I used to do otherwise; I go to church, make quilts for charity, and babysit my grandkids. Do you think I should be trying to find another job for a few years?" Which would be the most appropriate response by the nurse? a. "For lots of people, retirement, even if unplanned, is much like life has always been." b. "It's okay to slow down at your age; why look for problems?" c. "You really need to get out of your house more and be more active, even if you don't get paid at the position." d. "Without a job, you really don't have an identity. Have you been to the unemployment office?"

: A NURSINGTB.COM Community Public Health Nursing 7th Edition Nies Test Bank NU RS IN GT B.CO M The continuity theory of aging suggests that a person continues through life in a similar fashion as in previous years. Because the woman stated she is doing what she has previously done, and has not suggested any particular problems other than concern that what she is doing is acceptable behavior, she should be supported. The statement that best supports her decision states that retirement life is much like life has always been. The other statements do not support her current satisfaction with her activities in her life.

4. Which insight is being stressed by advocacy groups regarding persons with disabilities today? a. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. b. Handicapped persons have as much right to social support as nonhandicapped persons. c. It is recognized that an individual may be limited by an environmental barrier in society. d. Impairment is a result of society's reaction more than mental or physical condition.

: A Nearly all definitions identify an individual as disabled on the basis of a physical or mental impairment that limits the person's ability to perform an important activity. The complementary possibility—that the individual is limited by a barrier in society or the environment—is never considered. Advocacy groups, such as the Committee on a National Agenda for the Prevention of Disabilities, stress that environment and the reactions of others are as crucial as the actual physical or mental limitation.

16. A nurse overheard an adult woman, shaking her head in exasperation as she said, "Dad, you're being unreasonable. It's not safe!" Which is the most likely reason for this argument? a. The dad wants to keep driving. b. The dad wants to keep cooking his own meals. c. The dad wants to keep taking care of himself each day without assistance. d. The dad wants to marry some young woman who may just want his money.

: A One of the quality-of-life factors that is important to seniors is the ability to drive. Many older adults depend on driving in order to maintain independence and personal mobility. Age-related declines in vision, hearing, and other abilities as well as certain medical conditions and medications can affect driving skills. Thus, safety is a concern for any elderly driver. This safety concern outweighs the other concerns of cooking one's own meals, providing self-care, and marrying a younger woman.

3. A client is describing the time period that he served in the National Guard. Which statement would he be most likely to make? a. "I completed monthly drills and 2-week annual trainings." b. "I achieved the rank of officer and was promoted to the U.S. Army." c. "I served overseas based on decisions made by the federal government." d. "I selected Japan as my destination for my overseas tour of duty."

: A Personnel serving in the National Guard or Reserves are considered part-time employees. The key difference among them is that the Reserves report to the federal government, whereas the National Guard is administered by each state (e.g., the Pennsylvania National Guard is called into action by the governor of Pennsylvania). These individuals serve no more than 39 days a year, unless called into action. Usually, their service consists of monthly drills and 2-week annual trainings. Reservists may be called very suddenly to active duty (full-time) for deployments, requiring that they leave their family, regular job, and community for a time. The National Guard and Army are two separate entities—promotion does not change the military that is being served.

15. An ambulance medic reported a client was on the way with a traumatic brain injury (TBI). Which symptom would the nurse expect this client to display? a. Blurred vision and a headache b. Hypotension and tachycardia c. Irregular heart rate d. Fecal incontinence

: A TBI symptoms may be mild, moderate, or severe. Symptoms of mild TBI include headache, confusion, light-headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, and a change in sleep patterns or thinking. Moderate or severe TBI may demonstrate the same symptoms as mild TBI plus a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. The other symptoms are not indicative of TBI.

15. A man came for follow-up care to the free clinic, explaining that he had applied for a job based on his education and years of previous work experience, but, being in a wheelchair, he was turned down. Which response would be most appropriate for the nurse? a. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." b. "No one would want to hire a handicapped person, so you can continue to come here for free care." c. "Because it can be expensive to obtain the necessary equipment to help you do that job, the employer has every right to refuse to hire you." d. "The law says, if a handicapped person applies, he or she has to get hired even if an able-bodied person also applies."

: A The Americans with Disabilities Act (ADA) became law in 1990. This landmark civil rights-styled legislation prohibits discrimination toward people with disabilities in everyday activities by guaranteeing equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications. A qualified individual with a disability must meet legitimate skill, experience, education, or other requirements of an employment position. The person must be able to perform the essential functions of the job, such as those contained within a job description, with or without reasonable accommodations.

12. Which describes the most important need of every school-aged child with a disability? a. A teacher who understands the child's needs b. An advocate within the school system c. An assessment with comparison with developmental milestones d. An individualized education plan (IEP)

: D A child should have all of the above items, an advocate in the school nurse, a teacher who understands, an assessment including comparison with developmental milestones, as all of these are components of an IEP with goals, cooperatively developed with the parents, to help the child succeed in school. The IEP describes the goals, as well as any special support needed to help achieve them. The IEP is the most comprehensive answer.

