com24 3Q

Question 1

Which best describes the recent population trend in rural America?

a. The number of residents in rural areas of the United States is at one of its lowest
levels ever recorded.

b. Urban population rates increased from 2010 to 2015 as agricultural opportunities
diminished.

c. Nonmetro population rates have been steadily increasing because of increasing
job growth.

d. Population growth or loss in rural areas varies widely depending on available
economic opportunities.

Answer 1

d. Population growth or loss in rural areas varies widely depending on available
economic opportunities.

Although the urban growth rate has been steadily climbing since 1890, with numbers of urban dwellers surpassing those in rural areas around 1920, the number of rural residents is the highest in the country’s history (U.S. Department of Agriculture [USDA], 2016). In 2010 to 2015 population loss in nonmetro areas occurred in the United States as a whole. In 2014 nonmetro populations stabilized after 4 years of decline, likely related to improved rural employment growth (USDA, 2016). Opportunities for population growth and economic expansion vary widely from one nonmetro county to the next, and new regional patterns of growth and decline have emerged in recent years.

Question 2

Which best explains why there are so few hospitals in rural areas?

a. Few nurses and physicians enjoy the rural lifestyle.

b. Historically, hospitals began in large urban areas and have slowly expanded
outward but have not yet reached all rural areas.

c. Rural areas have very low population density.

d. Rural residents do not trust hospitals, preferring to receive care from neighbors
and friends.

Answer 2

c. Rural areas have very low population density.

Although 75% of U.S. counties are classified as rural, they contain only 20% of the U.S. population. The population density is too low to support a large hospital. There are providers available to serve the population and residents are accepting of health care services, but not as many services are needed because of the lower population density.

Question 3

From which causes are rural residents twice as likely to die from in comparison with urban residents?

a. Chronic diseases, especially cardiac problems and cancers

b. Diabetes from the higher incidence of obesity

c. Respiratory diseases (from pesticides and herbicides)

d. Unintentional injuries

Answer 3

d. Unintentional injuries

Residents of rural areas are nearly twice as likely to die of unintentional injuries, including motor vehicle accidents, when compared with their urban counterparts. The rates of chronic diseases, diabetes, and respiratory diseases are more similar to that of urban residents.

Question 4

Which best describes the purpose of the core-based statistical areas (CBSA) system?

a. To reflect trends in population distribution across the county

b. To differentiate between urban and metropolitan areas

c. To emphasize the importance of noncare areas

d. To report the demographic characteristics of those living in the area

Answer 4

a. To reflect trends in population distribution across the county

Question 5

Which compositional factor influences rural health needs?
a. Demographics of the people living in an area
b. Local environment
c. The geography of the area
d. The political and social institutions in the community

Answer 5

a. Demographics of the people living in an area

There is a growing emphasis on the distinction between context, which is defined by the characteristics of places of residence, and composition, which is the collective health effects that result from a concentration of persons with certain characteristics. Problems in rural areas are compositional when they derive from individual characteristics of groups of people residing in rural settings. Examples of compositional sources of health disparities include such characteristics as age, education, income, ethnicity, and health behaviors. The environment, geography, and political and social institutions are considered to be characteristics of place

Question 6

Which describes what has been identified by public health experts as the number one priority in rural areas?

a. Access to health care
b. Access to education
c. Access to telecommunications
d. Access to better-paying employment opportunities

Answer 6

a. Access to health care

Question 7

Which is particularly prevalent in rural areas (more so than in urban areas) of the South?
a. Falls and motor vehicle accidents
b. Less use of seatbelts and more drinking of alcohol
c. Obesity and sedentary lifestyle
d. Suicide and homicide

Answer 7

c. Obesity and sedentary lifestyle

Rural residents in the southern states are more likely to be obese, smoke more heavily if they do smoke, use smokeless tobacco, and engage in sedentary lifestyles. Rates of motor vehicle accidents and suicide are higher in rural areas, although not necessarily the South. Additionally, there is a decreased use of seatbelts and increased use of alcohol in rural areas; however, the textbook mentions that these rates are higher in the rural West than in the rural South. The rates of falls and homicide are not addressed in the textbook.

Question 8

Which statement best describes how firearm injuries are different in rural areas as compared with urban areas?

a. In rural areas, firearm deaths occur more frequently because of purposeful, rather
than accidental, shooting.
b. In rural areas, firearm injuries occur more frequently in the home.
c. In rural areas, firearm injuries occur more frequently during official hunting
season, whereas the frequency does not vary in urban areas.
d. In rural areas, firearm injuries are more frequently fatal than in urban areas.

Answer 8

b. In rural areas, firearm injuries occur more frequently in the home.

In rural counties, nonfatal firearm injuries occur most often at home compared with urban counties, where injuries occur most often in the streets.

