Unit 4 practice questions

A client mentions that having so many nurses in the unit must be increasing the cost of care because nurses get paid more. The client's nurse appropriately responds:" You are right. Care does cost more with RNs." "Costs rise because nurses waste supplies." "The cost of care is caused by decreased technology, not increased nurses." "Studies show that costs are decreased with an RN staff."

"Studies show that costs are decreased with an RN staff."

The nurse recognized making a medication error and immediately reported it to the unit supervisor. Which response from the supervisor should the nurse expect in an environment that promotes quality? "Why are you reporting that to me without completing an incident report?" "You need to report directly to the Chief Nursing Officer." "You have reported this to me, so you do not need to file an incident report." "We have a blame-free environment so you can report errors without fearing punishment."

"We have a blame-free environment so you can report errors without fearing punishment." Most errors in health care are a result of the healthcare system and not the fault of a single individual. If a clinic is afraid to report errors for fear of punishment or because reporting does not result in positive change, then problems within the system cannot be identified or addressed. A key component in quality improvement is establishing a blame-free environment in which healthcare providers can report errors or near misses without the fear of punishment. This helps identify problems, so that corrections can be made, and future events can be prevented. An incident report will be completed as a part of the investigation.

Which governmental agency should the nurse recognize as being instrumental in developing indicators of high-quality care and measures? U.S. Red Cross Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services (HHS) National Institutes of Health (NIH)

U.S. Department of Health and Human Services (HHS) HHS works with the American Medical Association (AMA) and the American Nurses Association (ANA) to develop indicators of high-quality care and measures to document the quality of care. The U.S. Red Cross works to provide support for disaster relief and blood donations. The CDC conducts and supports health promotion, prevention, and preparedness in an effort to improve health, but not actually measurements. The NIH's primary responsibility is biomedical and public health research.

The nurse chairs a committee tasked with improving the number of hospital-acquired infections and is asked for a definition of "benchmarking."Which response should the nurse give? A. Comparison of the performance of an individual or organization to industry standards B. Minimum starting point used for comparisons C. Process to identify vulnerabilities within an organization D. Analysis used to prevent certain events from repeating

a

The nurse in the blood bank is part of a team effort to reduce the cost of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies.Which quality improvement method is the team using in seeking to reduce waste? A. Lean Six Sigma B. Quality assurance C. Root cause analysis D. Utilization review

a

The nurse is discussing the purpose of a just culture.Which information should the nurse include? A. Balancing the blame-free environment with appropriate accountability B. Balancing the blame-free environment with discipline C. Balancing quality with justice D. Balancing discipline with accountability

a

Which statement correctly describes quality management? A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. B) Quality management refers to systematic actions that lead to improvements in healthcare services. C) Quality management is the degree to which health services increase the likelihood of desired health outcomes. D) Quality management provides clients with appropriate service in a technically competent manner

a

A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, "Why are you such a stupid kid?" The wife says, "I have difficulty disciplining the children. It's so frustrating." Which comments by the nurse will facilitate an interview with these parents? (Select all that apply.) a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult." d. "Do you or your husband ever spank your children?" e. "Calling children 'stupid' injures their self-esteem."

a. "Tell me how you discipline your children." b. "How do you stop your baby from crying?" c. "Caring for four small children must be difficult."

Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? a. "You are feeling violated because you thought you could trust your partner." b. "I'm here for you. I want you to tell me about the bad things that happened to you." c. "I was very worried about you. I knew you were living in a potentially violent situation." d. "Abusers often target people who are passive. I will refer you to an assertiveness class."

a. "You are feeling violated because you thought you could trust your partner."

A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? (Select all that apply.) a. Keep a cell phone fully charged. b. Hide money with which to buy new clothes. c. Have the phone number for the nearest shelter. d. Take enough toys to amuse the children for 2 days. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

a. Keep a cell phone fully charged. c. Have the phone number for the nearest shelter. e. Secure a supply of current medications for self and children. f. Assemble birth certificates, Social Security cards, and licenses. g. Determine a code word to signal children when it is time to leave.

A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, "My father doesn't like me. He calls me stupid all the time." The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? (Select all that apply.) a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support d. A safety plan for the wife and children e. Placing the children in foster care

a. Parental sessions to teach childrearing practices b. Anger management counseling for the father c. Continuing home visits to give support

The nurse is presenting a proposal to the board of directors regarding the impact of staffing on quality care. Which data point should the nurse include in the presentation? A. Limiting nursing hours helps to control costs. B. Increased nursing hours are shown to decrease patient mortality. C. Nursing skill does not correlate to patient outcomes. D. Readmission rates do not necessarily correlate with increased nursing staff.

b

The nurse is a member of the utilization review committee that is composed of members from various disciplines within the hospital. Which patient situation should the nurse understand will be of interest to the utilization review committee? A. Routine maintenance of medical equipment B. Routine use of sterile packs in surgery C. Application of adult diapers on every older adult patient D. Each inpatient provided with an admission kit

c

The nursing team is using statistics that reflect the organization's performance in a specific area to compare the quality of care within the organization to industry standards. Which activity is the team performing? A. Root cause analysis B. Auditing C. Benchmarking D. Risk management

c

A rape victim says to the nurse, "I always try to be so careful. I know I should not have walked to my car alone. Was this attack my fault?" Which communication by the nurse is most therapeutic? a. Support the victim to separate issues of vulnerability from blame. b. Emphasize the importance of using a buddy system in public places. c. Reassure the victim that the outcome of the situation will be positive. d. Pose questions about the rape and help the patient explore why it happened.