5. Which concern can a nurse as a citizen help address? a. Advocating for removal of environmental and social barriers to needed services b. Continuing to engage in political action to increase funding for care for the handicapped c. Recognizing that it is better to offer to help than to wait for a person with handicaps to have to ask for assistance d. Needing to not stare or ask personal questions of a person with a disability

: A The Committee on a National Agenda for the Prevention of Disabilities model states disability occurs when a person's physical or mental limitations, in interaction with physical and social barriers in the environment, prevent the person from taking equal part in the normal life of the community. Confronting environmental and social barriers to needed services can frustrate and exhaust many people with disabilities and their families. The nurse—as a citizen and a concerned professional—can advocate for removal of such barriers. This issue is the most important for the nurse to address, allowing the nurse to partner with clients and families affected by disabilities to remedy barriers that negatively affect quality of life for this population.

20. A daughter tells the nurse that her mother is frequently confused, but what is really upsetting is that she is incontinent during the night. "All I do is watch her and wash sheets," the daughter says. Which suggestion should the nurse provide to the daughter? a. Explain about respite care or the need to ask other family members to help so the daughter can have some time off. b. It's time to have her mother go into a nursing home where they can give her the care she needs. c. Refer the daughter to Adult Protective Services so responsibility for her mother's care may be assumed by an agency prepared for such tasks. d. Teach the daughter how to establish a toileting routine for the mother to help control the incontinence.

: A The best approach—because the daughter is willing to share her feelings with you—is to see whether there is anyone else in the family to help so the daughter can be less overwhelmed. If the mother has Alzheimer's, any number of resources are available for respite for the caregiver, support groups for both client and family, and daycare facilities for the client. Adult Protective Services assists in cases of abuse. The daughter is stressed and may become an abuser if assistance is not found. A toileting routine would probably not be successful during the night. Although a nursing home is possible, many families cannot afford such care or do not want a family member sent there.

20. A clinic nurse is completing a patient intake interview with a noncommissioned veteran who has recently transitioned to civilian life. Which would be the most appropriate for the nurse to ask to assess how the veteran is transitioning from military to civilian life? a. Have you been able to use your military experience to find a civilian job? b. Have you been able to find a leadership position in a local company? c. What hobbies have you been able to enjoy since leaving the military? d. What support have you recently received from the Veterans Benefits Administration?

: A Veterans who were noncommissioned are typically high school graduates who often held nonleadership positions. They are more likely to experience a negative transition, as they may lack the guidance, experience, and knowledge needed to prepare for separating from the military. Some veterans can transition to a civilian job similar or identical to their military job; however, this is not true for all service members. Veterans continue to have difficulty translating their job experience, qualifications, and training to the civilian job market. The Veterans Benefits Administration (VBA) is an administrative arm responsible for unemployment and pension payments, home loans, vocational training, and educational benefits.

5. A nurse is interviewing a client to determine if she is eligible for VA benefits. Which question would assist the nurse in determining the requirement of service? a. "Did you serve active duty for 24 consecutive months?" b. "Which branch of the military service did you serve?" c. "Were you dishonorably discharged?" d. "How long has it been since you left the military?"

: A Veterans—and sometimes their survivors and dependents—are eligible for VA benefits when they fulfill two requirements related to service and separation. (1) Service: they must have served in active duty for 24 consecutive months or for a full period of call (Reserves and Guard). There are some exceptions to the length of service minimum, the most important being when a person is discharged for disability incurred or aggravated in the line of duty. (2) Separation: they must have been separated under any condition other than dishonorable.

13. A nurse is caring for a veteran who served in Vietnam. Which exposure is the client most likely to report? a. Agent Orange b. Chromium c. Mustard gas d. Burn pits

: A Vietnam veterans suffer health disorders related to exposure to Agent Orange—an herbicide used to kill the vegetation that provided cover for the enemy. Gulf War and GWOT veterans were exposed to a number of health threats in the desert, including chromium, burn pits, and heat stroke or heat exhaustion. WWII veterans who were in the Battle of the Bulge, fought in December 1944 through January 1945, were exposed to extreme cold and may have sustained cold injuries. Some volunteers were exposed to mustard gas experiments, in which the DoD evaluated equipment for their protection against mustard gas attacks. About 4000 soldiers were subjected to severe, full-body exposures during testing.

14. A veteran has been diagnosed with chronic multisymptom illness. Which would most likely be part of the client's health history? a. History of active duty service during the Vietnam War b. Unexplained cognitive dysfunction c. History of severe hypertension d. Frequent episodes of dysuria

: B Approximately 250,000 veterans of the 1991 Gulf War (about 25% to 32%) returned home with multiple varied, unexplained symptoms, including fatigue, dizziness, headaches, cognitive dysfunction, musculoskeletal pain, respiratory problems, rashes, and diarrhea. Popular media of the time referred to the disorder as Gulf War Syndrome or Gulf War Illness, although today the VHA refers to this cluster of symptoms as chronic multisymptom illness (CMI).

