POP Exam 2 TB

Which of the following would the community health nurse most commonly need to address when planning programs for children with chronic illness? A) Asthma control B) Autism education C) Diabetes regimens D) Seizure control

A Although autism education, diabetic regimens, and seizure control are common issues related to chronic disease in children, asthma is the most common chronic disease. Thus asthma control would be a priority.

A community health nurse is implementing a family planning program near a local inner city's schools. The nurse is engaging which type of health service? A) Preventive program B) Health protection C) Health promotion D) Injury prevention

A Feedback: A family planning program is an example of a preventive program that provides birth control information and counseling. Health protection programs focus on safety including injury prevention. Health promotion programs focus on areas such as nutrition and weight control, and drug abuse education.

Which one of the following statements about elder abuse is most accurate? A) Elder abuse is a problem that is under recognized and underreported. B) It is more common for elderly men to be abused rather than elderly women. C) If there is long-term domestic violence in an elderly couple, it is not considered elder abuse for the perpetrator to continue to abuse the victim. D) Self-neglect is not considered to be a form of mistreatment.

A Feedback: Elder abuse is a problem that is under recognized and underreported. It is more common for elderly women to be abused rather than elderly men. The most common perpetrators of elder abuse are spouses or partners of elders, often in a relationship with long-term domestic violence. In some states, self-neglect is also considered a form of mistreatment.

A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A)Collaboration with their health care providers B)Demonstration of a reactive focus C)Hesitancy in the use of resources D)Viewing of situations as nonchangeable

A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.

A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A)Insurance B)Acculturation C)Knowledge of disease D)Marital status

A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.

When providing safety education for parents of school-age children, the community health nurse would focus interventions on which of the following as the priority? A) Motor vehicle safety B) Water safety C) Fire safety D) Poisoning prevention

A Feedback: For the 1- to 9-year-old age group, motor vehicle/traffic injury, drowning, and fire/burn injuries were the top three causes of injury death. For the 10- to 19-year-old age group, motor vehicle/traffic injuries, drowning, and poisoning are the three leading causes of injury death. Thus the priority would be to focus interventions on motor vehicle safety. Although water and fire safety and poisoning prevention would be important, motor vehicle safety would be most important.

A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A)Increase use of early screenings B)Increase emergency room visits C)Increase episodic care D)Increase disparities in care

A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.

A community health nurse is presenting a program to a local elementary parent-teacher association on the topic of pediculosis. The nurse determines that the group needs additional teaching when they identify which of the following as a likely mode of transmission? A) Coming into contact with an animal B) Combing hair with another's comb C) Using a towel of an infected child D) Sleeping in a friend's bed who had lice

A Feedback: Head lice are most often transmitted by direct contact (head-to-head) or may be passed from infected to uninfected children through shared items such as combs and brushes, hats, scarves, sheets, and towels (called fomites). Contrary to some popular myths, lice do not fly or jump, and they cannot be contracted from animals—they live only on humans.

Which of the following are characteristics of healthy older adults? A) They are able to perform functional activities of daily living. B) They are able to adapt, to continue to handle stress, and to be active in life and living. C) They maintain the maximum degree of physical, mental, and social vigor. D) They are likely to be dependent on others. E) They reside in institutions.

A Feedback: Healthy older adults' ability to function is a key indicator of health and wellness and is an important factor in understanding healthy aging. They are able to adapt, to continue to handle stress, and to be active in life and living. They maintain the maximum degree of physical, mental, and social vigor. The vast majority of older adults, even those with chronic diseases or other disabilities, are living outside institutions and are relatively independent.

local community agencies to provide services for children and adolescents with disabilities. 8. Based on the nurse's knowledge of the most common disabilities affecting this group, the nurse would advocate for which of the following to address the largest group? A) Special education services B) Speech therapy services C) Mental health services D) Mental retardation services

A Feedback: In descending order, the most common disabilities found in school-age children and adolescents are learning disorders; speech or language impairment; mental retardation; serious emotional disturbances and other disabilities, such as autism; deaf-blindness; orthopedic problems; traumatic brain injury; and other health impairments, such as asthma, diabetes, and epilepsy. Thus advocating for special education services would address the most common disability, learning disorders.

When describing the changes occurring in the older adult population globally, which of the following would be most accurate? A) The over-80 years age group is the fastest growing segment of the group. B) Males have a longer projected life expectancy when compared with females. C) Most countries have adequate numbers of social programs for older adults. D) Adults over age 65 are expected to account for about 25% of the population by 2050.

A Feedback: In most of the world, the population of those over 80 years of age is growing faster than any other population age group. A higher life expectancy at birth for females compared with males is almost universal. Many countries have few or no social programs available for older adults. By the year 2050, one tenth of the population is expected to be over the age of 65 years.

When explaining the concept of disability to a local community group, which of the following descriptions would be most appropriate for the nurse to include? A)A disability is a condition someone has, not something one is. B)The plan of care for two persons with the same disability would be the same. C)A disability refers to a person's inability to do something. D)Handicap and disability are two terms that go hand in hand.

A Feedback: Long-held negative views of disabilities are being replaced with new and more positive approaches that view individuals and their challenges from a more holistic standpoint. Thus, a disability is something that a person has, not something one is. Even persons with the same disability but their plan of care can be quite different. Earlier terminology equated disability with an inability or incapacity or handicap that presents a more negative view of the condition.

The nurse educator knows the nursing student understands the effect of homelessness on the health of children when the nursing student identifies which of the following? A) "Homeless children are four times more likely to become ill." B) "While approximately 87% of homeless children are enrolled in school, only about 77% attend regularly." C) "Fewer than 25% of homeless children graduate from high school." D) "Homeless children are twice as likely as their housed counterparts to repeat a grade in school."

A Feedback: Only one of these statements that directly relates to the effect of homelessness on the health of children is, "Homeless children are four times more likely to become ill."

When describing the importance of the World Health Report to a group of students, the instructor would emphasize which of the following? A) It challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. B) Lifestyle choices are not one of the key contributors to morbidity and mortality levels in either affluent or poor countries. C)Infectious disease is the major threat. D)Malnutrition is the only threat.

A Feedback: The World Health Report challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. It recognized that although infectious disease and malnutrition require ongoing vigilance because they continue to plague many parts of the world, they are not the only threat. Lifestyle choices are also one of the key contributors to morbidity and mortality levels in both affluent and poor countries.