: A Although the victim may have made choices that made her vulnerable, she is not to blame for the rape. Correcting this distortion in thinking allows the victim to begin to restore a sense of control. This is a positive response to victimization. The distracters do not permit the victim to begin to restore a sense of control or offer use of non-therapeutic communication techniques. In this interaction, the victim needs to talk about feelings rather than prevention.

A nurse interviews a 17-year-old male victim of sexual assault. The victim is reluctant to talk about the experience. Which comment should the nurse offer to this victim? a. "Male victims of sexual assault are usually better equipped than women to deal with the emotional pain that occurs." b. "Male victims of sexual assault often experience physical injuries and are assaulted by more than one person." c. "Do you have any male friends who have also been victims of sexual assault?" d. "Why do you think you became a victim of sexual assault?

: B Few rape survivors seek help, even with serious injury; so, it is important for the nurse to help the victim discuss the experience. The correct response therapeutically gives information to this victim. A male rape victim is more likely to experience physical trauma and to have been victimized by several assailants. Males experience the same devastation, physical injury, and emotional consequences as females. Although they may cover their responses, they too benefit from care and treatment. "Why" questions represent probing, which is a non-therapeutic communication technique. The victim may or may not have friends who have had this experience, but it's important to talk about his feelings rather than theirs.

Which situation describes consensual sex rather than rape? a. A husband forces vaginal sex when he comes home intoxicated from a party. The wife objects. b. A woman's lover pleads with her to have oral sex. She gives in but later regrets the decision. c. A person is beaten, robbed, and forcibly subjected to anal penetration by an assailant. d. A dentist gives anesthesia for a procedure and then has intercourse with the unconscious patient.

: B Only the key describes a scenario in which the sexual contact is consensual. Consensual sex is not considered rape if the participants are of legal age.

An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important? a. The patient's vital signs b. Consent signed by the patient c. Supervision and credentials of the examiner d. Storage location of the patient's personal effects

: B Patients have the right to refuse legal and medical examination. Consent forms are required to proceed with these steps.

A client with a long history of experiencing domestic violence tells the nurse, "There is no way out for me; this situation will never change." What nursing diagnosis would be most appropriate? A) Powerlessness B) Risk for Other-Directed Violence C) Ineffective Health Maintenance D) Chronic Low Self-Esteem

A

A rape victim is being seen in the clinic. Upon assessment it is discovered the client has contracted syphilis. Which prescription does the nurse anticipate for this client? A) Penicillin B) Ceftriaxone and azithromycin C) Tinidazole D) Doxycycline

A

The nurse is providing care for a client who experienced several fractures as a result of intimate partner violence. Which intervention is the most appropriate to include when planning care for the client? A) Assist the client to devise a safety or escape plan. B) Encourage the client to take charge of the situation. C) Offer to contact outpatient services if the client promises not to return home after discharge. D) Make it clear to the spouse that the couple needs to see a therapist.

A

Which diagnostic test might the healthcare team use to determine the full extent of an abuse victim's injuries if the victim complains of abdominal pain? A) Ultrasound B) X-ray C) MRI D) Blood test

A

Which theory states that individuals learn violent tendencies through association with others and a reinforcement of abusive behaviors? A) Social learning theory B) Psychopathology theory C) Neurobiology theory D) Environmental theory

A

Which type of rape often involves the use of date rape drugs? A) Acquaintance rape B) Marital rape C) Anal rape D) Gang rape

A

A victim of a violent rape was treated in the emergency department. As discharge preparation begins, the victim says softly, "I will never be the same again. I can't face my friends. There is no reason to go on." Select the nurse's most appropriate response. a. "Are you thinking of harming yourself?" b. "It will take time, but you will feel the same as before the attack." c. "Your friends will understand when you explain it was not your fault." d. "You will be able to find meaning from this experience as time goes on."

A The patient's words suggest hopelessness. Whenever hopelessness is present, so is suicide risk. The nurse should directly address the possibility of suicidal ideation with the patient. The other options attempt to offer reassurance before making an assessment.

A nurse works a rape telephone hotline. Communication with potential victims should focus on: a. explaining immediate steps victims should take. b. providing callers with a sympathetic listener. c. obtaining information for law enforcement. d. arranging counseling.

A The telephone counselor establishes where the victim is and what has happened and provides the necessary information to enable the victim to decide what steps to take immediately. Counseling is not the focus until immediate problems are resolved. The victim remains anonymous. The other distracters are inappropriate or incorrect because counselors are trained to be empathetic rather than sympathetic.

A victim of a sexual assault who sits in the emergency department is rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of which stage of rape-trauma syndrome? a. The acute phase reaction c. A delayed reaction b. The long-term phase d. The angry stage

A The victim's response is typical of the acute phase and shows cognitive, affective, and behavioral disruptions. This response is immediate and does not include a display of behaviors suggestive of the long-term (reorganization) phase, anger, or a delayed reaction.

The nurse working in the emergency department is aware that rape victims initially exhibit which emotions? Select all that apply. A) Shock B) Disbelief C) Anger D) Self-blame E) Humiliation

A, B

An emergency department nurse prepares to assist with examination of a sexual assault victim. What equipment will be needed to collect and document forensic evidence? Select all that apply. a. Camera b. Body map c. DNA swabs d. Pulse oximeter e. Sphygmomanometer

A, B, C Body maps, DNA swabs, and photographs are used to collect and preserve body fluids and other forensic evidence.

A patient was abducted and raped at gunpoint by an unknown assailant. Which nursing interventions are appropriate while caring for the patient in the emergency department? Select all that apply. a. Allow the patient to talk at a comfortable pace. b. Place the patient in a private room with a caregiver. c. Pose questions in nonjudgmental, empathetic ways. d. Invite the patient's family members to the examination room. e. Put an arm around the patient to demonstrate support and compassion.