16. A nurse is assessing a female veteran for military sexual trauma (MST). Which would be the most appropriate question for the nurse to ask? a. During your military service, were you ever raped? b. Did anyone ever use force or threat of force to have sexual contact with you against your will? c. Can you describe any incidents of sexual harassment that you have been involved in? d. How long did you serve in the military?

: B Because of stigma and shame, many veterans will not volunteer information regarding sexual trauma exposure. When screening for history of MST, it is best to avoid words that are emotionally or politically loaded (e.g., "rape") or words that are poorly defined (e.g., "sexual harassment"). Nonjudgmental, descriptive general questions are recommended, such as: Did anyone ever use force or threat of force to have sexual contact with you against your will?

14. A nurse completed the health assessment but needed to use the elderly woman's bathroom. The nurse noticed perineal pads under the sink. Which question would the nurse most likely ask the woman? a. "Can you tell me why you need to have perineal pads?" b. "Do you know how to do Kegel exercises to help control your urine?" c. "Does another woman live with you or visit often?" d. "Why do you have perineal pads? Are you bleeding down there?"

: B Because the woman did not mention incontinence, it may be assumed to be very embarrassing. Therefore, the nurse should matter-of-factly address urine control problems by suggesting a self-help intervention of Kegel exercises. It may be assumed that the nurse, having completed a health assessment, would know about bleeding, as well as frequent visitors or family nearby.

13. Which best describes the current perspective on how communities should treat persons with disabilities (PWDs)? a. Be supportive of PWDs and try to reduce environmental barriers b. Maximize opportunities for PWDs to work and otherwise contribute to community life c. PWDs have civil rights just as other citizens do d. Recognize that PWDs deserve our support both financially and otherwise

: B Contemporary disability policy minimizes this disadvantaged view and maximizes opportunities for PWDs to live productively in their communities. Early American public policy viewed PWDs as "deserving poor" who required governmental protection and provision, with little capacity for self-support or independence.

2. Which problem depends on the responses of other people and therefore cannot be measured? a. Disability b. Handicap c. Impairment d. Injury

: B In comparing these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis. Table 21.1 points out that both impairment and disability may be objective and measurable, whereas handicap is neither, because it is an experience related to the responses of other people.

14. A professional strongly encouraged institutionalization, so the parents could focus on care of their other family members. Which suggestion would be appropriate for the nurse to make to the parents? a. As the expert pointed out, institutionalization will reduce family stress. b. The child has a right to an education in the least-restrictive setting. c. The child will eventually adapt to whatever choice the parents make. d. The choice of what to do is entirely the parents'.

: B It is a given that it is the parents' choice. As an advocate for the child, the nurse can explain that children have a legal right to an appropriate public education based on the child's needs in the least-restrictive setting. This right is based on the Individuals with Disabilities Act (IDEA).

1. Which person meets the legal definition of a veteran? a. A 32-year-old male who has been dishonorably discharged from the Army b. A 50-year-old female who retired from the Navy c. A 65-year-old male who served in the National Guard d. A 22-year-old female who is currently serving in the Air Force

: B Legally, a veteran is an individual who has served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable. Any individual who completed service for any branch of armed forces is a veteran as long as they were not dishonorably discharged. Personnel serving in the National Guard are considered to be part-time employees and not active duty, full-time personnel.

9. Which best describes why grandparents would be the primary caregivers for their grandchildren? a. Because they fell in love with the newborn and wanted that small person to be a part of their lives b. Because the parents were drug abusers or in the prison system c. Raising a grandchild is easier because grandparents have already been experienced parents d. Raising a child gives purpose to life for the grandparents

: B Many older adults are faced with raising their grandchildren, often without the presence of the grandchildren's parents. Reasons include neglect related to parental substance abuse, abandonment, emotional and physical abuse, parental death, mental and physical illness, incarceration, teen pregnancy, and grandparents' assisting adult children who work or attend school.

10. Which best describes the prevalence of disabilities in U.S. children under age 15? a. About 5% b. About 10% c. About 15% d. About 20%

: B More than 8% of U.S. children under the age of 15 have some kind of disability and about half of them were classified as having severe disabilities.

9. A veteran has recently been diagnosed with posttraumatic stress disorder (PTSD). Which information obtained from the client during a health history would align with this diagnosis? a. The client reports that he has a history of hypertension and hyperlipidemia. b. The client states that he served as a sniper during the Gulf War. c. The client states that he was stationed in Japan. d. The client reports that his wife has a substance abuse problem.

: B PTSD is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. Factors that contribute to an individual developing PTSD include getting injured or seeing another person injured, viewing a dead body, feeling helpless, having little or no social support after a traumatic event, dealing with extra stress after the event (e.g., loss of a loved one, pain and injury), or having a history of mental illness or substance abuse.