A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A)Avoiding political involvement in issues B)Working with schools to reduce the dropout rate C)Organizing task forces to raise community awareness D)Holding community meetings to identify needs

A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.

In Healthy People 2020, what is the emphasis of the categories of objectives that relate to the goal of "Disability and Health to promote the health and well-being of people with disabilities?" A)A growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services B)A growing realization that healthy-life years for persons with disabilities do not equate to decreased health costs at local, state, and national levels, unlike they do for persons without disabilities C)Focus on personal responsibility for healthy lifestyle by persons with disabilities D)Concept that persons with disabilities are always dependent on others

A Feedback: In Healthy People 2020, the emphasis of the categories of objectives that relate to the goal of "Disability and Health to promote the health and well-being of people with disabilities" is a growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services. It also indicates a growing realization that healthy life years for persons with disabilities equate to decreased costs at local, state, and national levels, just as they do for persons without disabilities. There is not a focus on personal responsibility for healthy lifestyle by persons with disabilities or a concept that persons with disabilities are always dependent on others.

When working with school districts, which of the following would the community health nurse encourage as the most effective school- based approach to solve the problem of teenage suicide? A) Suicide prevention programs with direct interventions B) Teachers assessing suicide risk among students C) Promotion of stronger parental control of teens D) Punitive treatment of teens by the school administration

A Programs and interventions by counselors and school nurses that are focused on determining adolescent suicide intentions are the most effective approaches. Teachers do not feel comfortable or prepared to assess suicide risk, and this alone will not prevent teen suicide. Peer pressure is strong, and parent concerns are not as important to the teen. Teens are seeking independence, and stronger parental control is not an effective method of reducing teen suicide. This approach is inappropriate for any school-age child or teen behavior.

When working with the older adult population in the community, which of the following would be most important for the community health nurse to do? A) Develop case management programs to channel clients to appropriate services B) Place the older adult in skilled nursing facilities for the best care available C) Raise funds to support the needs of the older adults in the community D) Emphasize tertiary prevention at this stage in the lives of the older adult

A Services for the older adult should be proactive. Nurses should design interventions that maximize nursing resources and provide the greatest benefit to elderly clients. Skilled nursing facilities are for people with skilled needs, not for older adults managing chronic diseases independently. One's own home is most often the best place for elders and where they want to be. This is not something that is always needed or possible for a community health nurse to become involved in. Nurses can identify the needs for additional funding, advocate for more funding, and facilitate a community group's efforts to raise funds. This is how a nurse can best serve the elderly and support their needs rather than by actually raising the funds. Prevention should be proactive and focus on primary prevention regardless of the client's age.

When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A)Resource availability B)Relative risk C)Health status D)Housing E)Education

A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.

Which of the following are the three areas has Healthy People identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health? Select all that apply. A)Improve the conditions of life for persons with disabilities B)Address the inequitable distribution of resources among people with disabilities and those without disabilities C)Expand the knowledge base and raise awareness about determinants of health for people with disabilities D)Ensure the health of people with disabilities by influencing many social and physical factors E)Public health activities need to focus only on preventing disability

A, B, C Feedback: The three areas that Healthy People has identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health include improve the conditions of life for persons with disabilities; address the inequitable distribution of resources among people with disabilities and those without disabilities; and expand the knowledge base and raise awareness about determinants of health for people with disabilities. The plan to ensure the health of people with disabilities by influencing many social and physical factors is too broad. Public health activities need to focus only on preventing disability is a misconception.

Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A)Patients feel that they are unable to trust the information given to them and may not follow it as explained. B)Limited access to appropriate level of care C)Poor access to quality care D)Overt discrimination E)Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts

A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.

Which of the following are reasons why it is difficult to estimate the number of persons who are homeless? Select all that apply. A) It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. B) It is difficult to locate and account for people who are homeless. C) Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. D) In rural areas, there are fewer housing options and resources for the homeless and as a result people may be forced to live temporarily with friends or family. E) Homelessness is increasing due to poverty and the growing shortage of affordable rental housing.

A, B, C, D Feedback: The following are reasons: It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. It is difficult to locate and account for people who are homeless. Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. In rural areas, there are fewer housing options and resources for the homeless, and as a result, people may be forced to live temporarily with friends or family. It is true that homelessness is increasing due to poverty and the growing shortage of affordable rental housing, but this is not a reason why it is difficult to estimate the number of people who are homeless.

Which of the following are subpopulations that are more likely to be sheltered homeless in urban areas? Select all that apply A) Adult males B) African Americans C) Veterans D) Disabled E) Migrant workers

A, B, C, D Feedback: When compared to their housed counterparts nationwide, the sheltered homeless are more likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural areas, the homeless are more likely to be White, Native American, or migrant workers.

Which of the following are reasons for the increase in poverty rates over recent years? Select all that apply. A) Declining wages B) Decline in public assistance C) Loss of jobs that offer security and carry benefits D) A decline in manufacturing jobs in favor of lower paying service jobs E) Globalization and outsourcing F) Homelessness

A, B, C, D, E Feedback: The increase in poverty rates over recent years may be attributed to declining wages, loss of jobs that offer security and carry benefits, and increase in temporary and part- time employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in favor of lower paying service jobs, globalization and outsourcing, and a decline in public service. As wages drop, the potential to secure adequate housing wanes. This does not mean that homelessness is a cause of poverty. Actually, it is poverty that is known to cause homelessness.

Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A)HIV-infected persons B)Persons who use illicit drugs C)People of non-White race/ethnicity D)People of White race/ethnicity E)Homeless persons

A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.