A, B, C Neutral, nonjudgmental care and emotional support are critical to crisis management for the rape victim. The rape victim should have privacy but not be left alone. The rape victim's anxiety may escalate when touched by a stranger, even when the stranger is a nurse. Some rape victims prefer not to have family involved. The patient's privacy may be compromised by family presence.

An older adult client is brought into the emergency room after experiencing a fall. The nurse suspects elder abuse. Which assessment findings support the nurse's suspicions? Select all that apply. A) Poor hygiene B) Dehydration C) Intracranial trauma D) Fecal impaction E) Dislocations

A, B, D, E

When an emergency department nurse teaches a victim of rape-trauma syndrome about reactions that may occur during the long-term phase of reorganization, which symptoms should be included? Select all that apply. a. Development of fears and phobias b. Decreased motor activity c. Feelings of numbness d. Flashbacks, dreams e. Syncopal episodes

A, C, D These reactions are common to the long-term phase. Victims of rape frequently have a period of increased motor activity rather than decreased motor activity during the long-term reorganization phase. Syncopal episodes would not be expected.

Which aspects of assessment have priority when a nurse interviews a rape victim in an acute setting? Select all that apply. a. Coping mechanisms the patient is using b. The patient's previous sexual experiences c. The patient's history of sexually transmitted diseases d. Signs and symptoms of emotional and physical trauma e. Adequacy and availability of the patient's support system

A, D, E The nurse assesses the victim's level of anxiety, coping mechanisms, available support systems, signs and symptoms of emotional trauma, and signs and symptoms of physical trauma. The history of STDs or previous sexual experiences has little relevance.

The nurse is providing care for a client who was the victim of sexual abuse 8 months ago. Which ongoing, long-term treatment goals are appropriate? Select all that apply. A) The client's symptoms of anxiety and fear will decrease. B) The client will involve significant others in the treatment plan. C) The client will be able to verbalize legal rights. D) The client will establish rapport and build a trusting nurse—client relationship. E) The client will learn how to reconnect with others.

A, E

A 17-year-old high school student who was recently raped is reluctant to discuss the event. She can no longer use tampons during her period because she becomes dizzy and nauseated when trying to insert them. She states that she will never have another boyfriend because "I'm ruined." Which of the following nursing diagnoses is most appropriate for this client? a Rape-trauma Syndrome: silent reaction b Post-trauma Syndrome c Rape-trauma Syndrome: compound reaction d Sexual Dysfunction

A. The client is unable to talk about the trauma, has developed a phobic reaction to tampons, and is renouncing future relationships with men. Rape-trauma syndrome: compound reaction indicates reactivation of a physical or mental illness or use of addictive substances to cope with the trauma. The client is not displaying symptoms such as nightmares, hypervigilance, insomnia, panic attacks, flashbacks, or intrusive memories that are associated with a diagnosis of post-traumatic stress disorder (PTSD). There are no indications of a physical inability that would limit sexual activity.

The care plan formulated with a client includes the goal: client describes self as a rape survivor. For which client would this goal be inappropriate? a. Client in the emergency department immediately after the rape b. Client in individual therapy 1 month after a rape c. Client in the emergency department with a panic attack that the client relates with a rape 6 months ago d. Client in primary care setting 3 months after a rape

A. Immediately after the rape is too soon to expect the client to see herself as a survivor. The goals for this client might be to have the client make choices about treatment or to identify current feelings. Clients who are 1, 3, and 6 months after the rape might consider themselves as survivors. However, this does not mean they are free of the fears and feelings related to the rape.

A nurse is discussing silent rape reaction with a newly licensed nurse. Which of the following should the nurse identify as a characteristic of this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. Unwillingness to discuss the sexual assault

A. CORRECT: Sudden onset of phobic reactions is a characteristic of a silent rape reaction. B. INCORRECT: Development of substance use disorder is a characteristic of a compound rape reaction. C. CORRECT: Increased anxiety during interview is a characteristic of a silent rape reaction. D. INCORRECT: Reactivation of a prior physical disorder is a characteristic of a compound rape reaction. E. CORRECT: No verbalization of the sexual assault is a characteristic of a silent rape reaction.

A nurse is assessing a client who is the victim of sexual assault. Which of the following findings indicate the client is experiencing an initial impact reaction of rape-trauma syndrome? (Select all that apply.) A. Genitourinary soreness from the assault B. Difficulties with low self-esteem C. Sleep disturbances D. Emotional outbursts E. Difficulty making decisions

A. INCORRECT: Soreness from the attack indicates a somatic, rather than initial impact, reaction. B. INCORRECT: Difficulties with low self-esteem are an indication of the long-term reorganization phase rather than an initial impact reaction. C. INCORRECT: Sleep disturbances indicates a somatic, rather than initial impact, reaction. D. CORRECT: Emotional outbursts indicate an expressed initial impact reaction during the acute phase of rape-trauma syndrome. E. CORRECT: Difficulty making decisions indicates a controlled initial impact reaction during the acute phase of rape-trauma syndrome.

A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following is an appropriate response by the nurse? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do feel that you should not have been alone on the street at night?"

A. INCORRECT: This responses offers the nurse's opinion, which is a nontherapeutic communication technique. B. INCORRECT: This responses indicates disapproval, which is a nontherapeutic communication technique. C. CORRECT: This response uses the therapeutic communication technique of restating, which promotes reflection and verbalization of feelings. D. INCORRECT: This responses asks a "why" question, which is a nontherapeutic communication technique

A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates the need for further teaching? A. "Rape is a crime of aggression." B. "Acquaintance rape often involves alcohol." C. "Both men and women can be victims of rape." D. "The majority of rapists are unknown to the victims."