25. "Do you have any advice?" a young woman asked. "I'm eating lunch with my dad but he can't hear and he won't wear his hearing aid." Which suggestion should be made by the nurse? a. Encourage your dad to wear his hearing aid—if only for you b. Find a very quiet place with good lighting and very little background noise for lunch c. Repeat yourself several times using exactly the same words and gestures d. Talk very loudly while facing him directly

: B Suggestions include to find a quiet place to talk to help reduce background noise, especially in restaurants and social gatherings; stand in good lighting and use facial expressions or gestures to give clues; face the person and talk clearly; speak a little more loudly than normal, but do not shout; and repeat yourself if necessary, using different words.

4. A veteran is receiving veteran's health care benefits. Which department directly coordinates these benefits? a. Veterans Benefits Administration (VBA) b. Veterans Health Administration (VHA) c. U.S. Department of Veterans Affairs (VA) d. Civilian Health and Medical Program of the Department of Veteran's Affairs (CHAMPVA)

: B The Department of Veterans Affairs has three subdivisions: the VHA, the Veterans Benefits Administration (VBA), and the National Cemetery Administration. The VHA provides all types of health care in every setting, including inpatient, outpatient, and long-term care. The VBA is an administrative arm responsible for unemployment and pension payments, home loans, vocational training, and educational benefits. The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA.

19. A nurse came limping into work with a huge cast on her right leg and asked to have an assignment for a week or two that did not require driving. The nurse said, "I never realized how difficult it is to get some places without two good legs. Now I know how persons with disabilities must feel!" Which would be the most appropriate response from the nursing supervisor? a. "I'm sure you'll be even more understanding and supportive now." b. "Not really; you'll be out of that cast in a few weeks." c. "What a great opportunity to attend some support groups for people with disabilities and share with us which ones are most helpful." d. "Why don't you just take some sick leave rather than try to work with that leg cast?"

: B Those who have a temporary disability have a very different experience than those who are permanently disabled. Although they may experience frustrations, they view it as a temporary problem and a temporary setback. The other responses address this temporary disability as if it is similar to a permanent disability, which it clearly is not.

24. Which best explains why all family members should want their aged relatives to have a living will? a. To confirm that the attorney is serving as guardian and family members do not have to be responsible b. To fulfill the federal Patient Self-Determination Act requirements c. To help family members know what their loved one does or does not want if he or she becomes incapacitated d. To keep physicians from writing a do-not-resuscitate order

: C A living will is a legal document that allows individuals to specify what type of medical treatment they would or would not want if they became incapacitated or had an irreversible terminal illness. Living wills can direct physicians to withhold life-sustaining procedures and can assist family members in making decisions when they are unable to consult a comatose or medically incompetent relative. The purpose of a living will is not to appoint an attorney as a guardian. The Patient Self-Determination Act requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess an advance directive; it does not require that patients complete one.

22. Which best describes why some advocacy groups have taken a strong stand against physician-assisted suicide? a. Ethical belief that life is always preferable to death b. Emphasis that there is always hope for a research breakthrough or discovery of a new treatment intervention c. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions d. Helping someone die is murder, plain, and simple

: C Because people have previously been killed because they had a disability, some advocacy groups, such as Not Dead Yet, have taken a strong stance against physician-assisted suicide, fearing it will lead to the early or forced death of people with disability. Ethical and personal beliefs and emphasizing the hope for a new treatment have not been stands taken by advocacy groups against physician-assisted suicide.

1. Which is an accurate definition of impairment? a. A disadvantage resulting from a disability that prevents fulfillment of an expected role b. A restriction or inability to perform an activity in a normal manner c. A problem in body function or structure d. A defect that affects society on a macro level

: C Disability is an umbrella term describing impairments, activity limitations, and participation restrictions. An impairment is a problem in bodily function or structure. A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role. In a comparison of these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis.

Which is the most useful way to discuss aging? a. By divisions—young-old, middle-old, old-old, and elite-old b. Chronological age c. Functional age d. Number of chronic comorbidities

: C Functional age refers to functioning and the ability to perform activities of daily living, such as bathing and grooming, and instrumental activities of daily living, such as cooking and shopping. This definition of aging is a better measure of age than chronological age. After all, most older adults are more concerned with their functional ability than their chronological age. Assisting older adults to remain independent and functional is a major focus of nursing care.

9. Which best describes the proportion of the U.S. population that is made up of persons with a long-lasting condition or disability? a. The number is about 5% and increasing. b. The number is about 10% and stable. c. The proportion is about 15% and stable. d. The proportion is almost 20% and increasing.

: D In 2012, approximately 18.7 of those aged 5 years and older had a long-lasting condition or disability. As acquired age-related conditions occur during the lifespan, disability prevalence and disability severity levels rise with aging. In the United States, there is a shifting demographic of individuals living beyond the age of 65. Further, it is important for health care policy makers and health care providers to recognize that the prevalence of disability is increasing.

