NURS 375 Final

A community health clinic put a tax levy on the ballot. An angry man asks you, "How can you ask me to pay taxes to buy immunizations for parents who don't want to pay for their kids to get their shots?" What is your response?

- "Only by getting almost everyone immunized can we prevent epidemics that can hurt us all." - Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. If most persons are immune, it will be difficult for an infectious disease to spread.

A day care center asked the nurse to come because they had several children out as a result of chickenpox. How might the nurse reassure the staff?

- Chickenpox has low virulence so the children will be back at the day care center in a week or so. - Other considerations for understanding the action of agents include their power to invade and infect large numbers of people (infectivity), their ability to produce disease in those infected with the agent (pathogenicity), and their ability to produce serious disease in their hosts (virulence). When the above concepts are applied, the chickenpox virus has high infectivity, high pathogenicity, and very low virulence.

What would be one of the first steps in attempting to control a disease?

- Define what the disease looks like in confirmed or probable cases - Standardized definitions of diseases are necessary for public health monitoring and surveillance across all levels of government. Diseases are defined and classified according to confirmed cases, probable cases, laboratory-confirmed cases, clinically compatible cases, epidemiologically linked cases, genetic typing, and clinical case definition. Once defined, disease occurrence can be compared across time, populations, and geographic areas; and appropriate control efforts can be implemented.

As the nurse in charge that day, you note that two patients had communicable infectious diseases and were treated appropriately. Should anything further be done?

- Depends on your state health department's requirements - Because state health departments have the responsibility for monitoring and controlling communicable diseases within their respective states, they determine which diseases will be reported within their jurisdiction.

What is a fairly recent surprise regarding infectious diseases in the United States?

- Cervical cancer and coronary artery disease may be caused by infectious agents. - Recent scientific discoveries on the infectious etiology of stomach ulcers, coronary artery disease, and cervical cancer, for example, suggest that infectious agents may be responsible for more morbidity and mortality than previously recognized.

*A school had tried very hard to uphold the requirement for all children to be vaccinated. However, state law allowed parents to exempt their child if they had a religious reason for refusal. Two children had come down with chickenpox. What will be the probable result?

- Few children will get chickenpox because of herd immunity. - Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. Because most children in the school are immune, it will be difficult for the chickenpox to spread.

*Parents requested that their child be brought up to date on appropriate immunizations. After reviewing the child's medical history, you prepare to give the two immunizations. Is there anything else you should do?

- Give the parents the Vaccine Information Statement - The Centers for Disease Control and Prevention (CDC) produces Vaccine Information Statements (VISs) that explain the benefits and risks of vaccine to vaccine recipients, their parents, or their legal representatives. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given. Because the parents have previously had the child receive immunizations, they clearly have chosen to continue with immunizations so they don't need to hear the pros and cons of children being immunized. Children can't give consent, only assent, to procedures. Because the child is a minor, the child's parents make the decisions.

A city that depended on tourist dollars had feedback that tourists were saying they were never returning because of the constant mosquito bites. What should the town do?

- Have everyone in town search for and remove any standing stagnant water - Knowing the reservoirs for infectious agents is important because, in some cases, transmission can be controlled by eliminating the reservoir, such as eliminating the standing water where mosquitoes breed.

Which component of the epidemiological triangle is primarily responsible for a female client having a fungal vaginal infection after being treated with antibiotics for strep throat?

- Host - Infectious diseases are the result of interaction among the human host, an infectious agent, and the environment, which surrounds the human host and where transmission is occurring. This interaction is pictured in the epidemiological triad of agent, host, and environment also discussed in Chapter 5. The antibiotic therapy eliminated a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which caused a change in the vaginal environment allowing normally present fungi to proliferate, resulting in a yeast infection.

*One child in a kindergarten room had a slight fever and didn't eat lunch. Otherwise, the child seemed OK. Three days later, several children were absent from kindergarten. What happened?

- Infectious diseases can be contagious before any diagnostic symptoms occur. - The communicable period, or communicability, follows latency and begins with shedding of the agent. The incubation period is the time from invasion to the time when disease symptoms first appear. Frequently, the communicable period begins before symptoms are present. - Incubation/latency period

How are infectious diseases any different from any other health problem?

- Infectious diseases have the potential to spread, creating a community emergency - Most human diseases (e.g., cancer or diabetes) can be classified as personal health problems. Individuals with a personal health problem can be treated by the health care system one person at a time. By contrast, infectious diseases are categorized as public or community health problems. Because of their potential to spread and cause community-wide or worldwide emergencies, infectious diseases require organized, public efforts for their prevention and control.

*During an outbreak in the hospital, all staff members were given immunoglobulin if they were not already immune to the disease. What sort of immunity will the staff that received the immunoglobulin then have?

- Passive immunity - Passive immunity is the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, or antitoxins, or transplacentally, from mother to neonate. Passive immunity lasts only as long as these substances remain in the bloodstream. Active immunity is when the body produces its own antibodies against an antigen, from either infection with the pathogen or introduction of the pathogen in a vaccine.

*The nurse couldn't find a vaccine in the refrigerator. The unopened vaccine vial had been put in a storage cabinet with the other medications. The nurse drew up the appropriate dose in the syringe and then put the vial of vaccine in the refrigerator. What will be the probable result?

- Primary vaccine failure - Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that may render the vaccines ineffective, improper administration route, or exposure of light-sensitive vaccines to light. - Ineffective vaccine

A case of viral hemorrhagic fever (Ebola) was diagnosed immediately on signs of illness at a tourist site in Africa. What should be done to protect the badly needed income from tourist dollars?

- Quarantine the ill person and use isolation techniques in giving care - Although students may not know the screening of or treatment of Ebola, they should know to isolate persons with infectious diseases. Ebola is not highly infectious until symptoms occur. Treating infected persons, whether they are symptomatic or not, is effective in preventing transmission of pathogens directly to others.

What is particularly notable about infectious disease in the United States?

- Rate of infection varies extensively by income and ethnic groups. - Probably one of the most profound failures in infectious disease control in the United States and elsewhere is that the successes are not equally distributed in the general population. Infectious diseases continue to be differentially distributed by income and ethnic groups, and the poor and minorities continue to experience the greater burden.

Which infections continue to increase in the United States?

- STDs - Treatable sexually transmitted diseases (STDs), such as syphilis and gonorrhea, had declined until 2000 but increased in 2007 for the seventh straight year. At the same time, incidence of chlamydia, another treatable STD, has increased steadily since 1995, and the number of cases reached 1,108,374 (370.2 per 100,000 people) in 2007.

The daily patrons of a local town restaurant became ill with nausea, vomiting, and diarrhea. Without knowing the cause, what should be done immediately to help avoid future problems?