A. INCORRECT: This statement does not require further teaching. Rape is a crime of violence, aggression, anger, and power. B. INCORRECT: This statement does not require further teaching. Drugs and alcohol are often associated with date or acquaintance rape. C. INCORRECT: This statement does not require further teaching. Both men and women can be victims of rape. D.CORRECT: This statement requires further teaching. The majority of rapists are known to the victims.

A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements indicates the need for further teaching? A. "I will administer prophylactic treatment for sexually transmitted infections like chlamydia." B. "I need to obtain informed consent before the sexual assault nurse examiner obtains forensic evidence." C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." D. "I should perform a self-assessment before caring for a client who has been raped."

A. INCORRECT: This statement does not require further teaching. The nurse should administer prophylactic treatment for infections such as chlamydia according to the Centers for Disease Control and Prevention. B. INCORRECT: This statement does not require further teaching. The nurse must obtain informed consent to collect data that can be used as legal evidence. C. CORRECT: This statement requires further teaching. Manifestations of rape-trauma syndrome are similar to posttraumatic stress disorder rather than bipolar disorder. D. INCORRECT: This statement does not require further teaching. The nurse should perform a self-assessment prior to client care to ensure he is able to provide empathetic, objective, and nonjudgmental care.

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? A. "I know that it was not my fault." B. "My boyfriend has trouble controlling his sexual urges." C. "If I don't put myself in a dating situation, I won't be at risk." D. "Next time I will think twice about wearing a sexy dress."

ANS: A The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

Which statement made by an emergency department nurse indicates accurate knowledge of domestic violence? A. "Power and control are central to the dynamic of domestic violence." B. "Poor communication and social isolation are central to the dynamic of domestic violence." C. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." D. "Emotional injury and learned helplessness are central to the dynamic of domestic violence."

ANS: A The nurse accurately states that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

ANS: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

Which assessment data should a school nurse recognize as signs of physical neglect? A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors.

ANS: A The nurse should recognize that a child who is often absent from school and seems apathetic and tired might be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

Which of the following nursing diagnoses could be appropriate for an adult survivor of incest? (Select all that apply.) A. Low self-esteem B. Powerlessness C. Disturbed personal identity D. Knowledge deficit E. Noncompliance

ANS: A, B An adult survivor of incest would most likely have low self-esteem and a sense of powerlessness. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders. Disturbed personal identity refers to an inability to distinguish between self and nonself and is seen in disorders such as autistic disorders, borderline personality disorders, dissociative disorders, and gender identity disorders.

When planning care for women in abusive relationships, which of the following information is important for the nurse to consider? (Select all that apply.) A. It often takes several attempts before a woman leaves an abusive situation. B. Substance abuse is a common factor in abusive relationships. C. Until children reach school age, they are usually not affected by parental discord. D. Women in abusive relationships usually feel isolated and unsupported. E. Economic factors rarely play a role in the decision to stay in abusive relationships.

ANS: A, B, D When planning care for women who have been victims of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? A. Discourage the client from discussing the event as this may lead to further emotional trauma. B. Remain nonjudgmental and actively listen to the client's description of the event. C. Meet the client's self-care needs by assisting with showering and perineal care. D. Provide cues, based on police information, to encourage further description of the event.

ANS: B The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he or she is safe and that it is not his or her fault. Nonjudgmental listening provides an avenue for client catharsis needed in order to begin the process of healing.

An anorexic client states to a nurse, "My father has recently moved back to town." Since that time the client has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated and lives alone. What should the nurse suspect? A. Possible major depressive disorder B. Possible history of childhood incest C. Possible histrionic personality disorder D. Possible history of childhood physical abuse

ANS: B The nurse should suspect that this client might have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid that next time he might kill me." Which is the appropriate nursing reply? A. "Leopards don't change their spots, and neither will he." B. "There are things you can do to prevent him from losing control." C. "Let's talk about your options so that you don't have to go home." D. "Why don't we call the police so that they can confront your husband with his behavior?"

ANS: C The most appropriate reply by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions independently without the nurse being the "rescuer." Imposing judgments and giving advice is nontherapeutic.

A nursing student asks an emergency department nurse, "Why does a rapist use a weapon during the act of rape?" Which nursing reply is most accurate? A. "A weapon is used to increase the victimizer's security." B. "A weapon is used to inflict physical harm." C. "A weapon is used to terrorize and subdue the victim." D. "A weapon is used to mirror learned family behavior patterns."

ANS: C The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

In the emergency department, a raped client appears calm and exhibits a blunt affect. The client answers a nurse's questions in a monotone using single words. How should the nurse interpret this client's responses? A. The client may be lying about the incident. B. The client may be experiencing a silent rape reaction. C. The client may be demonstrating a controlled response pattern. D. The client may be having a compounded rape reaction.

ANS: C This client is most likely demonstrating a controlled response pattern. In a controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension.

Which teaching should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? A. Have ready access to a gun and learn how to use it B. Research lawyers who can aid in divorce proceedings C. File charges of assault and battery D. Have ready access to the number of a safe house for battered women

ANS: D The nurse should provide information about safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear for their lives.

A woman describes a history of physical and emotional abuse in intimate relationships. Which additional factor should a nurse suspect? A. The woman may be exhibiting a controlled response pattern. B. The woman may have a history of childhood neglect. C. The woman may be exhibiting codependent characteristics. D. The woman might be a victim of incest.