A community health nurse is preparing for a presentation on disabilities and is planning to include information about Healthy People 2020 goals. When addressing these goals, the nurse identifies differences from the goals addressed by Healthy People 2000. Which of the following would the nurse identify as different? Select all that apply. A)Rather than individuals with disabilities and/ or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole. B)The approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/or chronic illness. C)The goals for Healthy People 2000 have an entire section on disability and secondary conditions. A growing realization that healthy life-years for persons with disabilities equate to D) decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

A, B, D Feedback: A comparison among Healthy People plans over the last decades underscores the emergence of new approaches to identifying priority areas and planning to improve the health of individuals with disabilities and chronic illness. In Healthy People 2000, only one priority was devoted to disability and chronic illness. Over the past two decades, interest in disability has accelerated. Areas that are focused on with Healthy People 2020 include rather than individuals with disabilities and/or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole; the approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/ or chronic illness; and a growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

Which of the following are included in a comprehensive set of services? Select all that apply. A) Adequate financial support B) Health education C) Encouragement to spend much time alone D) Adult day care programs E) Access to high quality health care services F) In-home services

A, B, D, E, F Feedback: A comprehensive set of services for senior citizens should include the following: adequate financial support, adult day care programs, access to high quality health care services, health education, in-home services, recreation and activity programs that promote socialization (not encouragement to spend much time alone), and specialized transportation services.

When addressing homeless children and youth, which of the following situations are also considered homeless according to the education subtitle of the McKinney-Vento Homeless Assistance Act? Select all that apply. A) Children who share housing with others due to economic hardship or loss of housing B) Children who are abandoned in hospitals C) Children who are awaiting placement in foster care D) Children who are living in motels, trailer parks, or camping grounds E) Children who are living apart from one or more of their parents

ABCD Feedback: The education subtitle of the McKinney- Vento Homeless Assistance Act expands on the definition of homelessness when addressing homeless children and youth. The act includes as homeless those children who share housing with others due to economic hardship or loss of housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in motels, trailer parks, or camping grounds. Children who are living apart from one or more of their parents may not be homeless.

Which of the following comprise the primary criteria for effective programs for older adults? A) Coordination B) Accessibility C) Comprehensive D) Complex E) Quality

ABCE The primary criteria for effective programs for older adults include coordination, accessibility, comprehensive, and quality.

Which of the following statements are common misconceptions about older adults? Select all that apply. A) It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become "senile." B) As older adults age, they become more different and less alike other older adults. C) Older people are very capable of learning new things. D) As age increases, older adults withdraw, become inactive, and cease being productive.

AD The misconceptions or myths about older adults include the following: It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become "senile"; As age increases, older adults withdraw, become inactive, and cease being productive; As older adults age, they lose their individual differences and become progressively more alike; older adults are forgetful, unable to learn new things, and set in their old ways of doing things.

After reviewing statistics on homelessness, which of the following would a community health nurse identify as the fastest growing segment of the homeless population? A) Children under age 18 years B) Families headed by a female single parent C) Families headed by a male single parent D) Families with children

Ans: D Feedback: Families with children are the fastest growing segment of the homeless population based on statistics, accounting for approximately 34% of the homeless population. Single female parents account for most of the homeless families. However, because many two-parent families and families headed by single fathers are becoming homeless because of the recession, and most homeless provider organizations serving families are geared to serving single women with children, it can be harder for intact families and families headed by men to access shelter.

Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A)Exposure to risk factors affects the population's social and human capital. B)Everyone is at risk because of stressful events occurring in life. C)A risk for a negative outcome increases with lower education and income levels. D)Certain groups are impacted by stressful events more than others.

Ans: D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.

A community health nurse who is participating in a nutritional screening program with school-age children measures their body mass index (BMI). The majority of children fall within the 45th to 65th percentile for their age. The nurse would classify these children as which of the following? A) Underweight B) Healthy weight C) At risk for overweight D) Overweight

B Feedback: A BMI between the 5th and 95th percentile for age is considered healthy weight. Underweight refers to a BMI below the 5th percentile. At risk for overweight refers to children with a BMI between the 85th and 94th percentile. Overweight refers to children with a BMI equal to or greater than the 95th percentile.

Which one of the following statements about the benefits of universal design for all persons is the most accurate? A) It is the right thing to do to allow access to the built environment for all persons including persons with disabilities. B)A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions. C)The built environment refers to the naturally occurring features of the planet. D)Access implies universal design.

B Feedback: A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions. Universal design is the right thing to do for persons with disabilities but is not the most accurate or best reason to ensure universal design. The built environment refers to the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure). Universal design incorporates access, but access does not necessarily imply universal design.

A community health nurse is reviewing the effects of the Americans with Disabilities Act of 1990. Which of the following would the nurse identify as a major result of this legislation? A)Employers with five or more employees must abide by the American with Disabilities Act. B)Architectural barriers must be removed from pathways so that they are accessible by wheelchair. C)The disabled are eligible to receive telephone services in their home at no cost to them. D) Individuals with disabilities who wish to vote must be provided transportation to polling places to vote.

B Feedback: A major accomplishment of this law was the removal of architectural barriers; curbs, stairs, handicap toilets, etc. so that the disabled in wheelchairs can freely move about. Employers with 15 or more employees must follow this law. Adapted telephone services are provided for those who are hearing or physically impaired, but the telephone service is not free. Polling places must be accessible to the disabled and absentee ballots and voter registration can be done from home.

A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A)Keeping the clients to a firm schedule of visits B)Viewing the clients as active partners in the process C)Having the clients cut through bureaucratic red tape D)Focusing on the clients' limitations

B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).

When preparing a program about substance abuse prevention for adolescents, the community health nurse would focus on which substance as the most frequently used? A) Marijuana B) Alcohol C) Ecstasy D) Ketamine

B Feedback: Alcohol is the most frequently used substance for adolescents in the United States. Marijuana is the most commonly used drug among 14- to 17-year-olds. Ecstasy and ketamine are other drugs used by adolescents and young adults.

A community health nurse is working with local schools to help address teen pregnancy. The nurse would focus interventions on which of the following? A) Better use of contraceptives B) Decreased sexual activity C) Improved parenting skills D) Proper nutritional habits

B Feedback: Although contraceptives, parenting skills, and nutrition may be areas of focus for teen pregnancy, research has shown that the downward trend for teen pregnancy rates has been attributed largely to better contraceptive use rather than less sexual activity. Therefore, interventions should focus on the area of decreasing sexual activity.

A community health nurse meets with a group of adults at the local senior center. They range in age from 65 to 70 years. The nurse would recommend vision screening at which frequency? A) Every year B) Every 2 years C) Every 5 years D) Every 10 years

B Feedback: Currently, vision screening is recommended every 2 years for adults aged 65 years and older. Blood pressure screening should occur yearly, and total cholesterol evaluation should occur every 5 years. Tetanus and diphtheria immunizations should be administered every 10 years.