7. A veteran tells the nurse that he hates the VA health insurance program and wishes that he would be allowed to see the local doctor instead of traveling to the VA clinic. Which statement would be most appropriate to be made by the nurse? a. "I will check to see if your local doctor can be added to the list of approved providers." b. "Yes, you pay premiums for this health insurance and should be able to have a choose what providers you see." c. "The VA does not provide health insurance, rather this is a benefit that you receive for compensation for your service to our country." d. "The VA provides different benefit plans. Let me see if the local doctor is a provider on a different benefit plan."

: C Many veterans do not realize that their care at their VA hospitals and clinics is not a type of health insurance. Instead, it is a benefit that they receive in compensation for their duty and service to the country. The difference between health insurance and VA health benefits is twofold. First, veterans do not have to "pay into" their VA benefits the way one would pay premiums for a health insurance plan. Second, the "coverage" received in the form of VA benefits is not transferable to other non-VA providers, except through formal contracts deemed appropriate by the VA and its providers.

20. A mother has recently learned that her infant has been diagnosed with spina bifida. Which nutrient was lacking during gestation? a. Calcium b. Vitamin K c. Folic acid d. Vitamin D

: C SB occurs when there is failure of the neural tube to close during the 28 day of gestation. SB is associated with deficits in motor, sensory, and physical differences that may be largely prevented with proper folic acid intake during gestation. Adequate folic acid supplementation is important for prevention of neural tube development.

12. A nurse is making the first home visit to a recently discharged elderly client. Which should the nurse most likely expect to find? a. A client who is unhappy with the disorganization of the house b. A client who will expect the nurse to do everything now that the nurse is at his or her house c. A client who may have hearing or vision problems or both d. A client who is upset with being discharged while still so ill and having to take on problems at home

: C Sensory disabilities increase with age and may seriously affect an older person's quality of life and ability to carry out routine daily activities. The NHI Survey found that 7.3 million noninstitutionalized American adults 65 years and older reported significant vision loss. One in three adults 65 to 74 years of age and nearly half of adults 75 years old or older have difficulty hearing. Thus, the nurse should be anticipating the needs of the client rather than being concerned about the potential factors that the client may be upset about.

4. A man stated, "I used to work out at the exercise room at work, but now that I'm retired I sit and watch TV. My wife keeps nagging me to do something. What do you think I should be doing at my age?" Which would be the most appropriate response by the nurse? a. "I think you should try to please your wife. What is it she wants you to do?" b. "It's okay to slow down at your age; why look for problems?" c. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" d. "You've worked all your life; you have a right to rest now."

: C The activity theory posits that activity is necessary to maintain life satisfaction. Physical activity is beneficial for the health of people of all ages, including older adults. Therefore, because the man has previously been physically active, he should continue to be physically active to maintain satisfaction with his life.

11. A nurse is caring for a veteran who has suffered a polytraumatic injury. Which would be the primary consideration for the nurse when working with this client? a. Use of an assistive device for ambulation may be necessary. b. Diagnosis of posttraumatic stress disorder will be likely. c. Physical and cognitive abilities to complete ADLs independently may be lacking. d. A psychiatric referral will be needed.

: C The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event, and frequently includes TBI. For example, a soldier who has lost a limb, suffered a TBI, and lost his eyesight from a rocket-propelled grenade attack is said to have a polytraumatic injury. Care for veterans with these injuries is especially complicated because of the presence of several overlapping physical and cognitive impairments affecting their ability to perform ADLs. The primary consideration would relate to the client's impairments in completing ADLs.

17. A veteran is receiving treatment for posttraumatic stress disorder (PTSD). As part of the therapy, the veteran identifies negative thoughts and emotions while focusing on specific sounds and movements. Which trauma-focused therapy is the client receiving? a. Cognitive processing therapy b. Prolonged exposure therapy c. Eye movement desensitization and reprocessing d. Cognitive behavioral therapy

: C There are variations of trauma-focused therapies. These include (1) prolonged exposure therapy (where the individual is repeatedly questioned by the therapist about the trauma to encourage control of the thoughts and feelings to reduce fear of the memories); (2) cognitive processing therapy, which involves talking with the therapist about the negative thoughts and beliefs and development of strategies to manage the recollection of the trauma in a way that is less upsetting; and (3) eye movement desensitization and reprocessing, which involves identification of the negative thoughts, emotions, and feelings while focusing on specific sounds or movements, helping the brain work through the traumatic memories. Friedman noted that the most successful interventions include cognitive-behavioral therapy and medication (e.g., selective serotonin reuptake inhibitors such as sertraline [Zoloft] and paroxetine [Paxil]).