- Strongly emphasize the importance of proper hand washing to staff - Agents leave the human host through a portal of exit and invade through a portal of entry. Portals of exit include respiratory secretions, vaginal secretions, semen, saliva, lesion exudates, blood, and feces. Portals of entry are associated with the portal of exit and include the respiratory passages, mucous membranes, skin and blood vessels, oral cavity, and the placenta. Because it was food poisoning of some sort, until the cause is known, it can be assumed to probably be a fecal-oral transmission. Therefore, staff need to again be reminded of the importance of careful hand washing after using the facilities.

A young woman is panic-stricken. She hadn't realized how much she was drinking, and she thinks she had unprotected sex with several men last night. She is petrified and wants an HIV test immediately. What do you do?

- Suggest she be treated immediately to be safe - HIV infection is usually determined by the HIV antibody test, most commonly the enzyme-linked immunosorbent assay (ELISA). False-negative findings may occur, especially before the body produces antibodies after exposure. The student should be aware that treating HIV exposure with HIV medications has been shown to decrease the incidence of seroconversion and HIV infection.

Which group is especially at risk for sexually transmitted diseases (STDs)?

- Teenaged girls - Teenaged girls in particular may be more susceptible to STDs because they have fewer protective antibodies to STDs and a cervix that is biologically immature.

*Why are clinical areas so careful to assure sanitization of surfaces and equipment between each patient?

- To decrease transmission by fomites - Indirect transmission is the spread of infection through a vehicle of transmission outside the host. These may be contaminated fomites or vectors. Fomites can be any inanimate object, material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a contaminated tissue).

*Why was the Vaccine Adverse Event Reporting System legislated into being? Select all that apply.

- To determine whether changes should be made in procedures or biological agents, To provide assistance to families who experience a vaccine-related injury - No drug is perfectly safe or effective. Changes are made on the basis of the collected data. For example, whole cell pertussis vaccine was changed to an acellular pertussis vaccine because of adverse side effects. To monitor actual and potential vaccine-related problems, health care providers must report specific postvaccination "adverse events" to the Vaccine Adverse Event Reporting System (VAERS). The National Vaccine Injury Compensation Program reviews all VAERS reports and provides assistance for individuals and families who experience a vaccine-related injury, including disability and death.

What is the first step in preventing further spread of a particular sexually transmitted disease (STD)?

- Treat each infected person with the appropriate pharmaceutical agent - Anti-infective drugs, such as antibiotics, antivirals, antiretrovirals, and antimalarials, play important roles in controlling infectious diseases. Not only do they permit recovery of the infected person, but they also play a major role in preventing transmission of the pathogens to another. The first step in preventing transmission of tuberculosis and syphilis is to treat the infected person with antibiotics. Because the question asks about further spread, infection in a person has been diagnosed, so education is needed, but it is too late for that person. Adults not in school also are infected with STDs.

Which is true concerning tuberculosis infections in the United States?

- Under certain conditions, susceptible hosts may be infected by the tuberculosis bacillus. - The principle of multicausation emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Tuberculosis is caused by Mycobacterium tuberculosis; treatment with INH lasts for a year and is used when no active disease is present; patients can be contagious without having any symptoms.

*What can be used to protect staff at a community clinic when a patient walks in complaining of severe intestinal cramps and diarrhea?

- Use universal precautions with all patients regardless of the situation - In the late 1980s, the Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called universal precautions, to prevent transmission of diseases found in blood and other body fluids. These guidelines were developed because infected people may be asymptomatic and have no knowledge of their conditions; therefore health care workers must assume that all patients are infectious and protect themselves.

A man was crying and said, "I didn't mean to do it. She just got me so angry I lost control. It will never happen again." The woman said, "It was my fault. I shouldn't have upset him." Then, looking at the nurse, the woman added, "Please don't report this. It will never happen again." Which of the following is the most appropriate response by the nurse? a. "Abusers don't stop unless intervention occurs. I have to report it." b. "If you're sure it won't happen again, I'll let it go this time." c. "Legally, I'm required to put this in the medical record." d. "The decision is up to the physician, not me."

a. "Abusers don't stop unless intervention occurs. I have to report it." It is a common myth that abusers will stop the abuse on their own. Professional intervention is required to break the cycle of abuse. The only way to effectively begin breaking the cycle of abuse is to report the incident. The nurse has a professional responsibility to report the abuse, just as the physician does. Documenting the information in the medical record will not initiate stopping the cycle of abuse.

A principal called the school nurse into his office and asked, "Will this student be able to attend our school?" after handing over the medical record of a severely handicapped prospective student. Which of the following would be the most appropriate response by the nurse? a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." b. "The student clearly won't be comfortable here; other students can be so cruel. Let me talk to the student's family." c. "There are schools that specialize in the care of the severely handicapped. Let me get in touch to see if one of those schools has the needed resources." d. "This student is so handicapped there is no way to manage the needed care; the family needs a home schooling teacher."

a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." In 1976, Public Law 99-142 was enacted, giving all students, including those who are severely handicapped, the right to public education in the least restrictive environment possible, regardless of mental or physical disabilities. The Education for All Handicapped Children Act of 1973 and the subsequent Individuals with Disabilities Education Act of 1990 enhanced the opportunities for children previously served in acute care and long-term care settings to have access to public education.

Although violence seems endemic in human society, which of the following causative factors could be reduced if society agreed action was necessary? (Select all that apply.) a. Access to firearms b. Alcohol and other drug abuse c. Dysfunctional families with lack of emotional support d. Intolerance of those with a different religious ideology e. Media video games, television shows, and movies f. Pacifism as a belief system

a. Access to firearms b. Alcohol and other drug abuse c. Dysfunctional families with lack of emotional support d. Intolerance of those with a different religious ideology e. Media video games, television shows, and movies Pacifism is a belief in peaceful resolution of conflicts and refusal to participate in war. All other factors are universally recognized factors that contribute to violence. These factors are poverty, unemployment, economic dependency; polydrug and alcohol abuse; dysfunctional family and/or social environment and lack of emotional support; media influence (e.g., violent video games, television shows, and movies); access to firearms; political and/or religious ideology; and intolerance and ignorance.

*Which of the following is the most commonly used drug among children and adolescents in the United States? a. Alcohol b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

a. Alcohol All 50 states and the District of Columbia have outlawed the sale of alcohol to anyone under the age of 21 years, yet it is still the most commonly used drug among children and adolescents. Marijuana is the most commonly used illicit drug in the United States. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine, (3.8%) and steroids (3.6%).