Which one of the following statements regarding mental illness and homelessness is most accurate? A) 75% of the sheltered homeless report a severe mental illness. B) Deinstitutionalization or being released from institutions into the community contributes to the number of persons who have a severe mental illness who are homeless. C) Mental illness only contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. D) Mental illness and substance abuse are not often comorbid conditions that contribute to homelessness.

B Feedback: Deinstitutionalization or being released from institutions into the community contributes to the number of severely mentally ill persons represented in the homeless population. Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. Mental illness and substance abuse are often comorbid conditions, which, coupled with poor physical health, make it especially difficult to secure employment and safe, affordable housing.

After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A)Homelessness B)Acute illness C)Income D)Immigrant status

B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.

When working with community groups to develop appropriate programs for adolescent health promotion, the nurse integrates knowledge of the Healthy People 2020 objectives, keeping in mind that many of the objectives address which of the following? A) Self-esteem improvement B) Risk-taking behaviors C) Control of disease D) Behavioral issues

B Feedback: Healthy People 2020 objectives are geared to improve the health of all Americans. Twenty- one specific objectives have been ranked as critical for this population. The objectives focus on issues involving mortality and morbidity in this age group that stems primarily from risk-taking behaviors. Many of the objectives relate to reduction in alcohol- related unintentional injuries, declines in violent behaviors, suicide and mental health issues, as well as more responsible reproductive health behaviors.

When preparing a program to address violence among school-age children and adolescents, the community health nurse integrates knowledge of which of the following? A) Teen females commit homicide more frequently than teen males. B) Homicide is the second highest cause of death for all adolescents. C) Adolescents account for less than one half of all firearm injuries treated. D) Serious youth violence is unrelated to drugs and guns.

B Feedback: Homicide is the second leading cause of death for adolescents (ages 10 to 24) and is more common in males than females. Adolescents between the ages of 15 and 19 years account for almost 85% of all firearm injuries treated in emergency departments or hospitals. Serious youth violence is part of a constellation of risk-taking behaviors that also includes precocious sex, drugs, and guns.

A community health nurse is planning to apply the International Classification of Functioning, Disability, and Health to clinical care in the community. The nurse could use this document as a basis for which of the following? A)Curriculum design B)Needs assessment C)Quality of life measures D)Policy design

B Feedback: In clinical care, the ICF document would be helpful with a needs assessment. Using the ICF document for curriculum design would reflect education; using it for quality of life measures would reflect research; using it for policy design would reflect social policy.

An older adult interested in nutrition asks the community health nurse about the number of calories that he or she should eat every day. Which of the following would be most appropriate? A) 800 to 1,200 calories B) 1,200 to 1,600 calories C) 1,600 to 2,000 calories D) 2,000 to 2,400 calories

B Feedback: It is generally believed that older people need to maintain their optimal weight by eating a diet that is low in fats, moderate in carbohydrates, and high in proteins with a daily calorie count of 1,200 to 1,600.

An older adult comes to the community health center for a checkup. During the visit, he or she mentions that he or she is somewhat constipated. Which of the following suggestions would be most appropriate? A) Use a laxative about once or twice a week B) Increase your intake of fresh fruits and vegetables C) Drink about four 8-oz. glasses of fluid each day D) Walk around the block once a week

B Feedback: Older adults should add more fiber and bulk to their diet with fresh fruits and vegetables instead of relying on the habitual use of laxatives. Also inadequate fluid intake can contribute to bowel and bladder problems. Consuming a diet that includes eight or more 8-oz. glasses of fluid (water, juices, tea) each day assists the gastrointestinal and genitourinary system in their functions. Increased physical activity and exercise, such as a daily walk, help keep an older adult's bowel patterns regular.

Which one of the following statements about relative risk is most accurate? A)Lifestyle, behaviors, and choices do not relate to relative risk. B)Relative risk refers to exposure to risk factors identified from a substantial body of research. C)Relative risk means that if a risk exists, the illness or adverse event will occur. D)Any factor that is likely to cause increased risk is considered relative risk.

B Feedback: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.

Which one of the following statements is true regarding social capital? A)Social capital includes investments in individuals' capabilities and skills. B)Social capital includes marital status and family structure. C)Social capital includes jobs, income, housing, and education. D)Examples of social capital are education and job training.

B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.

A community health nurse is assessing an older adult's ability to perform activities such as shopping, doing the laundry, using the telephone, and handling finances. Which assessment tool would be most appropriate for the nurse to use? A) Barthel Index B) Instrumental Activities of Daily Living Scale C) Katz Index of Activities of Daily Living D) Modified Rankin Scale

B Feedback: The Instrumental Activities of Daily Living Scale looks at an older adult's ability to perform such activities as using the telephone, shopping, doing laundry, and handling finances. The Barthel Index assesses functional independence and is often used to determine levels of disability or dependence of stroke victims in respect to ADLs. The Modified Rankin Scale (MRS) is another common tool used for this purpose. The Katz Index of Activities of Daily Living is based on an evaluation of the functional independence or dependence of clients with respect to bathing, dressing, toileting, and related tasks.

A community health nurse is compiling a list of organizations that serve the needs of persons with disabilities. Which of the following would the nurse categorize as a federal agency? A)National Organization on Disability B)National Council on Disability C)National Association of the Deaf D)American Foundation for the Blind

B Feedback: The National Council on Disability is an independent federal agency. The National Organization on Disability, National Association of the Deaf, and American Foundation for the Blind are private organizations.

A community health nurse is providing immunizations to school-age children at a local health department. At which age would the nurse expect to administer the first dose of human papilloma virus (HPV) vaccine? A) 9 B) 11 C) 13 D) 15

B Feedback: The current recommendation is to administer the first dose of HPV vaccine at age 11. However, the earliest age that the vaccine can be given is age 9. The HPV vaccine is administered to females at age 13 to 18 if they have not been previously vaccinated.

Which of the following is a major difference between Healthy People 2010 and Healthy People 2020 with respect to people with disabilities? A)Healthy People 2010 emphasized the disparities that persons with disabilities experience. B)The emphasis on "secondary conditions" in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities. C)People with disabilities do not experience health disparities any more than people in the general population. D)Healthy People 2020 continues to emphasize secondary conditions.