6. A client reports hearing loss and tinnitus following military duty in the Gulf War. Which term would best describe this client's injury? a. Posttraumatic stress disorder b. Polytrauma c. Traumatic brain injury d. Service-connected disability

: D A service-connected disability is a disease or injury that was incurred as a result of or during the veteran's active duty, or one that was aggravated by military service. Posttraumatic stress disorder is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event. A traumatic brain injury is a disruption of brain function caused by an external mechanical force, including blunt force trauma, penetration by a foreign object, acceleration or deceleration movements, and pressure waves from explosive blasts. The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event and frequently includes TBI.

18. Which best describes the role of the suicide prevention coordinator (SPC) at the VHA center? a. Serve as a hotline responder for the National Veterans Crisis Line b. Create a suicide prevention safety plan for the client c. Provide counseling for suicidal veterans d. Assist veterans to access timely mental health care

: D A suicide prevention coordinator (SPC) works at every VHA center. The SPC's primary role is to help veterans access timely mental health care, particularly in times of crises, and to assist health care treatment teams with managing the care of suicidal veterans. SPC's maintain weekly contact with the veteran and ensure that the veteran's treatment team works with him or her to develop a suicide prevention safety plan that helps the veteran cope with suicidal ideation. The National Veterans Crisis Line provides veterans with immediate access to mental health crisis intervention and support 24 hours a day/7 days a week. Hotline responders are not SPC's, instead they are trained in suicide prevention and crisis intervention and assist callers by initiating dispatch of emergency services to callers in imminent suicidal crisis and refer veterans to VA suicide prevention coordinators to ensure that veterans are connected to local mental health care.

11. A nurse needed to do a quick assessment of a client's lifestyle behaviors to counsel appropriately. Which strategy would be the easiest way to determine the elderly woman's nutritional status? a. Ask the woman to keep a food diary for 2 weeks and bring it to the clinic b. Have the clinic dietitian interview the woman about her eating habits c. Quiz the woman verbally as to her usual meals during the day d. Use the DETERMINE mnemonic

: D All the responses are good approaches. However, the nurse should take a broad view of what assets or barriers are involved in relation to nutrition. A nutrition checklist, described by the mnemonic DETERMINE, reviews warning signs and risk factors of poor nutritional health. (See Table 19.2 in the textbook for more information.)

2. Which is an example of a nonstochastic theory of aging? a. Cross-link theory b. Error theory c. Free radical theory d. Immunologic theory e. Somatic mutation theory f. Wear and tear theory

: D All the theories except one are stochastic theories, that is, theories that are based on the assumption that events occur randomly and accumulate over time, which results in aging. The only nonstochastic theory, which views aging as predetermined, is the immunologic theory.

23. A wife explained to the nurse that her husband was becoming awfully forgetful, and now he's started getting lost on the way home from the golf club. She's scared he may be getting Alzheimer's disease. Which would be most appropriate action for the nurse to take? a. Ask the husband to explain why he thinks he got lost coming home b. Explain that all elderly persons get a little forgetful and not to worry c. Ask the husband to count backwards by 7 from 100 d. Hand the husband pencil and paper and ask him to draw a clock

: D Clients with Alzheimer's disease are unable to draw a normal clock. The clock drawing test has become one of the most widely used screening instruments in clinical and research settings. It has been found to be an effective and easy-to-administer tool to screen for dementia. This should be the first action taken by the nurse to screen the client for Alzheimer's disease and take appropriate action as necessary.

21. A wife, who had just come home after major abdominal surgery, explained to the home health nurse that she was really worried about her husband. He had not been sleeping well or eating well, seemed to have no energy, and did not seem to enjoy anything including activities he used to love. Which suggestion should the nurse give to the client? a. Ask what medications the husband is taking, because many medications can affect mood b. Explain her husband has probably been worried sick about her and the surgery, and she should reassure him frequently that she is OK c. Point out that many people get sad during the winter months and he should be fine when spring arrives, but in the meantime put full-spectrum light bulbs in all the household lamps d. Share that her husband seems depressed and that they should see his doctor immediately

: D Depressed people may experience several or all symptoms: changes in appetite or weight; changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt; and repeated thoughts of death or suicide. If any of these symptoms exist, the client should be referred to a physician for diagnosis. A physician can only make a diagnosis of clinical depression in the presence of five or more of the symptoms mentioned above.

7. Which accounts for the largest source of per capita family income? a. Employment income b. Pensions c. Savings d. Social Security

: D In 2014, the median household income of older adults was $36,895. Aggregate income for the population aged 65 years and over came largely from four sources: Social Security, earnings, pensions, and asset income. Social Security accounted for 49% of per capita family income. Among older Americans in the lowest fifth of the income distribution, Social Security accounted for 67% and earnings accounted for 13% of per capita family income, and public assistance accounted for 8%. For those in the highest fifth of the income distribution, Social Security accounted for 18% of per capita family income, pension income accounted for 26%, and earnings accounted for 40%.

10. Which statement about military sexual trauma (MST) is accurate? a. MST is more common among male veterans. b. The majority of women who report MST state the perpetrator was an intimate partner. c. An Army veteran is at greatest risk to report MST. d. Insomnia is more severe among veterans who report a history of MST.