ANS: D The nurse should suspect that this client might be a victim of incest. Women in abusive relationships often grew up in abusive homes.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? A. "These clients don't know life any other way, and change is not an option until they have improved insight." B. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." C. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

ANS: D The nursing supervisor is accurate when stating that clients in severely abusive relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner for some of the following reasons: for the children, for financial reasons, fear of retaliation, lack of a support network, religious reasons, and/or hopelessness.

A 72-year-old male client has been admitted to the emergency department after a nurse at the long-term care facility where the client lives found the client bleeding from his rectum. The client told the emergency department nurse that one of the caregivers at the facility raped him. What intervention will the nurse need to include in this client's plan of care before discharge? A) Help the client find a new long-term care facility. B) Help the client create a post-discharge safety plan. C) Help the client find a lawyer to sue the long-term care facility. D) Help the client understand the warning signs of suicide.

B

A client who has experienced domestic violence in the past has decided to stop participating in counseling. Which client statement would indicate that therapy has been effective? A) "Everyone knows what my problems are, and there is nothing I can do about it." B) "I am functioning fine now but I know that when problems come up again, I will ask for help." C) "My friends tell me that I have improved so this is a good time to stop." D) "It is so draining to deal with the same painful issues all of the time."

B

The nurse is caring for a client who has a history of being physically and sexually abused as a child, and his father abandoned the family when he was 7 years old. The nurse recognizes that this increases the client's risk of becoming a perpetrator of rape because of which type of risk factors? A) Individual B) Relationship C) Community D) Societal

B

A victim of a sexual assault comes to the hospital for treatment but abruptly decides to decline treatment and leaves the facility. While respecting the person's rights, the nurse should: a. say, "You may not leave until you receive prophylactic treatment for sexually transmitted diseases." b. provide written information about physical and emotional reactions the person may experience. c. explain the need and importance of infectious disease and pregnancy tests. d. give verbal information about legal resources in the community.

B All information given to a patient before he or she leaves the emergency department should be in writing. Patients who are anxious are unable to concentrate and therefore cannot retain much of what is verbally imparted. Written information can be read and referred to later. Patients may not be kept against their will or coerced into treatment. This constitutes false imprisonment.

An unconscious teenager is treated in the emergency department. The teenager's friends suspect a rape occurred at a party. Priority action by the nurse should focus on: a. preserving rape evidence. b. maintaining physiologic stability. c. determining what drugs were ingested. d. obtaining a description of the rape from a friend

B Because the patient is unconscious, the risk for airway obstruction is present. The nurse's priority will focus on maintaining physiologic stability. The distracters are of lower priority than preserving physiological functioning.

After an abduction and rape at gunpoint by an unknown assailant, which assessment finding best indicates that a patient is in the acute phase of the rape-trauma syndrome? a. Decreased motor activity c. Flashbacks and dreams b. Confusion and disbelief d. Fears and phobias

B Reactions of the acute phase of the rape-trauma syndrome are shock, emotional numbness, confusion, disbelief, restlessness, and agitated motor activity. Flashbacks, dreams, fears, and phobias are seen in the long-term reorganization phase of the rape-trauma syndrome. Decreased motor activity by itself is not indicative of any particular phase.

A nurse in the emergency department assesses an unresponsive victim of rape. The victim's friend reports, "That guy gave her salty water before he raped her." Which question is most important for the nurse to ask of the victim's friend? a. "Does the victim have any kidney disease?" b. "Has the victim consumed any alcohol?" c. "What time was she given salty water?" d. "Did you witness the rape?"

B Salty water is a slang/street name for GHB (g-hydroxy-butyric acid), a Schedule III central nervous system depressant associated with rape. Use of alcohol would produce an increased risk for respiratory depression. GHB has a duration of 1-12 hours, but the duration is less important that the potential for respiratory depression. Seeking evidence is less important than the victim's physiologic stability.

The nurse is teaching coping skills to clients who have experienced sexual trauma. Which of the following demonstrates that the teaching has been successful? (Select all that apply.) a. The client talks of the past more than the present. b. The client enjoys an intimate relationship with a significant other. c. The client restructures negative thoughts and makes positive self-statements. d. The client verbalizes feelings of anger and despair from past sexual abuse. e. The client practices deep breathing techniques when intrusive memories occur.

B, C, D, E The client who is able to enjoy an intimate relationship with a significant other is demonstrating the ability to relate to another; this is a barrier for those who have experienced sexual trauma.Verbalizing feelings of anger and despair from past sexual abuse allows the client explore these feelings before moving on to self-forgiveness and more complete healing. Practicing deep breathing techniques when intrusive memories occur is an effective stress management technique to self-soothe one's anxiety. Ability to restructure negative thoughts and make positive self-statements demonstrates a cognitive ability to monitor irrational thoughts and replace them with rational ones. Talking of the past more than the present indicates that the client is dwelling on past sexual abuse and is not able to move forward with life.

A client recovering from a rape tells the nurse that flashbacks do occur but can be managed. Which techniques should the nurse suggest to the client for managing flashbacks about the event? Select all that apply. A) Restoring personal choice B) Deep breathing C) Muscle relaxation D) Problem solving E) Guided imagery

B, C, E

A rape victim tells the emergency nurse, "I feel so dirty. Help me take a shower before I get examined." The nurse should: (select all that apply) a. arrange for the victim to shower. b. explain that bathing destroys evidence. c. give the victim a basin of water and towels. d. offer the victim a shower after evidence is collected. e. explain that bathing facilities are not available in the emergency department.

B, D As uncomfortable as the victim may be, she should not bathe until the examination is completed. Collection of evidence is critical for prosecution of the attacker. Showering after the examination will provide comfort to the victim. The distracters will result in destruction of evidence or are untrue.