Who should create a disaster plan including emergency supplies and where to meet in case of an emergency? a. All families b. All government officials c. All public health employees d. Members of Congress and the Supreme Court

a. All families The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are: (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

*Which of the following actions should a nurse take to ensure personal safety when engaging in home visits? (Select all that apply.) a. Always sit between the client and the exit, and, when in doubt, leave the situation b. Be sure of the correct address and always have a GPS system c. Carry a cell phone and drive in a well-maintained car with a full gas tank d. Have enough money that you can buy your way out of trouble e. Only accept assignments within a few blocks of your own home f. Take self-protection courses such as karate and carry a weapon for your own defense

a. Always sit between the client and the exit, and, when in doubt, leave the situation c. Carry a cell phone and drive in a well-maintained car with a full gas tank Plan ahead with the correct address, directions, and information about who will be in the home; tell the office where you will be and check in regularly; carry a cell phone, possibly a pager, and a small amount of money; dress for function and mobility, wear a name tag, and be sure your vehicle is in good repair with a full gas tank and emergency equipment. Carrying a weapon typically results in the weapon being used against you.

A woman was seen in the emergency department with a greenstick broken arm and chest bruises. She explained she fell up a staircase at home while carrying laundry to the bedrooms. Besides assessing for other injuries, which of the following actions should be taken by the nurse? a. Ask about and educate regarding intimate partner violence (IPV) b. Assess for use of alcohol or other drugs that might have been a causative factor in the fall c. Get the patient an x-ray examination to determine location and severity of the break d. Immediately apply ice and immobilize in a sling

a. Ask about and educate regarding intimate partner violence (IPV) IPV, formerly known as domestic violence, is a pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim, such as a spouse, ex-spouse, boyfriend or girlfriend, ex-boyfriend or ex-girlfriend, or date. These behaviors may include battering resulting in physical injury, psychological abuse, and sexual assault that contributes to progressive social isolation and intimidation of the victim. Abuse is typically repetitive and often escalates in frequency and severity. IPV crosses all ethnic, racial, socioeconomic, and educational lines. About 30% of women and 1% of men report experiencing physical forms of IPV at some point in their lives. Thus, the nurse must assess for IPV.

The school nurse only had the resources for one education program for all the schools' teachers and support staff. Which of the following topics would be the most important to address in this program? a. Asthma b. Diabetes c. Epilepsy d. Measles and mumps

a. Asthma In 2011, 9.6 % of children under the age of 18 had asthma, occurring most often among poor (13.5%) and non-Hispanic black children (17%). Asthma is one of the most common chronic childhood conditions, causing more than 4.6 million people to miss more than 1 day of school or work (CDC, 2011d). Because asthma is so prevalent, it is recommended that school-based support exists. Actions undertaken by some schools across the country include immediate access to asthma medications, development and implementation of asthma action plans, and student and staff education on asthma. Because of the severity and prevalence of asthma, this is the most important topic to address and should be addressed instead of diabetes, epilepsy, or measles and mumps.

*When does disaster management begin? a. Before a disaster occurs b. Immediately after the disaster c. Throughout the disaster period d. When the disaster begins

a. Before a disaster occurs When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.

For which of the following groups is homicide the leading cause of death in the United States? a. Black males aged 15 to 34 years b. Black children aged 1 to 14 years c. White children aged 1 to 14 years d. White males aged 15 to 34 years

a. Black males aged 15 to 34 years For black males aged 15 to 34 years, homicide is the leading cause of death. Homicide is the second leading cause of death among black males aged 1 to 4 and 10 to 14 years, compared with white males, where homicide is the third leading cause of death in ages 15 to 29 years.

Which of the following disasters are considered NA-TECH (natural-technological) disasters? (Select all that apply.) a. Constant rain led to mud slides, and whole neighborhoods were buried. b. An earthquake caused structural collapse of bridges and highways in the area. c. People stampeded out of the overcrowded arena, trampling people who had fallen. d. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. e. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. f. Volcanic eruption covered the town with ash, making it difficult to breathe.

a. Constant rain led to mud slides, and whole neighborhoods were buried. b. An earthquake caused structural collapse of bridges and highways in the area. d. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. e. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. Disasters are identified as natural, man-made, or a combination of both. A NA-TECH disaster is a natural disaster that creates or results in a widespread technological problem. Examples of NA-TECH disasters would include whole neighborhoods being buried by mudslides, earthquakes causing structural collapse of roadways or bridges, river flooding resulting in an overflow of the sewage plant and contaminated drinking water, and a tsunami washing out all of the power and telephone lines. People stampeding out of a crowded arena does not involve a disaster that results in a widespread technological problem, nor does a volcanic eruption that makes it hard to breathe.

*Which of the following is one of the most frequent health complaints of school-aged children? a. Anxiety over grades b. Dental caries c. Headaches in response to stress d. Stomachaches

b. Dental caries One of the most frequent complaints of school-aged children is dental caries. Causes include poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for dental care. Half of children aged 12 to 15 years will have dental caries. Approximately 75% of those between the ages of 12 and 19 years have had tooth decay. Dental caries occur as a more frequent complaint than anxiety over grades, headaches in response to stress, and stomachaches.

Which of the following do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives? a. Create fear to intimidate and coerce to accomplish a political goal b. Encourage others with similar beliefs to join them and their cause c. Obtain publicity for themselves and their goals d. Obtain increased negotiating power and respect

a. Create fear to intimidate and coerce to accomplish a political goal The U.S. Code of Federal Regulations defines terrorism as "the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives."

A school health nurse was concerned about the diagnosed eating disorders of three high school students. A nutrition and body image program was planned. Which of the following classes should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. Kindergarten students

a. Elementary school grades 4, 5, and 6 It is imperative that the school nurse recognize the association between feelings of inadequacy (e.g., low self-esteem, anger, anxiety, and depression) and unhealthy eating practices in adolescents and young people. These self-perceptions begin early in life; therefore education and counseling must begin in elementary school. This program would be offered too early for kindergarten students and too late for grades 7 through 12. Thus, the priority population would be the elementary school children.

Everyone in a high school was very upset over the fact that one of the students had shot and killed another student. The nurse decided this was an appropriate time to establish a program to help prevent violence. Which of the following groups of students should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. The students who knew the victim and his assailant

a. Elementary school grades 4, 5, and 6 Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children.

A female student is at a fraternity party where alcohol is flowing freely, the music is loud, and people are dancing and talking. Most people seem to be having a great time. What action should the student take, if anything, when she overhears two men talking about having put ketamine in a girl's drink? a. First get out of there, then call the campus police and report what was heard b. Nothing, because she had no idea which woman was targeted or even if she drank what was given to her c. Talk to the two men about the dangers and side effects of ketamine d. Watch to see if any young women pass out or are otherwise impaired

a. First get out of there, then call the campus police and report what was heard The text talks about date rape drugs including ketamine. The first priority is to keep oneself safe, so leaving would be prudent. Ideally, the police will allow the report to be made without sharing who reported the potential problem. Doing nothing, talking to the men, and watching young women at the party will not protect the females at the party from unknowingly consuming the ketamine.