B Feedback: The emphasis on "secondary conditions" in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities. Key to addressing the barriers is for people with disabilities to "(1) be included in public health activities; (2) receive well-timed interventions and services; (3) interact with their environment without barriers; and (4) participate in everyday life activities. Without these opportunities, people with disabilities will continue to experience health disparities, compared to the general population."

Which of the following would a community health nurse expect to assess in the population of homeless men? A) Marital status B) Substance abuse C) Permanent employment D) Frequent use of shelters

B Feedback: The majority of homeless men are single adults. Homeless men are more likely to be employed than their homeless female counterparts; yet, they usually hold temporary, low wage jobs that offer little security. They are also more likely than homeless women to have uncontrolled substance abuse issues. This makes it more difficult for them to access shelters, which tend to require abstinence for admission

For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually transmitted infections? A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infections. B) They lack education or job training skills and may resort to prostitution or survival sex, which increases their risk for HIV, hepatitis, and sexually transmitted infections. C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility. D) It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

B Feedback: The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually transmitted infections is that they lack education or job training skills and may resort to prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infection; they may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

When developing programs to assist individuals with disability and chronic illness, which of the following would be most important? A)Narrow focus B)Holistic practice C)Orientation to the present D)Episodic care

B Feedback: The role of the community health nurse with respect to disabilities and chronic illness requires a holistic practice and broad focus. Strong and sustained efforts are needed to achieve results. The community health nurse addresses current needs and plans for the future.

Which one of the following statements is true regarding the socioeconomic gradient of health? A)The behavior of smoking is lowest among those who have low income and low educational levels. B)The socioeconomic gradient of health has been found in populations around the world. C)All persons who have a low socioeconomic status will develop particular health problems. D)The socioeconomic gradient of health is universal.

B Feedback: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.

After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A)Direct B)Inverse C)Positive D)Unequal

B Feedback: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.

A community health nurse is working with an older adult population ranging in age from 75 to 85 years. The nurse correctly classifies this group as which of the following? A) Young-old B) Old-old C) Oldest-old D) Elite-old

B Feedback: Those between the ages of 65 and 75 are classified as "young-old," while those between 75 and 85 are labeled "old-old." The number of people living into "older" old age (75 years and older) is increasing. Forty percent of elderly people in the United States are among the "oldest-old" (85 to 100 years), while more than 200,000 are among the elite- old, or centenarians.

A community health nurse is teaching a group of parents about attention deficit hyperactivity disorder. Which statement by the parents would indicate the need for additional teaching? A) "We probably will need to give him medication to help him in school." B) "We need to keep him away from foods that have additives in them." C) "This condition is most likely due to problems with genes and nerve receptors." D) "We'll be alert to the possibility of more injuries and accidents." Ans:

B Feedback: While a number of parents feel that sugar and food coloring or additives may worsen ADHD symptoms in their children, research shows no behavioral or learning differences in double- blind studies with sugar and sugar substitutes. Medications are commonly used, with the primary goal of improving academics. New research is focusing on inherited tendencies for problems with dopamine receptors and transporter genes, supporting a neurologic basis for the condition. Children with ADHD are more prone to accidents and injuries.

A community health nurse is making a home visit to a family. The family has a son with a disability who requires a motorized wheelchair. The family asks for the nurse's assistance. Which response by the nurse would be most appropriate? A)"His disability should automatically cover the cost of the chair." B)"We'll need to check with the insurance company about coverage." C)"You'll probably be able to get it if you pay for half the cost." D)"You might be able to get a regular wheelchair, but a motorized one is impossible."

B Feedback: One major obstacle for families with a disabled or chronically ill member may be obtaining needed assistive devices and technology. Just because the technology exists does not mean that it can be obtained. Often the insurance carrier, whether private or governmental, sets limits on which products can be obtained or which brands are acceptable. Thus the nurse working with the family would need to check with the insurance company first and determine what if anything is covered and then determine how to go about obtaining what the son needs.

Which one of the following statements is most accurate when differentiating hospice from palliative care? A) Both palliative care and hospice focus on cure; however, hospice focuses on terminal illnesses, and palliative care focuses on diseases that are more chronic in nature. B) Palliative care consists of comfort and symptom management and is often a part of hospice care. C) Hospice is more of a specific place than a concept of care, whereas palliative care is more of a concept of care. D) Hospice is intended for people who have a projected life expectancy of 6 months or more, and palliative care is intended for people who are actively dying.

B Palliative care consists of comfort and symptom management and is often part of hospice care. Neither palliative care nor hospice focuses on cure. Hospice does focus on care of people who are known to be at end of life, and palliative care can be provided to people who have chronic ongoing health conditions even when death is not imminent. Hospice is more of a concept of care than a specific place. Palliative care should be a major focus of care throughout the aging process, regardless of whether death is imminent within 6 months.

Which of the following statements about children's health status and academic achievement are most accurate? A) All health problems that can affect learning and achievement in school-age children are preventable. B) Physical and emotional health can affect academic achievement in children and adolescents. C) Only behavioral health problems can affect learning and achievement in school-age children. D) Poverty is one health problem that does not affect learning and achievement in school-age children.

B Physical and emotional health can affect academic achievement in children and adolescents. Not all health problems that can affect learning and achievement in school-age children are preventable. Behavioral health problems can affect learning and achievement in school-age children, but other types of health problems can also affect learning and achievement in school-age children. Poverty is a health problem that also affects learning and achievement in school-age children.

When describing elder abuse to the families of older adults who are attending a local community presentation, which of the following would the community health nurse identify most commonly as the perpetrator? A) Elder's adult child B) Elder's partner C) Elder's neighbor D) Elder's grandchild

B The most common perpetrators of elder abuse are spouses or partners of elders. The next most frequent abuser is the adult child of the elder. Although it may be possible that the perpetrator is the elder's neighbor or grandchild, this situation would be quite rare.

The community health nurse is invited to speak to a group of students about clients with disabilities. As part of the class, the nurse intends to describe The International Classification of Functioning, Disabilities, and Health (ICF) and its attempts at standardized language. Which of the following would the nurse include as terminology that was standardized? Select all that apply. A)Disability impairment issues B)Body functions C)Handicapping conditions D)Activities E)Environmental factors F)Personal Factors

B, D, E, F Feedback: The ICF included definitions for body functions and structures, activities, and environmental and personal factors. Terms such as disability, impairment, and handicap have been removed from the definition and replaced with functioning, which is more holistic and positive.