Question 9

Which employment opportunities are among the most dangerous?
a. Food processing, textiles, and transportation
b. Highway construction, ranching, and public utilities
c. Large mechanized factory positions
d. Mining, forestry, and fishing

Answer 9

d. Mining, forestry, and fishing

Industries with the highest death rates were mining, agriculture, forestry, and fishing, followed by construction, transportation, and public utilities.

Question 10

As a concerned citizen and professional, a nurse encourages the local senators and representatives to support expansion of health clinics for the poverty stricken. Which location is in most desperate need?

a. Rural areas where migrant and seasonal farmworkers (MSFW) labor
b. Inner city poverty-stricken neighborhoods
c. Near elderly low-income housing units
d. Inside high schools in poverty-stricken neighborhoods

Answer 10

a. Rural areas where migrant and seasonal farmworkers (MSFW) labor

Question 11

Which is the most frequent cause of farm fatalities and nonfatal injuries?
a. Manure pits (methane poison)
b. Power take-off augers
c. Storage silos
d. Tractors
e. Very old and barely functioning trucks

Answer 11

e. Very old and barely functioning trucks

Question 12

Which statement best describes how working on a farm is different from working in a factory?
a. Factories have more dangerous dust than farming dust.
b. Farm chemicals are more immediately fatal than most industrial chemicals.
c. The worksite and the home are the same.
d. Workers on farms, unlike those in factories, can bring dangerous substances home on their clothing, which expose their families.

Answer 12

c. The worksite and the home are the same.

Farming is unusual because the home and the worksite are the same. Several types of farming activities are associated with higher-than-expected occurrences of acute and chronic respiratory conditions. Individuals with long-term exposure to grain dusts, such as grain elevator workers and dairy workers, have diminished respiratory function and increased frequency of respiratory symptoms. Occupational asthma and more exotic fungal or toxic gas-related conditions occur in higher frequency in agricultural than nonagricultural populations. Exposure risks to children and spouses may be heightened when farmers wear contaminated clothing and boots into the home, but the same can happen in several industries.

Question 13

A woman stumbled into the rural health clinic and explained that she had an incredible headache. She was sweating and began vomiting into the wastebasket by the intake nurse’s desk. Which diagnosis should be anticipated by the nurse?
a. Acute adult panic disorder
b. Acute alcohol intoxication
c. Acute appendicitis
d. Acute meningitis
e. Acute pesticide poisoning

Answer 13

e. Acute pesticide poisoning

Signs and symptoms of acute pesticide poisoning are fairly clear, and most health providers in rural communities would recognize them. Common symptoms include headache, dizziness, diaphoresis, nausea, and vomiting. If left untreated, those affected may experience a progression of symptoms including dyspnea, bronchospasm, and muscle twitching. Deaths are relatively uncommon, but they do occur. The nurse is reminded that not all farm laborers are men. The symptoms that are being displayed are not typical of acute panic disorder, acute alcohol intoxication, acute appendicitis, or acute meningitis.

Question 14

A nurse is explaining why migrant farmworkers experience cultural barriers when trying to receive care. Which would the nurse include in this explanation?

a. “As illegal immigrants, they are not eligible for tax-paid health care.”

b. “Families who travel in isolation seeking agricultural work do not mix with their
employers or other members of the community.”

c. “Mexicans who speak primarily Spanish and cannot understand English.”

d. “Usually perceived as outsiders, they are from many countries and cultures.”

Answer 14

d. “Usually perceived as outsiders, they are from many countries and cultures.”

Question 15

A nurse was becoming very frustrated at the ongoing stream of farmworkers with respiratory problems each spring. Which action should be taken by the nurse?

a. Provide community education on herbicides and other chemicals spread each
spring with information on self-protective measures, such as respirators.

b. Fight to get farmers to quit spreading chemicals on their fields each spring.

c. Suggest that farmers spray water on the fields immediately after the chemicals are
spread to reduce dust in the air.

d. Tell farm workers to obtain different employment.

e. Try to get farmers to reduce the amount of chemicals used on their fields.

Answer 15

a. Provide community education on herbicides and other chemicals spread each
spring with information on self-protective measures, such as respirators.

Environmental health issues in rural communities, such as pesticide exposure or health hazards from point-source factory emissions, are more effectively assessed and remedied on a community level than on a case-by-case basis. Nurses’ involvement in helping people understands health problems in a larger context can be the genesis of change. It is not realistic to have farmers quit or reduce the spreading of chemicals, spray water on their fields after chemical application, or ask them to obtain different employment. Nurses must work with farmers so that they are able to use safe measures when applying the chemicals to t

Question 16

A nurse was trying to decrease the amount of respiratory illness in the community. Which approach should be used by the nurse?.

a. Attend each farmworkers’ meeting and listen to how they perceive and discuss
their problems

b. Offer to teach the farmers’ spouses how to protect their families, such as having
the farmer shower and change clothes before coming into the house

c. Suggest the community work together to obtain a community college so farmworkers could be educated for other employment opportunities

d. Teach children in the school system the importance of seeking employment in cities rather than staying on the farm

Answer 16

a. Attend each farmworkers’ meeting and listen to how they perceive and discuss
their problems

Using informal networks in the community is essential. The involvement of informal networks and local leaders in planning health interventions is crucial. To be able to do that, the nurse must first listen to how the community perceives its problems.