Which of the following best describes the risk for violence among females in the United States today? a. One of top five causes of death from age 1 to 44 years b. One of top 10 causes of death, especially among girls aged 1 to 4 years c. One of the top 10 causes of death, especially among women aged 15 to 24 years d. One of the top 10 causes of death, especially among vulnerable elderly

a. One of top five causes of death from age 1 to 44 years Among all females, homicide ranks in the top five causes of death among ages 1 to 44 years. Homicide is the third leading cause of death among females in the age groups of 1 to 4 and 20 to 29 years, is the fourth leading cause of death in the 5 to 14 year age group, and ranks fifth in the 30 to 34 year age group.

The 7-year-old boy's hands were badly burnt; it was suspected that his mother had forced his hands into boiling hot water after she caught him masturbating. The staff did not want the mother to be allowed near the boy. Which of the following statements would be made by the nurse to encourage the staff to interact more objectively with the mother? a. "If we won't let the mom near, who does the child have for support at this painful time?" b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." c. "The child may feel responsible; we have to let the mother fix their relationship." d. "We need to encourage the mother to continue parenting him or the boy will become a ward of the state."

b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." Most child maltreatment occurs within the family. Risk factors for child maltreatment include but are not limited to special needs children (children with disabilities, mental retardation, or chronic illness), children less than 4 years of age, family history of violence, substance abuse, poverty, and social isolation. Thus, it is most important that the staff provide support to the mother. The purpose of allowing the mother with the child is not for additional support for the child or mother, rather the recognition that the mother may have a history of abuse as well and needs assistance to change the patterns of behavior that have been learned through her own life experience.

Which of the following disasters would most likely cause the most long-lasting mental health concerns for its victims? a. For the fourth year in a row a flood hit an area, demolishing several houses, but families heard the warning siren and evacuated in time. b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. c. A tsunami hit the beach with unbelievable force, water sweeping over the entire harbor, although most boats had been moved to deep water. d. A volcano erupted and lava destroyed the main road to the village where several houses burned, but no one died in the eruption.

b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are: (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged.

Which of the following statements best describes how a disaster is the same as or different from an emergency? a. A disaster is personal, whereas an emergency is communitywide. b. An emergency is personal, whereas a disaster is communitywide. c. Both emergencies and disasters are devastating. d. Both emergencies and disasters are failures resulting in extensive insurance claims.

b. An emergency is personal, whereas a disaster is communitywide. A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Emergencies differ from disasters in that the agency, community, family, or individual can manage an emergency using their own resources. However, a disaster event may be beyond the ability of the community to respond to and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community. The type of emergency or disaster will determine the level of devastation or need for extensive insurance claims to be filed.

In addition to their homes, where are children most likely to be injured? a. At entertainment sites (theaters, amusement parks) b. At school, especially on playgrounds c. At their part-time job settings d. Transportation (automobiles, school buses)

b. At school, especially on playgrounds Safety on the schoolyard and playground is also important for this age group, because about 200,000 children per year are injured on playgrounds in the United States. Thus, school playgrounds are the most likely place where children are injured. Injuries at entertainment sites, part-time job settings, and through modes of transportation are less likely to occur than injuries at school.

As a nurse and a citizen, what is the nurse's additional responsibility in relation to disasters? a. Assume the nurse will be asked to volunteer to assist the American Red Cross with helping care for disaster victims b. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms c. Expect and plan for the possibility of being called to report to work for additional work efforts in caring for the sick and injured d. Expect to be a role model in preparing for and reacting to a disaster

b. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms As a nurse, one is expected to be informed regarding the Guidelines for Early Detection for Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular disease, an unusual number of persons seeking care with similar complaints, clusters of patients from a single location, or a person presenting with an uncommon disease.

Which of the following best describes how a community will know whether its disaster plan is adequate? a. After a disaster occurs and reports of deaths and injuries are fairly accurate b. By following practice drills involving various feasible scenarios as an initial step of planning c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the plan

b. By following practice drills involving various feasible scenarios as an initial step of planning For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

Which of the following health problems has been reduced in school-aged and adolescent children? a. Chronic diseases (such as asthma or diabetes) b. Contagious diseases c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

b. Contagious diseases Vaccine-preventable deaths (VPD) are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. Chronic diseases have been increasing in school-aged and adolescent populations due to the increase in overweight and obesity. STDs and stomach flu have not been greatly reduced in school-aged and adolescent children.

Every day a child came into the school nurse's office with vague complaints, but sometimes it seemed to the nurse that the child just wanted to talk and be listened to for a while. Unfortunately, the child took up almost 15 minutes of the nurse's very busy day. Which of the following actions should be taken by the nurse? a. Ask a staff person to talk with the child so the nurse could complete required tasks b. Continue to listen while assessing for possible underlying problems c. Refer the child to a private physician for follow-up on the constant physical symptoms the child presented d. Talk to the teacher about not letting the child leave the classroom unless obvious symptoms (fever, vomiting) of illness were present

b. Continue to listen while assessing for possible underlying problems The nurse or teacher may be the only stable adult in the child's life who will listen without being judgmental. Therefore, one of the most important roles of the school nurse is to act as counselor and confidante. Children may come to the school nurse with various vague complaints, such as recurrent stomachaches, headaches, or sexually promiscuous behavior, and the nurse must look beyond the initial complaint to identify underlying problems.

An 80-year-old woman lived with her eldest daughter, the daughter's husband, and their three children. On this visit, the nurse noted the woman looked dehydrated and seemed depressed. Both wrists were red and scabbed. When asked if she was all right, the woman protested she was fine and her daughter took good care of her. Which of the following actions should be taken by the nurse? a. Begin the paperwork to have the elderly woman put in a nursing home b. Discuss respite care and other stress relief measures with the daughter c. Report the elder abuse to the state department of aging d. Review with the total family how to share responsibilities for the woman's care

b. Discuss respite care and other stress relief measures with the daughter Working with victims of elder abuse, the nurse must establish rapport and trust. The nurse should remember that competent adults have the right to make decisions about their own care, including staying in an abusive situation. The nurse should support the family in examining potential respite care options and support groups for the elderly woman and her caregivers.

A student had been absent 4 days out of the last 3 weeks. When the school nurse asked what was wrong, the student replied, "Headaches" in a rather angry tone. The student had previously been heard to complain that school was boring and it was hard to concentrate on such dumb stuff. Which of the following actions would be most appropriate for the nurse to take next? a. Emphasize the importance of completing school for lifelong success b. Express concern that the student was under a lot of stress and offer to help if possible c. Meet with the student's parents to discuss the headaches and the school absences d. Refer the student to a neurologist for a workup to see what is causing the headaches

b. Express concern that the student was under a lot of stress and offer to help if possible Warning signs of stress include angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or other ailments, and inconsistent school attendance.