When working with the community to develop effective plans to meet the needs of people with disabilities, the community health nurse reviews the statistics involving individuals with disabilities. Which of the following would the nurse identify as accurately reflecting the number of persons with ongoing disability? A)10 million people—less than 5% of the US population B)27 million people—about 10% of the US population C)36 million people—about 12% of the US population D)150 million people—almost 50% of the US population

C Feedback: An estimated 36 million people or 12% of the population is living with some ongoing level of disability. The other statistics of 10 million, 27 million, and 150 million are inaccurate

A community health nurse is working with the local health department on screening for sexually transmitted infections. Which of the following would the nurse identify as the most common? A) Syphilis B) Gonorrhea C) Chlamydia D) Herpes simplex virus

C Feedback: Chlamydia is the most common STI in adolescents and should be a major focus of the screening. Syphilis, gonorrhea, and herpes simplex virus also are common among adolescents but less than Chlamydia.

After teaching a group of students about the most common health problems affecting older adults in the community, which of the following if identified by the students would alert the instructor to the need for additional teaching? A) Arthritis B) Hypertension C) Emphysema D) Peripheral vascular disease

C Feedback: Emphysema is not considered a common health problem of older adults. The most common health problems of older people in the community are arthritis, reduced vision, hearing loss, heart disease, peripheral vascular disease, and hypertension.

A community health nurse is engaged in a community-wide program for promoting nutrition in adolescents. Which of the following would lead the nurse to target the program to adolescent girls? A) Girls eat larger quantities of food than boys. B) They are more physically active than boys. C) They have a tendency to diet inappropriately. D) They are more conscious about food nutrients.

C Feedback: Girls are more at risk for problems with nutrition for several reasons: They tend to diet inappropriately, to have more finicky eating habits, and to be less physically active than teenage boys. Boys typically eat large quantities of food, which increases the likelihood of obtaining adequate nutrients, and they also tend to be more physically active than girls.

A community health nurse is preparing a teaching program that addresses chronic 13. diseases common among older adults. Which of the following would be most appropriate to include? A) Forty percent of older adults are diagnosed with diabetes. B) Weight-bearing exercises are related to increased cases of osteoporosis. C) Postural hypotension can be related to falls in elders. D) Older White men have the highest rates of hypertension.

C Feedback: Older adults need to have sufficient cerebral circulation to avoid dizziness. Dizziness can lead to falling. A normal to high-normal blood pressure for the elder should be maintained. Based on the most current statistics, 15.1% of men and 13.0% of women report having diabetes. Weight-bearing exercises are a way to prevent osteoporosis. Older African American men have the highest rates of hypertension.

A community health nurse is evaluating a population for socioeconomic resources. Which of the following would the nurse address? A)Quality of care provided B)Access to health care services C)Educational opportunities D)Adequacy of health care providers

C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.

A community health nurse is teaching a group of older adults at a senior center about strategies for successful aging. Which of the following would the nurse include? A) "Limit drinking alcohol to once or twice a month" B) "Avoid eating too many fruits and vegetables" C) "Keep in touch with friends and family" D) "Get up early in the morning"

C Feedback: Strategies for successful aging include maintaining contacts with family and friends and staying active through work, recreation, and the community. Moderation in drinking is key. The older adult should eat a healthy diet of fruits, whole grains, vegetables, and lean meat. They also should get as much sleep and rest as needed. Getting up early in the morning may or may not be appropriate.

An instructor reviews the definition of homelessness according to the McKinney Vento Homeless Assistance Act with a group 1. of community health nursing students. The instructor determines that the students need clarification when they include which of the following as homeless? A) Someone living in a public shelter B) Someone living in a park C) Someone who is incarcerated D) Someone who lives in his or her car

C Feedback: The McKinney-Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a person as homeless who lacks a fixed, regular, adequate night time residence including supervised public or private shelters that provide temporary accommodations, institutional settings providing temporary shelter, or public or private places that are not designed for or used as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds). Incarcerated individuals, however, are not considered homeless under this definition.

A community health nurse is speaking to a group of parents of incoming college freshmen students who will be living in the dormitories. The focus of the program is on the college health program, health issues, and immunizations. Which immunization would the nurse most strongly encourage the students to receive if they have not received it previously? A) Varicella virus vaccine B) Human papilloma virus vaccine C) Meningococcal vaccine D) Influenza vaccine

C Feedback: The meningococcal vaccine is a catch-up vaccine that is recommended for all previously unvaccinated college freshmen living in dormitories. Adolescents who have not had chickenpox and have not received prior vaccination should receive the varicella vaccines. The HPV vaccine is given to females only. The influenza vaccine should be given only those who are considered high risk.

While working with another group of community health nurses, a nurse overhears one of the nurses saying, "That older man should just retire. He's 70 years old. How productive can he be?" The nurse interprets this statement as reflecting which of the following? A) Prejudice B) Bias C) Ageism D) Insight

C Feedback: The one nurse's statement reflects stereotyping and a negative image of an older adult. This is called ageism. It may be due to negative personal experiences, myths, or a general lack of information. It is not reflective of prejudice or bias. Insight would reflect an understanding of the older adult, which this statement does not do.

After teaching a group of students about leading health risks, the instructor determines that the teaching was successful when the students identify which of the following as the #1 leading health risk? A)Unsafe sex B)High blood pressure C)Underweight D)Tobacco consumption

C Feedback: The ten leading health risks are (1) underweight; (2) unsafe sex; (3) high blood pressure; (4) tobacco consumption; (5) alcohol consumption; (6) unsafe water, sanitation, and hygiene; (7) iron deficiency; (8) indoor smoke from solid fuels; (9) high cholesterol; and (10) obesity.

When reviewing the concept of universal design with a group of community developers, the community health nurse recognizes that the emphasis is on which of the following as the underlying theme? A)Disability needs B)Adaptation C)Access D)Safety

C Feedback: The underlying theme of universal design is ensuring access. Universal design is the design of products and environments to be usable by all people, including those with disability needs as well as chronic illness. The concept incorporated issues of adaptive design and safety measures such as reinforcement in bathroom walls to allow for installation of grab bars, but the key issue is accessibility.