Question 17

Which best describes a proposed strategy to address the lack of health care professionals in rural communities?
a. Advertise that there are more men than women in many rural areas to attract
female nurses who want to be wives and mothers
b. Offer free housing and office space to a professional who will come to live in the
community
c. Pay extremely high salaries to professionals willing to relocate
d. Support local students obtaining an education while continuing to live at home

Answer 17

d. Support local students obtaining an education while continuing to live at home

A solution proposed for the shortage of health care providers is for rural communities to “grow their own.” A rural community, a group of small communities, or a county could support local students attending college and recruit students currently attending professional schools. The students make a commitment to work in the community in return for monetary support for their educations.

Question 18

Which difference is found in parish nursing in a rural area as opposed to parish nursing in an urban area?

a. Rural parish nurses are less likely to be involved in case management or care
coordination than their urban counterparts.

b. Rural residents are more grateful for the nurse’s assistance because there are so
few health resources in rural areas.

c. Rural residents are typically less committed to traditional values or a strong
religious faith.

d. Rural residents may discuss health concerns with the nurse wherever they meet,
whether in church or the local market.

Answer 18

d. Rural residents may discuss health concerns with the nurse wherever they meet,
whether in church or the local market.

In urban settings, contact with parishioners was primarily at the church, whereas contacts in rural settings were most often in the home, on the phone, or in other community-based settings.

Question 19

A nurse saw there was a need for a hospice facility in a rural area, because so many of the residents were quite elderly and death was common. Which best explains why the community would not immediately see the wisdom of the nurse’s suggestion?

a. Change is always difficult; the nurse just needs to keep reinforcing the need for
such a facility.

b. The nurse did not tell residents how much their taxes would need to go up to
support such a facility.

c. Residents were fearful of confronting death in such an open way.

d. Rural residents prefer to use their informal social support networks when help is
needed.

Answer 19

d. Rural residents prefer to use their informal social support networks when help is
needed.

Limited availability and accessibility of formal health care resources in rural areas combined with self-reliance and self-help traits of rural residents have resulted in the development of strong rural community informal care and social support networks. Rural residents are more apt to entrust care to established informal networks than to new formal care systems. It is unlikely that creation of such a facility would impact their taxes. The nurse needs to partner with the community to implement the change process while building upon the community’s strengths, beliefs, and values systems.

Question 20

Which would most likely to be provided by a local health department in a rural community?
a. Collaborating with local health clinics to provide outreach services
b. Funding a local research project
c. Establishing the poverty guidelines for the area
d. Building a free-standing migrant health clinic

Answer 20

a. Collaborating with local health clinics to provide outreach services

Uniquely positioned within rural communities, LHDs are a potential catalyst for addressing the long-standing challenges associated with urban–rural health disparities. While focused on improving the health of populations, LHDs provide a wide array of services focused on assessing health status, mobilizing action to address health-related issues, and ensuring the delivery of important health services in the community. The ability of rural health departments to develop and cultivate partnerships is important for the integration of public health within the larger health care delivery system. The local health department would be more likely to collaborate with existing resources before building its own free-standing clinic. Poverty guidelines are established by the federal government. It is unlikely that a local health department in a rural area has funding available for research projects.

Question 21

Which best describes how the federal government tries to both encourage and support rural health clinics under the Community Health Centers (CHC) program?

a. Allowing tax deductions for charitable contributions to rural health clinics
(RHCs)

b. Donating equipment and supplies to establish such clinics

c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise

d. Requiring recipients to serve in a rural health clinic for 3 years in exchange for
financial assistance while in school

Answer 21

c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise

Question 22

Which factors result in rural residents having less access to health care than urban dwellers? (Select all that apply.)

a. Employment opportunities may be low paying and seasonal.

b. There are greater distances to travel and limited choice of health care providers.

c. Health care providers prefer to work in higher-paying urban settings.

d. Rural residents are less likely to have health insurance.

e. Rural persons’ economic resources are tied up in land, not easily accessible cash.

f. Rural persons believe in self-sufficiency and self-care, not asking others for help.

Answer 22

A, B, C, D
A recent Institute of Medicine study reported rural medical access problems in these areas, with some hospital and pharmacy closures; greater distances to travel for physician services; and limited, if any, choice of providers. Rural residents were more likely than urban residents to lack insurance. In 2015, about 18% of the persons living in rural counties were at the poverty level. Having economic resources invested in land and believing in self-sufficiency and self-care are not reasons why rural residents have less access to health care than urban dwellers.