: D MST is more common among women veterans, with 32.4% reporting MST compared with 4.6% of their male counterparts (Klingensmith et al, 2014). It is estimated that in one of seven women who report MST, the trauma was perpetrated by an intimate partner (Mercado et al, 2015). Insomnia is more common and more severe among veterans who report a history of MST (Jenkins et al, 2015). One of the risk factors/characteristics of veterans experiencing MST is being a Navy veteran, not Army.

17. Which statement about Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) is correct? a. SSI is funded through disability trust fund monies. b. To qualify for SSDI, the person with disabilities must have limited income and resources. c. SSDI recipients receive Medicaid health benefits. d. Persons with disabilities who receive SSI may receive a state supplement.

: D NURSINGTB.COM Community Public Health Nursing 7th Edition Nies Test Bank NU RS IN GT B.CO M SSI is funded through general tax revenues, whereas SSDI is funded through disability trust fund monies (Social Security taxes paid by workers, employers, and self-employed workers). To qualify for SSDI, the person with disabilities must be "insured" through Federal Insurance Contributions Act (FICA) earnings of self, parents, and/or spouse, and to qualify for SSI, the person with disabilities must have limited income and resources. SSDI recipients receive Medicare health benefits, and SSI recipients receive Medicaid health benefits. Some states may elect to pay a state supplement to some persons with disabilities in SSI programs, whereas in SSDI programs persons with disabilities are never provided with state supplements.

8. A young woman rolled her wheelchair up the ramp into the clinic to the desk where the intake nurse greeted her. Which should be the nurse's first response? a. "How can I help you?" b. "Who came with you today?" c. Compliment her on her skill with the wheelchair d. Sit so the nurse is at wheelchair level with the young woman

: D Nurses who demonstrate understanding of the issues confronting people with disabilities should approach them at wheelchair level, listening to understand. Moving to wheelchair level should be the first action that the nurse takes before beginning a conversation with the client. NURSINGTB.COM Community Public Health Nursing 7th Edition Nies Test Bank NU RS IN GT B.CO M

19. A veteran has received special training to provide recovery-oriented support to other veterans within the VHA health system. Which role will the veteran most likely fulfill? a. Peer counselor b. Suicide hotline responder c. Suicide prevention coordinator d. Peer support specialist

: D Peer support specialists are veterans who have been trained to provide recovery-oriented support and outreach that encourages other veterans to utilize VHA health services, particularly mental health, to assist with their recovery. The suicide prevention coordinator's primary role is to help veterans access timely mental health care, particularly in times of crises, and to assist health care treatment teams with managing the care of suicidal veterans. Hotline responders are trained in suicide prevention and crisis intervention and assist callers by initiating dispatch of emergency services to callers in imminent suicidal crisis and refer veterans to VA suicide prevention coordinators to ensure that veterans are connected to local mental health care.

: D SSI is funded through general tax revenues, whereas SSDI is funded through disability trust fund monies (Social Security taxes paid by workers, employers, and self-employed workers). To qualify for SSDI, the person with disabilities must be "insured" through Federal Insurance Contributions Act (FICA) earnings of self, parents, and/or spouse, and to qualify for SSI, the person with disabilities must have limited income and resources. SSDI recipients receive Medicare health benefits, and SSI recipients receive Medicaid health benefits. Some states may elect to pay a state supplement to some persons with disabilities in SSI programs, whereas in SSDI programs persons with disabilities are never provided with state supplements.

22. A son explained to the home health nurse that since his mother died, his father did not seem to have any interest in life and had even told his son he was considering suicide. Which would be the most appropriate response by the nurse? a. "If he really wants to kill himself, he will, and there really isn't anything you can do to stop him." b. "If you talk to him about it, you're strengthening the idea." c. "People who talk about suicide rarely do it, so don't worry." d. "Suicide is a serious concern; let's talk to his doctor about what you've noticed."

: D Suicide is a serious health concern. Elder suicide is associated with depression, chronic illness, physical impairment and conditions that significantly limit functioning or life expectancy, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Warning signs to watch for in the elderly are loss of interest in things or activities that are usually found enjoyable; social isolation; self-care neglect; not following medical regimens (e.g., going off diets, not taking prescriptions); experiencing or expecting a significant personal loss (e.g., death of spouse or friend); feeling hopeless or worthless; putting affairs in order; giving things away; making changes in a will; and stockpiling medications or obtaining other lethal means for committing suicide. The most significant warning sign is any expression of intent. Because the father is at high risk for suicide, the son must discuss the problem with the father's physician so that care can be obtained.