Which of the following would a community health nurse use to define vulnerable populations? A)Those persons with higher mortality rates B)Individuals with lower life expectancy C)Those with increased risk for adverse health outcomes D)Individuals with chronic illness

C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, pres​ence of just one of these does not necessarily indicate that the population is vulnerable.

Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A)Helping them to make choices B)Guiding them to think things through C)Getting them to interact with the nurse D)Providing honest feedback

C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.

Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A)Setting up an community agency clothing drive collection B)Working for changes in community attitudes C)Sending a personal donation to an agency in the area D)Remaining grounded

C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.

After teaching a class about the International Classification of Functioning, Disability, and Health (ICF), the instructor determines that the teaching was successful when the students identify which of the following as a personal factor? A)Problems with ambulation B)Working C)Coping styles D)Amputation

C Feedback: Personal factors are the features of an individual's background, life, and living that are not part of a health condition or health status, such as gender, race, age, other health conditions, fitness, lifestyle habits, upbringing, coping styles, social background, education, profession, past and current experience, overall behavior pattern and character style, individual psychological assets, and other characteristics. Problems with ambulation would be considered an activity limitation. Working would be an activity. Amputation would be an impairment.

When visiting a local senior center, a community health nurse engages several of the older adults in a discussion about immunizations. Which statement best reflects the importance of older adult immunization? A) "We're at greater risk of dying from the flu or pneumonia." B) "You don't get the flu from the flu shot." C) "The doctor told us that we should get it." D) "Many of us get the shot here at the center for free."

C Older adults are at risk of not only contracting influenza or pneumonia but of dying from them, underscoring the importance of obtaining the immunizations. The statement about not getting the flu from the shot addresses one of the common reasons for not getting it, the belief that the flu shot will give them the flu. The statement about the doctor telling them to get it indirectly reflects another reason for not getting it, lack of knowledge about the need. The statement about getting the shot for free suggests that finances may be a barrier to obtaining the shot but not why it is important.

Which of the following measures would be most appropriate for a community health nurse to include when developing programs to address childhood obesity? A) Encouraging television watching for about 3 hours per day B) Suggesting that families eat less meals together at home C) Urging participation in physical activity for 30 minutes per day D) Limiting the intake of unsaturated oils in cooking

C Research has demonstrated an association between poor eating habits and physical inactivity. Low levels of physical activity and more than 2 hours of watching television per day were found to be predictors of overweight status in a large longitudinal study of children. Therefore, interventions should focus on increasing levels of physical activity and encouraging limited television for school- age children, encouraging families to eat more meals together at home, advocating for increased physical education in the school setting, and for more safe recreational opportunities in all neighborhoods. In addition, healthy eating habits such as using unsaturated oils in cooking need to be stressed.

After teaching a group of older adult women about preventing osteoporosis, which of the following if stated by the group indicates the need for additional teaching? A) "We should eat foods that are high in calcium and vitamin D." B) "We need to get bone density screenings regularly." C) "We should avoid activities that involve weight bearing." D) "We need to make sure that maintain a healthy weight."

C Weight-bearing activities are encouraged to promote strong bones. In addition, individuals should be encouraged to eat diets that are rich in vitamin D and calcium, and include calcium supplements as needed. Not smoking, maintaining a healthy weight, and receiving ongoing bone density screenings are positive health behaviors that can contribute to strong bones throughout life.

A community health nurse is making a home visit to a family who is providing care to an older adult member with Alzheimer's disease for the past 6 months. During the visit, which of the following would be most important for the nurse to assess? A) Cognitive status B) Medication regimen C) Personality changes D) Caregiver's status

D Although assessment of the various aspects of the patient's status is important, that of the caregiver is even more important. Often, the person with AD is cared for at home until very late in the disease course. The intense care given to these clients can be a constant drain on the emotional and physical reserves of their families. The stress of providing care puts the caregiver's health at risk, as well.

Which of the following care options would be most appropriate for an older adult who experiences confusion, requires daily insulin injections and blood glucose monitoring, and needs assistance with bathing, dressing, and feeding? A) Personal care home B) Respite care C) Intermediate care facility D) Skilled nursing facility Ans:

D Based on the situation, a skilled nursing facility would be most appropriate. A skilled nursing facility provides skilled nursing care, such as injections and blood glucose monitoring, along with personal care that is considered nonskilled such as bathing, dressing, and feeding. A personal care home offers 24 hours basic custodial care but no skilled services. Respite care provides time off for caregivers and can take place in a variety of settings. An intermediate care facility provides health care, but the amount and type of skilled care is less than that provided in skilled nursing facilities.

A group of community health nurses who work in continuing care retirement centers are asked to talk to a group of seniors about what they do. Which of the following would the nurses identify as unique for this setting? A) Accept clients who primarily need skilled nursing services B) Are similar to board and care homes C) Are respite centers for family members of older adults D) Provide a variety of housing and care options that elders need as they age

D Continuing care retirement centers are comprehensive centers and have become the last place an older adult needs to live, meeting independent to dependent needs, including skilled nursing and Alzheimer's disease services. They can age in place without moving to another location as their needs increase. They accept residents at all stages of need, from totally independent living to assisted living to skilled nursing care. In some settings, residents cannot enter the residence at the skilled nursing level. These beds are filled by residents with increasing needs as they move from independent living, to assisted living, to skilled nursing care. Skilled nursing facilities provide skilled nursing care along with personal care that is considered nonskilled. Board and care or personal care homes offer 24 hours basic custodial care but provide no skilled nursing services. Respite care centers provide time off for caregivers. It can take place in an adult day center, home, or residential setting.

Which of the following would a community health nurse expect to assess in the adolescent population with an eating disorder? A) High levels of peer support B) Clear sense of self C) Feelings of being in control D) Distorted body image

D Feedback: Adolescents with eating disorders typically have a disturbed body image, low levels of peer support, distorted self-concept and low self-esteem. In addition, they have issues with control, such that they used eating as a means for control.