A male strong firearms advocate stressed his guns were for self-protection and he wanted all criminals to know his family had loaded guns in their home. Which of the following best explains why a nurse would not support his actions? a. Criminals carry more powerful and illegal guns. b. Guns in the home typically result in dead family members and friends. c. His children may be less careful than the adults in the family. d. Less trained individuals might think the guns were unloaded.

b. Guns in the home typically result in dead family members and friends. Concern about firearms arises when it has been shown that guns kept in the home for self-protection are more likely to kill a family member or a friend than an attacker. Furthermore, the presence of a gun in the home triples the risk for homicide in the home, increases the risk of suicide three to five times, and accidental deaths by four times.

Which of the following is the most commonly used illegal drug among children and adolescents in the United States? a. Inhalants b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

b. Marijuana The most commonly used illicit drug among youth in the United States is marijuana. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine (3.8%), and steroids (3.6%). Inhalants are the most widely abused.

Which of the following health problems continues to increase in school-aged and adolescent children? a. Contagious diseases b. Obesity and related problems (diabetes) c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

b. Obesity and related problems (diabetes) Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children.

Which of the following agencies should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response? a. Federal Emergency Management Agency (FEMA) b. Office of Emergency Management c. State Disaster Office d. The National Disaster Relief Agency

b. Office of Emergency Management The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain and improve the capacity to prepare for, protect against, respond to, recover from and mitigate all hazards. There is no specific government agency called the State Disaster Office or the National Disaster Relief Agency.

For which of the following groups is suicide the second leading cause of death? a. People aged 15 to 24 years b. People aged 25 to 34 years c. People aged 35 to 65 years d. People over age 65 years

b. People aged 25 to 34 years For people between the ages of 25 and 34 years, suicide is the second leading cause of death, and it is the third leading cause of death in people aged 15 to 24 years.

A woman is in the emergency department for the fifth time this year, each time with more severe injuries. Which of the following is the primary responsibility of the nurse? a. Insist she be discharged to a safe shelter where the perpetrator cannot find her b. Provide information regarding safe shelters and sources of support c. Report the assault and battery to the local police department so the perpetrator is arrested for the crime d. Treat the injuries and inform the woman she may be killed if she stays with the perpetrator

b. Provide information regarding safe shelters and sources of support Working with victims of intimate partner violence (IPV) requires the nurse to establish rapport and trust; deal with issues of confidentiality honestly; provide current information regarding shelters and sources of support; and recognize and accept that clients may "choose" to stay in an abusive relationship. Because the nurse wants to establish rapport and trust, it would not be in the best interest of building this relationship if the nurse insist that she go to a safe shelter (rather the nurse should provide her the necessary information) or inform the woman she may be killed (rather the nurse should recognize and accept that the client may "choose" to stay in an abusive relationship). Additionally, the nurse should recognize that even if the assault is reported, it may be denied by the woman and will not result in an arrest of the perpetrator.

A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. Which of the following actions should be taken next? a. Put a green tag on his shirt and he can get in line to wait his turn for medical treatment b. Put a yellow tag on his shirt and then await transport to a medical facility c. Put a black tag on his shirt and give him a chair to rest in until something can be done d. Put a green tag on his shirt and ask him to use his good arm to help others make it to the staging area

b. Put a yellow tag on his shirt and then await transport to a medical facility Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); and black is for the deceased or for those whose injuries are so extensive that nothing can be done to save them (e.g., multiple severe injuries).

Which of the following actions should be taken during a biological attack? a. Close doors and windows and turn off all ventilation b. Seek medical attention if you become sick c. Develop a family emergency plan d. Keep a written record of everything that you have eaten

b. Seek medical attention if you become sick During a biological attack one should: move away quickly; wash with soap and water; contact authorities; listen to the media for official instructions; and seek medical attention if you become sick. If a chemical attack were occurring, the first action would be to close doors and windows. In the case of a biological attack, one should move quickly away from the area. A family emergency plan should be developed well in advance of a biological attack. Unless directed by the authorities, it should not be necessary in any type of an attack to keep a written record of everything that is eaten.

A 6-month-old infant was brought in unresponsive by both parents. X-ray examination showed evidence of shaken baby syndrome. Which of the following persons is most likely responsible? a. The babysitter b. The dad c. The grandparents d. The mom

b. The dad In approximately 65% to 90% of abusive head trauma cases, also known as shaken baby syndrome, the father or the mother's boyfriend is the perpetrator.

The new principal stopped the school nurse in the hall and said, "I need to get oriented here. We seem to have a lot of handicapped children. Please make me a copy of their medical records so I can be prepared to meet with the parents if they come in." Which of the following is the most appropriate response by the nurse? a. "I'd be happy to help you get oriented to our students. I'll prepare a summary of our special students' needs and problems for you." b. "I'm so happy to hear of your interest; I'll get those records to you immediately." c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." d. "Let me check our school board policies regarding sharing of information and get back to you."

c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." The Family Educational Rights and Privacy Act, a strong privacy protection act, protects student education records, including the health records. Student health records should be afforded the same level of confidentiality as that given to clients and patients in other settings.

A rape victim says to the nurse, "He said he loved me; he had been so nice; he said he wanted to show me how much he loved me. And then he...." Which of the following is the most appropriate response by the nurse? a. "Anyone can lose control; I'm sure he'll never do it again." b. "I'm not sure he loves you; he may just have wanted easy sex." c. "Rape isn't about love or even sex; it's about power and control." d. "You shouldn't have gone up to his room alone when the two of you had both been drinking."

c. "Rape isn't about love or even sex; it's about power and control." Intimate partner abuse is about control, not anger. The objective of abuse is to exert power and control over the victim.

Which of the following best describes the incidence of abuse among pregnant women? a. It is too difficult to determine the actual incidence of abuse among this population. b. It is estimated that approximately 1 out of every 10 women experiences abuse. c. Approximately one out of every six women has been abused by a partner. d. Abuse does not occur among pregnant women.

c. Approximately one out of every six women has been abused by a partner. Pregnancy does not protect women from the danger of abuse. Indeed, pregnancy may increase stress within the family and provoke the first instances of battering. It is estimated that one in six pregnant women have been abused by a partner.

Which of the following steps should the nurse take first when triaging a victim of a disaster? a. Assess mental status b. Assess perfusion c. Assess respirations d. Assess blood pressure

c. Assess respirations To assess an individual within the 1-minute guideline, the START system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual a question. Assessing blood pressure is not part of the 1-minute guideline.

Which of the following best explains why the school nurse and the principal athletic director of the school would frequently be working together? a. As neither are teachers, each is susceptible to job layoffs if the community school tax levy does not pass. b. As support staff to teachers, they have many mutual problems in communicating how they can help teachers be more successful. c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. d. Both have to create a budget plan and allocate funds for their department for the year.

c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. Obesity and its prevention or treatment must be of concern to the school nurse. Although many of the underlying causes of obesity are not well understood, several contributing factors have been identified, including reduced access and affordability of nutritious foods, decreased physical activity, and cultural and genetic influences. The nurse and the athletic director would want to cooperate on how to increase physical activity of the students.