6. A nurse is completing an assessment of a client who states that his chronic obstructive pulmonary disease (COPD) has worsened, and he is no longer able to do his own grocery shopping. Which stage of the NADP model is the client experiencing? a. Pathology b. Impairment c. Functional limitation d. Disability

: D The NAPD model provides an alternative framework for viewing four related and distinct stages in the disabling process. Pathology at the cellular and tissue levels may produce impairment in structure or function at the organ level. An individual with an impairment may experience a functional limitation, which restricts their ability to perform an action within the normal range. The functional limitation may result in a disability when certain socially defined activities and roles cannot be performed. Although the model appears to indicate unidirectional progression from pathology to impairment, to functional limitation, to disability, stepwise or linear progression may not occur. Disability prevention efforts can limit or reduce many of the risk factors or stages in the disabling process.

2. Which is the largest branch of the U.S. military? a. Navy b. Marine Corps c. Coast Guard d. Army

: D The U.S. Army is the largest branch of the military, making up 39% of all military personnel. Other branches of the service include the Air Force, the Navy, the Marine Corps, and the Coast Guard.

7. A young man rolled his wheelchair up the ramp into the clinic to the desk where the intake nurse greeted him. After welcoming him to the clinic, which should be the initial question asked by the nurse? a. "Are you a vet home from the war?" b. "Can I help you into the treatment room to see the nurse practitioner?" c. "Do you have any family with you to help today?" d. "What brings you to the clinic today?"

: D The client should be asked what is needed just as any other client would be. A veteran would more probably be at a Veterans Affairs (VA) clinic, and there is nothing in the statement to imply that the clinic is part of the VA medical system. Because the man made it into the clinic, it is doubtful he would need help into the treatment room. Not all persons live with families. The handicap may be unrelated to why he is at the clinic. He may be ill or merely need immunization or other health promotion activity.

8. A veteran has been diagnosed with an immersion foot injury. Which finding should the nurse anticipate when completing an assessment on the client? a. A foot that is deformed b. A foot that is unable to tolerate immersion in water c. A foot that the client is unable to bear weight on d. A foot that has occasional numbness

: D The major cold injuries veterans suffer include frostbite, nonfreezing cold tissue damage, immersion foot (formerly called trench foot), and hypothermia. Cold injuries may result in long-term health problems, including the following signs and symptoms (at the site of exposure): changes in muscle, skin, nails, ligaments, and bones; skin cancer in frostbite scars; neurological injury with symptoms such as bouts of pain in the extremities, hot or cold tingling sensations, and numbness; vascular injury with Raynaud phenomenon with symptoms such as extremities becoming painful and white or discolored when cold.

15. Which veteran is most likely to experience homelessness? a. A 40-year-old single female b. A recently divorced 25-year-old male c. A recently divorced 30-year-old female d. A 35-year-old single male

: D The majority of homeless veterans are single males between the ages of 31 and 50. Only 9% of homeless veterans are females. Marital status is not reported as one of the risk factors that relate to incidence of homelessness.

11. A nurse is caring for an individual with disabilities. Which would put this client at risk for the fatal four? a. A history of falls b. Immobility c. Anorexia d. A history of constipation

: D The term fatal four refers to four common medical conditions that could result in complications and fatality more frequently for the IDD population and other PWD. Nurses and primary care providers should be knowledgeable about the fatal four, which includes (1) constipation/bowel obstruction, (2) aspiration/gastroesophageal reflux disease (GERD), (3) dehydration, and (4) seizures, as complications related to these conditions could result in death if not assessed, diagnosed, and treated swiftly (Smith and Escude, 2015). The etiology of the fatal four includes polypharmacy, improper positioning, obesity, and dysphagia.

19. A male nurse is enjoying a very hot summer day at the zoo when he notices a family approaching. An elderly member of the family is moving very slowly and being scolded by another adult, saying "You are not sick. Let's keep moving." The nurse touches the elderly adult who has a flushed face and notices clammy and moist skin. What should the nurse say to the adult? a. "I'm a nurse, and your family member needs to go to the emergency department right now." b. "I'm a nurse, and your family member has heat stroke. I'm calling 911." c. "Take your family member to the air-conditioned restaurant, and have him drink a cold soda immediately." d. "Take your family member to the air-conditioned restaurant, and let your family rest for a while."

: D There is not enough evidence to be quite sure what is wrong with the elderly adult, but clearly the elderly person is suffering from being in the hot sun for a period of time. The elderly adult—and probably the rest of the family as well—needs to be moved to a cooler environment and be made to lie down and rest. Drinking chilled water (not soda with caffeine) would also be helpful. In that cooler environment, the nurse can assess the situation to determine whether further action should be taken.

16. Which problem was the Ticket to Work and Work Incentives Improvement Act (TWWIIA) designed to address? a. Employers trying to avoid hiring persons with disabilities b. Employers resenting being forced to hire persons with disabilities c. Persons with disabilities not being able to receive on-the-job training d. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports

: D Typically, people with disabilities could qualify for such benefits as health care, income assistance programs, and personal care attendant services only if they chose not to work. To address employment and benefit issues for persons with disabilities, in December 1999, the TWWIIA was signed into law. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work.

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