An instructor is reviewing the principles that resulted from the 2011 reassessment of global progress on addressing disability with a class. Which of the following would the nurse include? A)The government must focus solely on seeking improvement in the lives of individuals and families living with disability. B)Government must play the only role in addressing disability. C)It is unimportant for service providers, academic institutions, the private sector, communities, and people with disabilities and their families to address disability. D)The importance of all persons, including those with disabilities to participate in their country's development.

D Feedback: In 2011, the World Health Organization and the World Bank reassessed global progress on addressing disability in light of the 2006 Convention on the Rights of Persons with Disabilities. It was determined that not only must governments seek improvements in the lives of individuals and families living with disability, but every citizen needs to participate in their country's development. Government at every level may play a most significant role, but there are important roles for service providers, academic institutions, the private sector, communities, and especially people with disabilities and their families.

When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A)Vulnerable populations are fairly similar across the nation and globally. B)Statistics about vulnerable populations are highly accurate. C)The most important causative factor is race or ethnicity. D)Many of the factors and conditions suggest vulnerability overlap.

D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

When assessing a population's vulnerability, 5. which of the following would the community health nurse identify as a predisposing factor? A)Social support networks B)Crime rates C)Transportation D)Living conditions

D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

A community health nurse is providing information handouts that describe the need for annual gynecologic exams to local health clinics that provide care for individuals with disabilities. The nurse is fulfilling which role? A)Advocate B)Coordinator C)Researcher D)Educator

D Feedback: Providing information handouts is a method for teaching. Therefore, the nurse is assuming the role of an educator at the community level. In the advocate role, the nurse would assist in arranging for the population to receive the appropriate screening, ensuring that any special modifications or adaptations would be available. In the coordinator role, the nurse might arrange for screening to be performed during a routine visit made by a client to a facility or make arrangements for transporting the clients to a facility for the screening. In the researcher role, the nurse might contact other community health nurses about their experience in ensuring screening for this population to discover if they have similar needs or problems.

Which of the following would likely provide the best estimate of the number of persons who are homeless? A) Counting the number of homeless people on a particular day B) Counting the persons who are homeless in a given week C) Counting the number of persons who are homeless at a specific time on a specific date D) The number of people who have been homeless over the course of a year

D Feedback: Rather than trying to count the number of homeless people on a given day or week (point in time counts), it may be more prudent to measure the number of people who have been homeless over a longer timeframe such as over the course of a year (period prevalence counts).

Which of the following programs would be least effective to institute for a community of school-age children who are experiencing dental caries? A) Ensuring that the drinking water is fluoridated B) Having the school to institute a fluoride rinse program C) Encouraging the parents to get their children's teeth sealed D) Advising parents to encourage the children to brush once daily

D Feedback: Regular brushing and flossing is important for dental hygiene. However, once daily is not enough. Fluoridated drinking water, school- based fluoride rinse or gel, and dental sealant programs are cost-effective, proven methods of reducing dental caries in school-age children.

When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A)Well-balanced diet B)Up-to-date immunizations C)Enabling factors D)Exposure to abuse

D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse Ans: D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.

A community health nurse is preparing a program for a local community group about homelessness. A portion of the program will address homeless men. Which of the following would the nurse include? A) Homeless men are not looked down upon less than other groups. B) Homeless men are usually eligible for social services. C) Homeless men are perceived as blameless for their situation. D) Single, low-income men only qualify for medical assistance if disabled.

D Feedback: Single, low-income men only get medical assistance if they are disabled. Homeless men are more likely to be treated with disdain than other homeless subgroups. Some people perceive homeless men as largely to blame for their plight, believing that they are able bodied and should be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough to warrant eligibility for health and social services. Often health and social programs give priority to women and children.

A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A)Better job training B)Improved educational programs C)Expanded employment opportunities D)More community organizations

D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.

A community health nurse is working with a group of school nurses to develop interventions for a 10-year-old girl exhibiting signs and symptoms of school refusal. Which of the following would be most appropriate? A) Limiting parent involvement in the school B) Exposing the child rapidly to the classroom C) Keeping the child at home for a while D) Providing relaxation training

D Feedback: The most effective interventions for school refusal include early return to school with parental involvement in school, systematic desensitization (gradual exposure to the classroom), relaxation training, and counseling.

A community health nurse is working with a group of visually impaired individuals and is developing a program to promote self- confidence and self-respect. Which of the following organizations would be a valuable resource for the nurse? A)American Foundation for the Blind B)American Council of the Blind C)Guide Dogs for the Blind D) National Federation of the Blind

D Feedback: The nurse would contact the National Federation of the Blind whose focus is on helping blind individuals achieve self- confidence and self-respect. The American Foundation for the Blind advocates for the visually impaired through increased state and federal funding. The American Council of the Blind provides services such as information and referral, scholarship assistance, public education, and industry consultation, governmental monitoring, consultation, and advocacy. The Guide Dogs for the Blind makes guide dogs available for the visually impaired.

The nurse educator is aware that the nursing student has a grasp of the primary prevention needs of older adults when the nursing student makes which of the following comments? A) It is unnecessary for older adults to receive immunizations. B) All older adults must restrict their sodium intake. C) Older adults don't need to drink as much fluid as they are often less thirsty. D) The oral health of older adults is often neglected and so it is important that they see a dentist regularly.

D Feedback: The oral health of older adults is often neglected, and so it is important that they see a dentist regularly. It is necessary for older adults to receive immunizations. Neither of these statements is true: All older adults must restrict their sodium intake and older adults don't need to drink as much fluid as they are often less thirsty.

A community health nurse is developing a plan of care for a family who is providing round-the-clock care in their home for a daughter who is chronically ill. Which of the following would be most important for the nurse to integrate into the plan? A)Insurance limitations B)Skill teaching C)Flexible visiting D)Respite care

D Feedback: Respite care is another area of great importance for families of the disabled and the chronically ill. It can be emotionally draining to meet the daily needs of a member who cannot perform self-care. This often leads to caregiver fatigue and increased stress. It is also important to recognize the effect of the situation on noncaregivers in the family, particularly nondisabled siblings of a disabled child. Respite care offers some needed relief to the family and allows for uninterrupted attention to the nondisabled children. Whatever the source, some type of respite care is often vital to the family's health and should be a priority in the overall treatment plan of the family. Although insurance considerations, teaching, and flexible visiting would be issues to be addressed, respite care is a priority.