A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. Which of the following actions should the hospital take immediately? a. Ask the governor of the state to declare the area a disaster area so state help can be obtained b. Call surrounding hospitals to set up burn units, because there will be too many patients for one hospital to manage c. Call in physicians and nursing staff who are experts in burn care d. Get in touch with the American Red Cross to assist families of the victims

c. Call in physicians and nursing staff who are experts in burn care A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

*Which of the following actions would public health professionals want to use as primary prevention against widespread community violence? (Select all that apply.) a. Women seen in emergency departments should be asked about abuse b. Courses for prisoners about avoiding violence and resolving conflict c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence f. Home visits to elderly clients should include screening for elder abuse

c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence The goal of primary prevention is to stop violence, abuse, or neglect before it occurs. Education plays a major part in primary prevention and may include parenting and family wellness, and anger management or conflict resolution. Professionals should increase their awareness of violence, identification of cases, and provision of early treatment. The nurse can work in or with the community to educate citizens about the problem of violence, potential causes of violence, and available community services. Screening is secondary prevention, and courses for those already known to be violent are tertiary prevention.

In which of the following clinical areas are nurses most at risk for workplace violence? (Select all that apply.) a. Acute care/intensive care units b. Community health clinics c. Emergency departments d. Geriatric units e. Psychiatric units f. Rehabilitation units

c. Emergency departments d. Geriatric units e. Psychiatric units In the health care field, the most frequent areas for the occurrence of violence are the emergency departments, psychiatric units, geriatric units, and waiting rooms.

*Which of the following types of behaviors would a nurse expect to see when a disaster first strikes a community? a. A sense of all being okay and that one can rebuild and go on b. Anger and despair that help being offered is insufficient, slow, and inadequate c. Everyone trying to help strangers, as well as their neighbors, survive. d. People involved sharing their stories and reliving what occurred.

c. Everyone trying to help strangers, as well as their neighbors, survive. The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

*Which of the following must be involved for an act to be considered a terrorist act? a. A commitment to a political or religious belief b. An attempt to force compliance with a particular set of religious or political beliefs and behaviors c. Fear, intimidation, and violence d. Violence resulting in plural deaths

c. Fear, intimidation, and violence

Which of the following best describes why all citizens should care about young people joining gangs? a. Gangs are beginning to be seen in suburban areas. b. Gangs are responsible for destroying lives and property in inner cities. c. Gangs commit as much as 90% of all crime in some communities. d. Gangs help give the young person protection, respect, and sense of belonging.

c. Gangs commit as much as 90% of all crime in some communities. It is estimated that gangs are responsible for approximately 48% of all crime and up to 90% in some areas. These crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder. Gangs exist throughout the country, in urban and suburban areas. Destruction of lives and property is not the major reason why citizens should be concerned with gangs. Although gangs do give young persons protection, respect, and sense of belonging, the major concern would be the amount of crime that is associated with gangs.

Which of the following best describes why earthquakes would be more frightening than floods to many people, even though both can cause extensive damage? (Select all that apply.) a. Death rate and scope are higher in earthquakes. b. There is a higher frequency of earthquakes. c. Imminence of earthquakes is unknown. d. It is not possible to prevent an earthquake. e. The intensity of earthquakes is higher. f. The predictability of earthquakes is lower.

c. Imminence of earthquakes is unknown. d. It is not possible to prevent an earthquake. f. The predictability of earthquakes is lower. Death rate, intensity, and frequency depend on location and other factors. Hawaii, for example, has frequent earthquakes with little damage resulting. However, earthquakes cannot be predicted or prevented, whereas flooding can usually be predicted and most communities have taken steps to avoid or at least lessen the damage from floods. The frequency or intensity of earthquakes is not higher than that of flooding.

Where is youth violence most likely to occur? a. At home b. At recreational facilities c. In inner city schools d. In fast-food facilities where young adults are employed

c. In inner city schools Youth-related violence is more concentrated in minority communities and inner cities, causing a disproportionate burden on these communities. Children are often not taught peaceful ways of resolving differences and learn by default from what they observe on television and in movies. Consequently, schools have become a common site for violence.

Which of the following best describes why the numbers of children seen by the school health nurse is increasing? a. Higher expectations for performance by parents and school administrators b. Increasing school enrollments c. Lack of another source of regular health care d. Overcrowding within the community

c. Lack of another source of regular health care Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care.

Who is responsible for ensuring the safety and welfare of communities? a. Federal government b. Federal Emergency Management Agency c. Local government d. State government

c. Local government The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

Which of the following led to school nurses moving beyond the role of screening, assessment, intervention, and exclusion of children for communicable diseases? a. A communicable disease outbreak, which led to the requirement that all children be vaccinated against common infectious diseases b. Federal legislation, which required immunizations for communicable diseases c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco d. The need for inspecting schools to identify children who were ill and exclude them until they were no longer infectious

c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco The federal government was not involved in school health because education and health are responsibilities of the state government. The first citywide vaccination program—against smallpox—was in the 1870s before school nurses were first employed in 1902. Other issues beyond treatment for minor problems quickly became part of school nurse school practice. In the early part of the twentieth century, the temperance movement led schools to teach about the effects of alcohol and tobacco.

A 4-year-old child is seen in the emergency department with a spiral fracture of the right arm. X-ray examination shows previously broken and healed bones. Which of the following is the immediate responsibility of the nurse? a. Call social services to immediately set up foster care for the child b. Provide information about parenting and anger management classes c. Report the child abuse to the local legal authorities d. Try to establish rapport and trust with the child's family

c. Report the child abuse to the local legal authorities Spiral fractures are only possible from abuse, because they require a wringing motion to occur. When working with victims of child abuse, the primary obligation of all health care providers is to protect the child. The abuse must be reported as a legal and ethical obligation.

Which of the following types of maps is crucial to be included in any disaster plan? a. Communication map showing telephone wires and cell phone towers b. Geographic map showing, for example, roads, highways, and train routes c. Resource map showing potential resources in persons and supplies d. Response maps showing sites of first responders, such as fire stations and police stations

c. Resource map showing potential resources in persons and supplies A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed).

A new school nurse was concerned about being accepted, as the previous nurse had been at the school for more than 20 years. Which of the following would be the best approach for the nurse to take? a. Do the best job possible of revising policies and approaches to reflect current information and trends b. Put all the nurse's credentials (degrees, certifications) in an obvious spot in the health office c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff d. Spend time with each student, making sure the students all think she is very helpful

c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff The school nurse can assist the faculty and staff by giving workshops on exercise and nutrition, screening for increased blood pressure, and establishing weight management programs.

Which of the following best describes how Lillian Wald helped encourage the idea of school nurses in the schools? a. She brought political pressure to bear on school boards through her political action movement. b. She persuaded very wealthy women to convince their husbands to fund such positions. c. She demonstrated that school nurses decreased absenteeism by 50%. d. She used volunteer nurses until school boards were persuaded to fund such positions.

c. She demonstrated that school nurses decreased absenteeism by 50%. In 1902, New York City hired the first nurses to help inspect children, educate families, and ensure follow-up treatment. Within a few years, the renowned nurse Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%.

Which of the following legislation marked the first entry of the federal government into school health? a. The Drug-Free Schools and Community Act b. The Education for the Handicapped Act c. The National School Lunch Program d. The Safe and Drug Free Schools and Communities Act

c. The National School Lunch Program The federal government did not get involved with school health until the passage of the National School Lunch Program in 1946. The School Breakfast Program was implemented 30 years later. The Drug-Free Schools and Community Act was implemented in 1986 to fight substance abuse through education and was expanded in 1994 to include violence prevention measures. The Education for the Handicapped Act in 1975 mandated that all children, regardless of disabilities, have access to educational services. The Safe and Drug Free Schools and Communities Act supports programs that focus on prevention of school violence and illegal use of alcohol, tobacco, and drugs.

Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. Which of the following best describes how these patients are different from the first patients to arrive? a. Burn patients probably have skin damage, whereas the firefighters have lung damage. b. Burn patients will need extensive care over time, whereas the firefighters can probably stay the night with oxygen treatment and then be discharged. c. The burn patients were direct victims, whereas the firefighters are indirect victims. d. The second set of victims may have scarring, shortness of breath, and persistent hoarseness for the next few days.

c. The burn patients were direct victims, whereas the firefighters are indirect victims. Both sets of victims would have inhaled smoke and have lung damage. The treatment and length of stay would be determined by the amount of damage, which may vary from victim to victim. Both sets of victims, depending on the severity of the burns, may have scarring, shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an individual who is immediately affected by the event; the indirect victim may be a family member or friend of the victim or a first responder.

*Which of the following best describes the typical perpetrator of homicide? a. A person trying to engage in rape with the woman fighting back b. A person who wanted money and she refused to give it to him c. A stranger d. An intimate partner

d. An intimate partner Over 50% of the victims were killed by someone they knew. Notably 37% of female murder victims are killed by an intimate partner. Thus, the typical perpetrator would be an intimate partner. It would be less likely to be a stranger, someone who wanted money, or someone trying to engage in rape.

Which of the following best explains why more nurses do not report violence against themselves to authorities? a. Assumption that the nurse somehow "asked for it" by not being cautious enough or alert enough to avoid it b. Assumption that nothing would be done about the situation anyway c. Assumption that nurses can accept anything, from taking blame to being scapegoats for when outcomes are not positive d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job

d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job Workplace violence tends to be higher in some service-oriented work environments, including health care. Such violence is widely believed to be underreported, perhaps in part because of beliefs that it is an expected part of certain jobs.

Which of the following best describes why hate crimes involving violence are often considered worse than other crimes involving violence? a. Because hate crimes cannot be avoided because one cannot change one's race or religious or sexual orientation b. Because hate crimes often are committed by groups rather than individuals c. Because more damage is typically done in a hate crime than in a typical assault and battery d. Because the crime is personal, attacking the victim's identity

d. Because the crime is personal, attacking the victim's identity Hate crimes are crimes based on an individual's race, sexual orientation, religious beliefs, ethnic background, or national origin. Hate crimes may include rape, sexual or physical assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate crimes attack an individual's identity, the emotional effects are compounded.

Which of the following are the responsibilities of the Centers for Disease Control and Prevention (CDC) in relation to disasters? (Select all that apply.) a. Contacting family members with up-to-date information regarding victims and their condition b. Coordinating local services to prevent duplication and fragmentation c. Delivering first aid and arranging for prescription medications that were lost to be replaced d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims f. Setting up safe and comfortable disaster shelters (emergency housing) for families

d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), the CDC—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross.

*Which of the following statements best describes how the American Red Cross (ARC) is different from the Federal Emergency Management Agency (FEMA) or the National Incident Management System? a. Funding includes only voluntary contributions. b. It emphasizes being prepared for emergencies, not just reacting to them. c. It has only volunteers as staff. d. It is a nongovernmental volunteer agency.

d. It is a nongovernmental volunteer agency. The ARC is not a governmental agency. The ARC, however, is chartered by Congress to provide disaster relief. It works in partnership with FEMA, the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other federal agencies to provide and manage needed services. The ARC receives federal money as well as voluntary contributions. The ARC has both paid and volunteer staff. All of these agencies focus on preparation for disasters (not emergencies) as well as reacting after they occur.

Which of the following does the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service include in its routine screening that may not be included in a typical private physician preschool physical? a. Comprehensive health and developmental history b. Immunizations c. Laboratory testing d. Lead toxicity screenings e. Unclothed physical examination

d. Lead toxicity screenings The EPSDT includes lead paint screening. Medicaid-eligible children are guaranteed access to comprehensive health care services and routine dental examinations. Screening services must include a comprehensive health and developmental history, an unclothed physical examination, plus immunizations and laboratory testing that are age appropriate, as well as lead toxicity screenings. Because these children are very-low income, they probably live in older housing that may have lead paint. Private physicians caring for children with insurance see children of higher income levels who probably live in newer, safer housing.

*A friend who was raped and beaten appeared to be coping well. However, she recently dropped out of school and shared with the nurse that she is having nightmares where it happens all over again, and these nightmares are becoming impossible to live with. Which of the following would be the concern of the nurse? a. A late psychological reaction of despair and hopelessness b. Depression that no one rescued her and saved her from the traumatic event c. Guilt and concern over what she could possibly have done to invite such an event d. Posttraumatic stress syndrome disorder (PTSD)

d. Posttraumatic stress syndrome disorder (PTSD) PTSD is a psychiatric disorder that can occur after an individual's experiencing or witnessing a life-threatening event. People who suffer from PTSD often relive the experience through nightmares and flashbacks. The social and psychological symptoms can be severe enough, and last long enough, to significantly impair a person's daily life.

An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. Which of the following actions should the community take first? a. Send in ambulances to transport injured persons to medical facilities b. Send in media personnel to share the event and begin efforts to obtain donations for the injured c. Send in medical personnel to administer first aid and triage the injured d. Send in law officials to secure the area and ensure the safety of the victims

d. Send in law officials to secure the area and ensure the safety of the victims Before search and rescue should begin, safety must be considered. In some instances, if a criminal action is suspected, law officials will be among the first to respond to secure the area and possibly gather evidence. While the area is being checked and then cleared of potential threats, a staging area can be set up at or near the site of the incident to direct onsite activities. Search and rescue of victims can begin once clearance is given, a disaster triage area is established, and an emergency treatment area is set up to provide first aid until transportation for victims to hospitals or health care facilities for treatment can be coordinated.

A school nurse is conducting a program with high school students about adolescent sexuality. Which of the following information would the school nurse most likely include? a. Abstinence is the only way to avoid pregnancy and sexually transmitted diseases. b. Resources are available for assisting teenage parents with, for example, maternity clothing and baby needs. c. There are many sources of free or very-low-cost birth control measures. d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. e. Abortion is dangerous, is illegal in most areas, and can result in lifelong sterility.

d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. Although the nurse might want to include information on abstinence and birth control, it is important to convey the reality of teenage pregnancy. Adolescent fathers can confront a lifetime of paying child support. Teen mothers are less likely to complete high school and are more likely to be single parents and live in poverty.

Everyone is talking about the disaster that has been widely seen on the news programs. Which of the following suggestions would be most appropriate for the nurse to make at this time? a. That this opportunity should be used to discuss how to be brave in a crisis. b. That programs in collaborative problem solving should be created for students and staff. c. That the staff should reassure students that such a disaster would not occur here. d. That the school should develop an emergency management plan.

d. That the school should develop an emergency management plan. Every school is encouraged to develop an emergency management plan. In fact, many states mandate that schools develop plans to address the potential threat of another terrorist attack or a natural or man-made disaster. It would not be appropriate for the nurse to discuss bravery, student safety should come before bravery. Collaborative problem solving will not help the students be safer should this type of a crisis arise at the school. It is not appropriate to provide the students with reassurance as it is impossible to prevent all of these disasters, rather the school must develop an emergency plan so that they are prepared if this would happen at their school.

Which of the following U.S. agencies is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster? a. American Red Cross (ARC) b. The Department of Homeland Security (DHS) c. Federal Emergency Management Agency (FEMA) d. The National Incident Management System (NIMS)

d. The National Incident Management System (NIMS) Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President George W. Bush established the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2012). The ARC is not a governmental agency. It is chartered by Congress to provide disaster relief. It works in partnership with FEMA, DHS, the Centers for Disease Control and Prevention, and other local, state, and federal agencies to provide and manage needed services. The DHS was established to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.

*Which of the following best describes the mission of the U.S. Department of Homeland Security (DHS)? a. To consolidate all existing agencies, groups, and organizations into a single department b. To distribute federal financial aid to disaster-stricken areas c. To enable appropriate response to assist a state having a disaster d. To protect against and respond to threats and hazards to the nation

d. To protect against and respond to threats and hazards to the nation The mission of DHS is to: (1) lead the unified national effort to secure America, (2) prevent and deter terrorist attacks, and (3) protect against and respond to threats and hazards to the nation. This agency was created to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland, but this is not the mission of the agency. The Federal Emergency Management Agency distributes federal financial aid to disaster-stricken areas and is responsible to enable the appropriate response to assist a state having a disaster.

A school nurse was responsible for five schools. To give students required medications during the day, the school nurse teaches a particular office staff member in each school exactly what to give to whom and when, and they practice until both are comfortable. Which of the following remains as the nurse's responsibility in relation to the administration of medications? a. To begin teaching a second person at each school because the original staff member might occasionally not be available to give the medications b. To confirm with each student that they do not mind obtaining their medication from the staff person assigned to the task c. To continue to evaluate the comfort level of the staff person in completing the task d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs

d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs Not every school has a full-time nurse available on site. Often a nurse is assigned to three or four schools, resulting in delegation of certain tasks to unlicensed personnel. Each state's nurse practice act stipulates which procedures may be delegated. The responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. When tasks are delegated, the nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers.

Which of the following is the single leading preventable cause of death in the United States? a. Alcohol b. Firearms (guns) c. Overweight and obesity d. Tobacco use

d. Tobacco use Tobacco use is a major problem in this country and is the single leading preventable cause of death in the United States. Overweight and obesity is the second leading cause of preventable death in the United States. Alcohol and firearms (guns) are not leaders in the causes of preventable death in the United States.

Some of the medical staff thought an abused woman deserved what she got when she told them she was not going to a safe house following discharge from the emergency department. Which of the following information should the nurse stress to the medical staff? a. When the woman leaves the emergency department, her abuser will most likely be arrested. b. The woman probably feels fearful and helpless and, until her life is clearly threatened, nothing will probably change. c. The woman needs additional reinforcement that she would be safer in a domestic violence shelter. d. When a woman attempts to leave the situation, it is often when the abuser kills her.

d. When a woman attempts to leave the situation, it is often when the abuser kills her. The most dangerous time for the victim is when the victim leaves or attempts to leave the relationship, because it is seen as an erosion of the abuser's control. The victim is more likely to be killed at this time than at any other time in the relationship. It is unlikely the abuser will be arrested, even following this incident of violence. Because the woman is fearful for her life and recognizes the dangers that occur with leaving, she most likely will not leave the relationship. Additional education about the domestic violence shelter will most likely not change her mind to leave the situation.

When would the National Guard become involved in a disaster? a. When the Federal Emergency Management Agency requests such assistance b. When the local government requests help keeping order in the community c. When the president has declared the area a national disaster d. When the state has been asked to help an overwhelmed community

d. When the state has been asked to help an overwhelmed community When a disaster overwhelms the local community's resources, then the state's department or office of emergency management is called for assistance. Before an event, state officials provide technical support for prevention, preparedness, response, and recovery. State officials are on scene at disaster events to facilitate coordination of state resources and to disseminate information. In some cases, the National Guard may be called in to aid the community.

Which of the following medications can a school nurse expect to most frequently administer? a. Analgesics and antipyretics b. Antibiotics c. Antitussives d. Anticonvulsants e. Attention-deficit hyperactivity disorder (ADHD) medications

e. Attention-deficit hyperactivity disorder (ADHD) medications Medications used to treat ADHD are the most commonly administered. Medications commonly given in schools include analgesics and antipyretics, antacids, antitussives, anticonvulsants, antiemetics and antidiarrheals, antifungals, antihistamines, and antibiotics.

*Which of the following sets of symptoms would be unexpected after a disaster? a. Confusion, disorientation, indecisiveness, and memory loss b. Depression, fear, or just numbness c. Fatigue with headaches, nausea, and dizziness d. Irritable, suspicious, argumentative, and inappropriate e. No unusual feelings or behavior

e. No unusual feelings or behavior Common responses to disasters include all sorts of cognitive, emotional, physical, and behavioral symptoms. Therefore, to have no unusual feelings or behavior would indeed be unexpected.