The nurse is caring for a victim of rape. Which interventions should the nurse include in the client's plan of care? Select all that apply. A) Notifying an attorney for the client B) Supporting the victim during the examination C) Identifying the individual who committed the rape D) Treating acute injuries E) Providing referrals for follow-up care

B, D, E

A female was sexually assaulted in the parking lot of a mall and was brought to the emergency department by a friend. Which of the following is improper procedure for conducting a sexual assault assessment? a. At the victim's request, the friend is present during the examination. b. The victim uses the bathroom and washes her hands before the examination begins. c. After obtaining permission, the nurse takes photographs of the victim's injuries. d. The nurse documents the victim's verbal and nonverbal behavior.

B. It is improper procedure for the victim to use the bathroom and wash her hands before the examination begins because valuable forensic evidence may be destroyed. The victim has the right to have friends or family present during the assessment. The victim must give permission before any photographs or other evidence is collected. Careful documentation of the victim's statements and behavior must be done to assist with possible prosecution of the perpetrator.

There are several biopsychosocial theories associated with the causation of rape and intrafamily abuse. However, the nurse knows that: a. The greatest predictor for family rape is the perpetrator's history of abuse as a child. b. None of the contributing factors consistently results in or is predictive of rape. c. Inability to control impulses is a consistent finding. d. Stranger rape has a sexual connotation, while the dynamics associated with family rape relate to power and control.

B. There is no consistent predictor of rape behaviors. Although genetic predisposition may make certain behaviors more likely, it does not make them inevitable. Controlling impulses is not a consistent finding. All rape is about power and control. Although some abused children grow up to become abusers, this factor is not the greatest predictor for family rape.

The nurse is conducting a teaching session at a community center for women about rape. The nurse would include that which individual is at highest risk for experiencing rape? a A 30-year-old married female who works out of the home b A student c A 50-year-old woman living alone who rides a bus to work d An older client in a long-term care facility

B. Studies show that the young, women who are unmarried, women who are unemployed or are from low income groups, and students have the highest incidence of sexual assault. Older women and women who work do not fit into this category.

A client who was raped tells the nurse that she must not get pregnant. Which response by the nurse is appropriate? A) "The baby could always be given up for adoption." B) "You will not know for sure for at least a few more days." C) "Emergency contraception is available to prevent pregnancy." D) "Are you sure the rapist did not use a condom?"

C

A client, who was raped and refuses to see any male healthcare providers, tells the nurse that she had an "incident" that she does not want to talk about, and wants a bed by the door. Which nursing diagnosis is appropriate for the client? A) Relocation Stress Syndrome B) Readiness for Enhanced Power C) Rape-Trauma Syndrome D) Acute Confusion

C

A pediatric nurse is caring for an 8-month-old client. While making rounds, the nurse enters the room and finds the infant's father violently shaking the infant. The father attempts to make it appear as though the infant was choking. Upon further assessment, the nurse notes bruised areas on the infant's arms and legs. What is a priority action for the nurse to take? A) Discuss what the nurse witnessed with the infant's mother. B) Discuss what the nurse witnessed with the other nurses. C) Report what the nurse witnessed and assessed to the authorities. D) Call security to remove the father from the room.

C

A rape victim is being seen in the clinic. Upon assessment it is discovered the client has contracted trichomoniasis. Which prescription does the nurse anticipate for this client? A) Penicillin B) Ceftriaxone and azithromycin C) Metronidazole D) Doxycycline

C

The nurse is completing a morning assessment on an older adult Asian client. Assessment findings reveal circular red welts over the client's upper back with several bruised areas. Which nursing action is the most appropriate? A) Contact adult protective services. B) Call the healthcare provider immediately. C) Assess the client's cultural traditions. D) Contact the client's family.

C

The nurse is preparing to teach a class about date rape to a group of college-age students. When discussing date rape drugs, which method of prevention should the nurse include in her presentation? A) Never leave a location with a friend. B) Only accept premade drinks from someone you know. C) Never leave your drink unattended. D) Only consume drinks handed to you directly by the bartender or a waitress.

C

Which of the following is a common element of abuse experienced by the victim? A) Accidental injury B) Feelings of control C) Humiliation D) Manipulation

C

A rape victim visited a rape crisis counselor weekly for 8 weeks. At the end of this counseling period, which comment by the victim best demonstrates that reorganization was successful? a. "I have a rash on my buttocks. It itches all the time." b. "Now I know what I did that triggered the attack on me." c. "I'm sleeping better although I still have an occasional nightmare." d. "I have lost 8 pounds since the attack, but I needed to lose some weight."

C Rape-trauma syndrome is a variant of posttraumatic stress disorder. The absence of signs and symptoms of posttraumatic stress disorder suggest that the long-term reorganization phase was successfully completed. The victim's sleep has stabilized; occasional nightmares occur, even in reorganization. The distracters suggest somatic symptoms, appetite disturbances, and self-blame, all of which are indicators that the process is ongoing.

The nurse is providing care for a 2-year-old client. When assessing the client's risk for abuse, which factors increase this client's risk? Select all that apply. A) The child has bruises on the knees and shins. B) The child's parents are married. C) The child is less than 3 years old. D) The child is deaf. E) The child's parents are unemployed and receive medical assistance.

C, D, E

According to systems theory, families in which sexual abuse occurs, are characterized by: a. Consistent equality within their structure and roles. b. High expressed emotion. c. Fluid boundaries. d. Openness with nonfamily members.

