Chapter 19 Flashcards
- A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, nonmetropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding?
a. Client who lives next to a ranch in a town of 1200 people
b. 70-year-old client residing in an assisted living facility in a rural area
c. Apple grower who lives in a 100-square-mile county with a population of 19,900
d. Soybean grower and his wife who live in a 400-square-mile county with a population of 39,501
ANS: D : Soybean grower and his wife who live in a 400-square-mile county with a population of 39,501
Farm residency denotes living outside “city limits” and involvement in agriculture. Frontier regions have fewer than six persons per square mile; rural communities have fewer than 20,000 residents or fewer than 99 persons per square mile. Nonmetropolitan statistical areas are regions without a central city of 50,000 or more citizens. The soybean grower and his wife make their living in agriculture (farm resident), and the county where they live has fewer than 99 persons per square mile (rural).
- A community health nurse is prioritizing health-promotion activities with the local rural community. An understanding of the health status and health risks of the rural community would lead the nurse to give priority to:
a. aerobic exercise classes and an exercise class for seniors with arthritis.
b. English as a second language program using health promotion literature as reading materials.
c. mentoring program to increase adult literacy.
d. motor vehicle and farm accident prevention project and prenatal care outreach program.
ANS: D : motor vehicle and farm accident prevention project and prenatal care outreach program.
All of the health-promotion activities mentioned would be helpful for a rural community. However, health-promotion activities should be prioritized according to the most common causes of morbidity and mortality for the population served. Rural residents are at increased risk of injury and death secondary to motor vehicle accident and farm-related occupational injuries. Rural residents also have increased rates of infant and maternal morbidity and mortality
- A community-oriented nurse newly assigned to a rural community learns that the characteristics of rural and small town life include:
a. consistent employment, formalized professional interactions, and openness to people new to the community.
b. informal social and professional relationships, acquaintance of residents with most other members of the community, work of many residents in high-risk occupations, and often a lack of openness to newcomers.
c. lack of anonymity, fractured family systems, role of churches as socialization centers, and mistrust of newcomers.
d. tendency of residents to work in safety-oriented occupations, preference for autonomy rather than working as a community, and work in agriculture-related factories
ANS: B : informal social and professional relationships, acquaintance of residents with most other members of the community, work of many residents in high-risk occupations, and often a lack of openness to newcomers.
The characteristics of rural life include such things as more space; greater distances between residents and services; cyclic/seasonal work and leisure activities; informal social and professional interactions; access to extended kinship families; high proportion of residents who are related or acquainted; lack of anonymity; confidentiality challenges; significant number of small, family-owned businesses; economic orientation to land and nature; higher prevalence of high-risk occupations; town center orientation; role of churches and schools as socialization centers; and a preference for “insiders” and mistrust of newcomers (“outsiders”).
- Community and public health nurses (PHNs) practicing in rural locales consistently note which of the following characteristics of their practice environments?
a. Broad scope of practice, independence and autonomy, and opportunity for community involvement
b. Expanding scope of practice, plentiful resources, and increased opportunity for less formal interactions
c. Lack of autonomy and independence, along with greater flexibility than in an urban practice
d. Narrower scope of practice and focus than in an urban practice
ANS: A : Broad scope of practice, independence and autonomy, and opportunity for community involvement
Characteristics of nursing practice in rural environments include broad, diverse, and/or intergenerational scope of practice, greater independence, public status and autonomy, and a greater opportunity for community involvement than in many urban practice environments.
- Nurses practicing in rural communities often observe that protecting client confidentiality is a unique challenge because:
a. nurses’ family members expect nurses to share client information when something serious is happening to a community member.
b. nurses in rural areas are well known to their service populations and are often approached by their clients in social and other settings with requests for counsel and advice.
c. professional nurses in rural areas often work in more than one role in the community, which reduces their professional credibility.
d. rural residents do not expect nurses to keep client information confidential because “everyone knows everyone” and his or her family.
ANS: B : nurses in rural areas are well known to their service populations and are often approached by their clients in social and other settings with requests for counsel and advice.
Nurses practicing in rural areas are obligated to maintain client confidentiality just as they would in an urban setting. However, nurses are often asked for health information and advice in nonclinical settings. Nurses must be especially sensitive and exercise creativity to maintain client confidentiality when approached in public settings.
- A rural health nurse who is planning programs to address the population’s needs should recognize that, in general, rural populations:
a. engage in physical activity during leisure time.
b. engage in preventive health behaviors.
c. perceive their overall health as less favorable.
d. use seat belts.
ANS: C : perceive their overall health as less favorable.
In general, people in rural areas have a poorer perception of their overall health and functional status than those in urban areas.
- When using the health measure of death rates for working adults, the nurse could expect to find the highest death rates in which areas?
a. Large metropolitan areas
b. Most rural and highly populated urban areas
c. Most rural and suburban areas
d. Small suburban and all urban areas
ANS: B : Most rural and highly populated urban areas
Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults are found in the most rural areas. Residents of rural areas have the highest rates of death as a result of unintentional injuries in general and because of motor vehicles injuries in particular. Homicide rates are the highest in the central counties of large metropolitan areas.
- A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach?
a. Assessment
b. Case management
c. Geriatrics
d. Tertiary prevention
ANS: B : Case management
Nurses working in rural areas, including those working with migrant workers, have opportunities to use community-oriented nursing skills. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models for addressing some of these deficits and reducing rural health disparities.
- When determining whether a geographic area is rural or urban, the nurse should recognize that:
a. rural and urban areas by their nature occur on a continuum.
b. rural regions have fewer than six persons per square mile.
c. rural residents feel isolated.
d. rural areas are recreational, retirement, and resort communities.
ANS: A : rural and urban areas by their nature occur on a continuum.
Rural and urban residencies are not opposing lifestyles. Rather, they occur on a rural-urban continuum ranging from living on a remote farm, to living in a village or small town, to residing in a larger town or city, to living in a large metropolitan area with a core inner city. Although some communities may seem geographically remote, the residents who live there may not feel isolated. For the affluent, the term rural may bring to mind recreational, retirement, and resort communities in the mountains, seashore, or lake country. For the less affluent, it may mean an impoverished Indian reservation or migrant labor camp. Therefore rural may be a state of mind.
- Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression? (Select all that apply.)
a. Delays in seeking mental health services
b. High rate of poverty
c. Gaps in the continuum of mental health services
d. Sufficient number of mental health services
e. Tolerance for destructive coping mechanisms
ANS: A, B, C, E
There appears to be more persistent, endemic depression among rural residents. Factors that relate to this level of depression are the high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.