C. In a family with fluid boundaries, an adult may move down in the structure or the child may move up in terms of roles and influence (boundaries). If the father moves downward, he assumes a childlike role and is cared for and nurtured like a child in the family. In this position, the father assumes little parental responsibility. He may then turn to a child as a peer for sexual gratification. Openness with nonfamily members does not affect this process. Consistent equality within their structure and roles is a healthy response. This phenomenon has little to do with expressed emotion.

A nurse on the quality improvement committee understands that the step of quality improvement which analyzes current protocols of care and their associated outcomes includes all except: An individual, unit, or facility must understand their baseline performance records. Can be used to discover areas for improvement and to analyze areas of excellence. Performance can be assessed on an intradisciplinary level or an interdisciplinary level. Peer review

Can be used to discover areas for improvement and to analyze areas of excellence.

The nurse is explaining the meaning of equitable care. Which explanation should the nurse include? Care that does not vary in quality because of personal characteristics Care that is respectful of and responsive to individual patient preferences, needs, and values Reducing wait times that may result in harmful delays for those who receive and give care Avoiding injuries to patients from the care that is intended to help them

Care that does not vary in quality because of personal characteristics Equitable care is defined as providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, or geographic location. Patient-centered care is described as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring patient values guide all clinical decisions. Efficient care involves decreasing wait times and avoiding waste, including waste of equipment, supplies, ideas, and energy. Safety is guided by avoiding injuries to the patients in the nurse's care.

The nurse chairs a committee tasked with improving the number of hospital-acquired infections and is asked for a definition of "benchmarking." Which response should the nurse give? Minimum starting point used for comparisons Comparison of the performance of an individual or organization to industry standards Process to identify vulnerabilities within an organization Analysis used to prevent certain events from repeating

Comparison of the performance of an individual or organization to industry standards Benchmarking is a process used to compare the performance of an individual or organization to industry standards. It uses indicators, or statistics, of an organization's performance in a specific area, to use in a comparison to industry standards. The indicators or statistics are a baseline or a starting point for improvement. Risk management is the process by which an organization looks into vulnerable areas and makes changes to improve outcomes and avoid making repeated mistakes.

A rape victim tells the nurse, "I should not have been out on the street alone." Select the nurse's most therapeutic response. a. "Rape can happen anywhere." b. "Blaming yourself increases your anxiety and discomfort." c. "You are right. You should not have been alone on the street at night." d. "You feel as though this would not have happened if you had not been alone."

D A reflective communication technique is most helpful. Looking at one's role in the event serves to explain events that the victim would otherwise find incomprehensible. The distracters discount the victim's perceived role and interfere with further discussion.

A woman was found confused and disoriented after being abducted and raped at gunpoint by an unknown assailant. The emergency department nurse makes these observations about the woman: talking rapidly in disjointed phrases, unable to concentrate, indecisive when asked to make simple decisions. What is the woman's level of anxiety? a. Weak c. Moderate b. Mild d. Severe

D Acute anxiety results from the personal threat to the victim's safety and security. In this case, the patient's symptoms of rapid, dissociated speech, inability to concentrate, and indecisiveness indicate severe anxiety. Weak is not a level of anxiety. Mild and moderate levels of anxiety would allow the patient to function at a higher level.

The nursing diagnosis Rape-trauma syndrome applies to a rape victim in the emergency department. Select the most appropriate outcome to achieve before discharging the patient. a. The memory of the rape will be less vivid and less frightening. b. The patient is able to describe feelings of safety and relaxation. c. Symptoms of pain, discomfort, and anxiety are no longer present. d. The patient agrees to a follow-up appointment with a rape victim advocate.

D Agreeing to keep a follow-up appointment is a realistic short-term outcome. The victim is in the acute phase; the distracters are unlikely to be achieved during the limited time the victim is in an emergency department.

The nurse at a university health center leads a dialogue with female freshmen about rape and sexual assault. One student says, "If I avoid strangers or situations where I am alone outside at night, I'll be safe from sexual attacks." Choose the nurse's best response. a. "Your plan is not adequate. You could still be raped or sexually assaulted." b. "I am glad you have this excellent safety plan. Would others like to comment?" c. "It's better to walk with someone or call security when you enter or leave a building." d. "Sexual assaults are more often perpetrated by acquaintances. Let's discuss ways to prevent that."

D Females know their offenders in almost 70% of all violent crimes committed against them, including rape. The nurse should share this information along with encouraging discussion of safety measures. The distracters fail to provide adequate information or encourage discussion.

Before a victim of sexual assault is discharged from the emergency department, the nurse should: a. notify the victim's family to provide emotional support. b. offer to stay with the patient until stability is regained. c. advise the patient to try not to think about the assault. d. provide referral information verbally and in writing.

D Immediately after the assault, rape victims are often disorganized and unable to think well or remember instructions. Written information acknowledges this fact and provides a solution. The distracters violate the patient's right to privacy, evidence a rescue fantasy, and offer a platitude that is neither therapeutic nor effective.

A nurse cares for a rape victim who was given a drink that contained flunitrazepam (Rohypnol) by an assailant. Which intervention has priority? Monitoring for: a. coma. c. hypotonia. b. seizures. d. respiratory depression.

D Monitoring for respiratory depression takes priority over hypotonia, seizures, or coma.

. A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, "I can't talk about it. Nothing happened. I have to forget." What is the patient's present coping strategy? a. Compensation c. Projection b. Somatization d. Denial

D The patient's statements reflect use of denial, an ego defense mechanism. This mechanism may be used unconsciously to protect the person from the emotionally overwhelming reality of the rape. The patient's statements do not reflect somatization, compensation, or projection.

In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? A) Research factors that contribute to better outcomes. B) Compare outcomes to benchmarks. C) Identify areas for improvement. D) Analyze current protocols of care and associated outcomes. E) Implement changes to improve outcomes F) Analyze client outcomes to determine effectiveness of changes.

D B C A E F

Which of the following statements would hinder the therapeutic relationship between the nurse and an adult victim of a recent sexual assault? a. "You handled the attack as well as you could; you survived." b. "You may feel anger, guilt, fear or resentment, but these are very normal reactions." c. "You didn't do anything to cause the attack, and it's not your fault you were raped." d. "You may want to have an abortion if you find out you are pregnant."

D. Mentioning abortion hinders the therapeutic relationship because it advises the client to make a personal choice that may be against her values and beliefs. This statement would block further communication about the options that are available to the client. The therapeutic relationship is facilitated by reassuring the client that she acted as rationally and appropriately as anyone could in a life-threatening situation, by letting the client know that the nurse understands the emotions one commonly feels following a violent attack, and by reminding the client of her innocence. Many victims think they could have avoided the rape if they had acted differently.

The hospital management is concerned about feedback regarding long waiting times for treatment in the emergency department and forms a committee to resolve the issue. Which should be the first task by the leader of the committee to solve the problem? Form a Continuous Quality Improvement team to define the desired outcome. Reevaluate emergency room waiting times. Collect baseline data to determine if a problem exists. Ask the director of operations for solutions.

Form a Continuous Quality Improvement team to define the desired outcome. The first step in the Continuous Quality Improvement (CQI) process is to assemble a team of individuals who are stakeholders in the problem to form a CQI team to define the desired outcome. From there, the nurse can measure performance against the desired outcome, analyze the results, provide feedback, implement a solution, and evaluate its effectiveness. If the nurse were to collect baseline information without determining the desired outcome, they might not measure the relevant indicators. CQI is about including the team in the problem-solving process, rather than dictating what needs to be accomplished. By including the team in the problem solving, it is more likely they will buy into the solutions. Asking the operations manager for solutions is not the best way to resolve the issue, and reevaluating the wait time will only help after implementation of the first plan of action to reduce that issue.

Which statement should the nurse use to describe the purpose of the root cause analysis? Brainstorming preferred outcomes Identifying risks causing financial loss Providing a report to the leader of the committee Identifying the root cause of the problem through problem solving

Identifying the root cause of the problem through problem solving The purpose of a root cause analysis is to determine the root cause of a problem. Brainstorming outcomes and reporting to the leader would be part of the task force to implement quality improvements. Identifying risks of financial loss is part of an audit.

Which term describes an assessment occurring within a group of individuals with similar positions within a healthcare system? Six Sigma audit Interprofessional Internal audit Intraprofessional

Intraprofessional An intraprofessional assessment is one occurring within a group of individuals with similar positions within a healthcare system. A peer audit is a review used to professionally critique a colleague's work, based on a predetermined set of standards. An audit is an examination of records to verify accuracy and proper use. Outcomes management uses patient experiences to improve all areas of health care.

The nurse in the blood bank is part of a team effort to reduce the cost of collecting and storing blood components. The nurse conducts an inventory check for expired sterile supplies. Which quality improvement method is the team using in seeking to reduce waste? Utilization review Root cause analysis Quality assurance Lean Six Sigma

Lean Six Sigma The objective of Lean Six Sigma, the quality improvement method used by the blood bank team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.

The nurse in the blood bank is part of a team effort to reduce the costs of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. In seeking to reduce​ waste, which quality improvement​ (QI) method is the team​ using? Quality assurance Lean Six Sigma Root cause analysis Utilization review

Lean six sigma

The nurse is evaluating the effectiveness of changes made to improve quality of care. Which procedure is the nurse conducting? Quality assurance Total quality management Continuous quality improvement Quality management plan

Quality assurance Implemented changes must be evaluated to assess their impact on patient care, patient outcomes, patient and clinical satisfaction, and resource utilization. Data related to the original problem must be collected and are then analyzed on the basis of benchmark standards to determine whether standards are being met. This is called quality assurance. A quality management plan is used to help healthcare facilities integrate new programs, models, and technologies with the primary care services that are already in place. Total quality management (TQM) is a comprehensive management philosophy used to improve quality and productivity by using data and statistics to improve processes. Continuous quality improvement (CQI) is a structured organizational process for including personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.

The urology nurse is reviewing medical records of the last five clients discharged after transurethral resection of the prostate​ (TURP). The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief. Which activity is the nurse participating in with this review​ process?Utilization review Concurrent audit Retrospective audit Root cause analysis

Retrospective audit

The nurse manager complimented the night staff on recent data about reducing noise. The day shift nurses asked each client about obstacles to sleep the previous night. They recorded the clients​' responses as either achieving the goal of sleep or being disrupted by the defect of loud sounds or other obstacles. Which kind of quality improvement activity is taking​ place? Six Sigma Performance improvement Continuous quality improvement Benchmarking

Six Sigma

Which type of agency should the nurse recognize as being responsible for providing health insurance for low-income individuals and families? Centers for Disease Control and Prevention Office of the Surgeon General State agency Office of Medicare

State agency Even with the advent of the Affordable Care Act, state agencies are partially responsible for providing health insurance programs for low-income individuals and families. The Surgeon General reports to the Assistant Secretary for Health (ASH), who may be a four-star admiral in the commissioned corps, and who serves as the principal adviser to the Secretary of Health and Human Services on public health and scientific issues. As the nation's health protection agency, the Centers for Disease Control and Prevention (CDC) saves lives and protects people from health, safety, and security threats. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease.