Exam 3 Flashcards

Question

The most important predictor of overall mortality is: a. race. b. age. c. gender. d. income.

Answer 1

ANS: B The mortality curve by age drops sharply during and after the first year of life to a low point in childhood, then begins to increase through adolescence and young adulthood and then increases sharply through middle and older ages. Race, gender, and income are not the most important predictor for overall mortality.

Answer 2

ANS: B One temporal and spatial pattern of disease distribution is the point epidemic. A point epidemic is most clearly seen when the frequency of cases is plotted against time. The sharp peak charac-teristic of such graphs indicates a concentration of cases in some short interval of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Secular trends are long-term patterns of morbidity or mortality rates. Event-related clusters are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.

Answer 3

ANS: C A cohort study is the type of epidemiologic study that is used to describe a group of persons en-rolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. A case-control study uses a sample from the cohort rather than following the entire cohort over time. A cross-sectional study provides a snapshot of a pop-ulation or group at one point in time. An experimental study is one in which the investigator ini-tiates some treatment or intervention that may influence the risk or course of the disease.

Answer 4

ANS: A A cross-sectional study collects information on current health status, personal characteristics, and potential risk factors or exposures all at once. A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. An ecolog-ical model considers the multiple factors that contribute to disease development.

Answer 5

ANS: C A community trial is similar to a clinical trial, but the issue is often health promotion and disease prevention rather than treatment of existing disease. An ecological model considers the multiple factors that contribute to disease development. A double-blind study is one in which neither the subject nor the investigator knows who is receiving the treatment. A screening involves the test-ing of groups of individuals who are at risk for a certain condition but are not yet symptomatic.

Answer 6

ANS: B Selection bias is attributable to the way subjects enter a study. It has to do with selection proce-dures and the population from which subjects are drawn. Determining the population to be stud-ied relates to the design of the study. Studying cause and effect relationship has to do with eco-logical studies. Documenting the results of the study is completed at the end of the study after the participants have been selected.

Answer 7

ANS: B, D Factors contributing to the development and application of epidemiologic methods in the twenti-eth century were: improved nutrition, new vaccines, better sanitation, the advent of antibiotics and chemotherapies, and declining infant and child mortality and birth rates. A rise in the stand-ard of living occurred for many following the Great Depression and World War II. The ad-vancements in medical technology have not influenced the examination of the epidemiology of various diseases.

Answer 8

ANS: B, C, D Collection, reporting, analysis, and interpretation of data, environmental risk communication, and documentation on patient charts and records are examples of the use of epidemiology in practice. Policy making and law enforcement do not apply to epidemiology.

Answer 9

ANS: D MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations. MRSA is still largely a health care-associated infection, but it is becoming more common. VRE was found before MRSA. MRSA is not asso-ciated with chronic illness.

Answer 10

ANS: D The ability of an agent to produce a severe pathologic reaction is known as virulence. Antigenic-ity is the ability to stimulate an immunological response. Invasiveness is the ability to penetrate and spread throughout a tissue. Toxicity is the ability to produce a poisonous reaction.

Answer 11

ANS: B Immunity refers to species-determined resistance to an infectious agent and is determined by the characteristics of the host. The agent is the infection that is causing the infection/disease. Envi-ronmental factors may influence the susceptibility of the host. The epidemiologic triad involves the interaction of the host, agent, and environment.

Answer 12

ANS: B An agent is described by its ability to cause disease and the nature and the severity of the dis-ease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. Host resilience is a host factor. Infectiousness is the measure of the potential ability of an infect-ed host to transmit the infection to other hosts. Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts, such as a bug bite.

Answer 13

ANS: A Active immunity refers to the immunization of an individual by administration of an antigen (in-fectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host. Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual. Natural immunity refers to species-determined, innate resistance to an infectious agent. Acquired immunity is the re-sistance acquired by a host as a result of previous natural exposure to an infectious agent.

Answer 14

ANS: C Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts. Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment. An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacte-ria, (2) parasites, (3) fungi, and (4) viruses. A food handler is an example of a host, which is a human or animal that can harbor an infectious agent.

Answer 15

ANS: B The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms. The communicable period is the interval during which an in-fectious agent may be transferred directly or indirectly from an infected person to another per-son. Infectiousness is the measure of the potential ability of an infected host to transmit the in-fection to other hosts. Endemic refers to the constant presence of a disease within a geographic area or a population.

Answer 16

ANS: A Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth. Transmission through sexual contact is horizontal transmission. Transmission from mosquito bites is vector transmission. Transmission from con-taminated food is common vehicle transmission.

Answer 17

ANS: B Vectors are arthropods such as ticks and mosquitoes that transmit the infectious agent by biting or depositing the infective material near the host. Contaminated water, a dirty needle, and an in-fected person would be common vehicles.

Answer 18

ANS: B The occurrence of one case of smallpox in a population in which it was considered to be previ-ously eliminated is an epidemic. Endemic refers to the constant presence of a disease within a geographic area or population. Pandemic refers to an epidemic occurring worldwide and affect-ing large populations. Infectivity is the ability to enter and multiply in the host.

Answer 19

ANS: C Requirements for disease reporting in the United States are mandated by state laws and regula-tions. These diseases are then reported to the CDC. State public health officials collaborate with the CDC to determine which diseases should be nationally notifiable. The federal government and WHO are not involved in disease reporting.

Answer 20

ANS: B Surveillance gathers the “who, when, where, and what”; these elements are then used to answer “why.” Nurses are frequently involved in surveillance by collecting data, making diagnoses, in-vestigating and reporting cases, and providing information to the general public. Client educa-tion, program evaluation, and advocating for changes are not part of the surveillance process.

Answer 21

ANS: B Malaria is on the list of infectious diseases notifiable at the national level. The Morbidity and Mortality Weekly Report is published weekly with the rates of disease; however, this would not be the first consideration by the nurse. Malaria is not spread by direct contact, rather from a bite from an infected mosquito. Malaria begins with flu-like symptoms, or the client may have very few symptoms.

Answer 22

ANS: B Globalization of food supplies is one of the many factors that can influence the emergence of in-fectious diseases. The increased use of childcare facilities could contribute to the emergence of new infectious diseases. The lack of sanitation systems in third world countries could contribute to the emergence of new infectious diseases. The increased availability of immunizations should decrease the emergence of diseases.

Answer 23

ANS: C The Americas are certified polio free. The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lyme’s disease is characterized by a bull’s-eye lesion.

Answer 24

ANS: C Tertiary prevention reduces complications through treatment and rehabilitation. Primary preven-tion seeks to reduce the incidence of disease by preventing occurrence. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Primary health care is con-sidered to be the essential health care services provided by physicians and other health care pro-viders.

Answer 25

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or dis-ability. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Tertiary prevention reduces complications through treatment and rehabilitation. Assessment re-fers to the systematic collection of data.

Answer 26

ANS: A Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20-40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and se-lected hemorrhagic viruses. West Nile Virus, SARS, and H1N1 are not viruses that would be used for bioterrorism.

Answer 27

ANS: C Tracking children known to be at risk for underimmunization is a function of PHNs who work in health departments where immunizations are given and tracked. Reading the Mortality and Mor-bidity Weekly Report, requiring that children have all of their immunizations before attending school, and leading teams of health care workers would not be as effective in increasing immun-ization coverage for this population.

Answer 28

ANS: A Food intoxication is caused by toxins produced by bacterial growth, chemical containments, and a variety of disease-producing substances found naturally in certain foods such as mushrooms and some seafood. Bacterial, viral, or parasitic invasion of food is not a cause of food intoxica-tion. Food intoxication is not caused by overcooking meat or adding too many ingredients to food.

Answer 29

ANS: C Lyme disease is the most common vector-borne disease in the United States, with over 30,000 confirmed cases and probable cases reported to CDC in 2012. Yellow fever and Rocky Mountain spotted fever are both vector-borne diseases, but are not the most common. Malaria is most prev-alent vector-borne disease worldwide.

Answer 30

ANS: B West Nile virus is carried by a mosquito, which is a vector. Food-borne illnesses are carried by food. Water-borne illnesses are transmitted through water. Zoonoses are infections that are transmitted from vertebrate animal to a human under natural conditions.

Answer 31

ANS: C Transmission of pinworm occurs through the fecal-oral route, so good hand washing after toilet-ing is essential. It is not necessary to treat all children or close the day care. It is necessary that action be taken, as without any action being taken, the pinworm outbreak will continue.

Answer 32

ANS: A Hand washing is the best way to prevent infection. If good hand washing is in place, it is not necessary to isolate patients or implement contact isolation. Prevention is possible with the use of good hand washing.

Answer 33

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Tertiary prevention reduces complications through treatment and rehabilitation. Health care-associated infections are prevented through the use of good hand washing.

Answer 34

ANS: C Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use. Proper specimen collection is necessary so that the clinical diagnosis can be confirmed. It is not necessary for the nurse to know the signs and symptoms for all para-sitic infections in order to provide care for the client. Public policy about parasitic infections is not important to know when providing care for the client.

Answer 35

ANS: A, B, C, D There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them. Application of research is not part of the 10 basic elements of surveillance.

Answer 36

ANS: B This act provides emergency services, services for early intervention and care, and drug reim-bursement programs for HIV-infected individuals.

Answer 37

ANS: B When HIV enters the body, a person may experience a mononucleosis-like syndrome, referred to as a primary infection, which lasts for few weeks. This may go unrecognized. The body’s CD4 white blood cell count drops for a brief time when the virus is most plentiful in the body. The dendrite cells, macrophages, and monocytes are not as severely damaged as the CD4 cells.

Answer 38

ANS: A HIV can be transmitted through exposure to blood. HIV is not transmitted by insect bites, shar-ing of school supplies, or toilets.

Answer 39

ANS: A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents. Eliminating STDs from developed countries, reducing deaths from gonorrhea, and increasing awareness about HIV among lesbian females are not addressed by Healthy People 2020.

Answer 40

ANS: B | HIV can be transmitted through breast milk. HIV is not transmitted by coughing, sneezing, or mosquito bites.

Answer 41

ANS: C The priority role of the nurse should be role model, as nurses must be role models because many HIV-positive patients are stigmatized. The need to be an advocate and policy maker does not address the individual needs of the client. The nurse is able to counsel the client while providing supportive care.

Answer 42

ANS: D It is mandatory to report HIV cases by name in all states, although not all states require viral load and CD4 counts. There are not laws in place that mandate administration of medications, naming of sexual contacts, or referral to case management.

Answer 43

ANS: B HIV infection in infants and children has a shorter incubation period. The physical signs and symptoms in children are different and include failure to thrive, unexplained persistent diarrhea, developmental delays, and bacterial infections such as tuberculosis (TB) and severe pneumonia. Detection is made through different tests in infants of infected mothers than from those who are over 18 months. The effectiveness of antiretroviral therapy in pregnant women and newborns in preventing transmission from mother to fetus or infant has made pediatric HIV rates decline sharply; thus, these children are less likely to contract the virus.

Answer 44

ANS: A The EIA is used to indicate the presence of the antibody to HIV. To minimize false positive re-sults, the Western blot is used as a confirmatory test to verify the results. The EIA does not iso-late the virus, nor does it reveal whether the individual has symptomatic AIDS.

Answer 45

ANS: A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays. Kaposi’s sarcoma and oral candidiasis are common opportunistic diseases later in the disease process. Fatigue is a symptom seen with hepatitis and TB.

Answer 46

ANS: D The most common reportable infectious disease in the United States is chlamydia. Gonorrhea is the second most commonly reported infectious disease. Syphilis and herpes are not among the most common reportable infectious diseases in the United States.

Answer 47

ANS: C | Trichomonas, HIV, and genital warts are caused by viruses. Syphilis is caused by bacteria.

Answer 48

ANS: A Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees. Disclosing a worker’s infection to other workers, terminating employ-ment, and isolating an infected worker are examples of situations that have led to litigation be-tween employees and employers. Thus, the priority will be to protect the employer from litiga-tion.

Answer 49

ANS: A | PID is a common complication of gonorrhea. PID is not a common complication of syphilis, chlamydia, or herpes.

Answer 50

ANS: C A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis. Primary syphilis occurs when the bacteria produce infection in the form of a chancre at the site of entry. Tertiary syphilis usually occurs several years after initial infection and is rare in the United States because the disease is usually cured in its early stages with antibiotics. Congenital syphilis is transmitted transplacentally.

Answer 51

ANS: A Hepatitis A would likely be found where sanitation is inadequate. Hepatitis B and C are spread through blood and body fluids. Hepatitis D can only exist in people who are already infected with Hepatitis B.

Answer 52

ANS: D Those who have been in close contact with persons who develop hepatitis A should receive im-mune globulin. The other groups do not describe populations in direct contact with the person who has hepatitis A.

Answer 53

ANS: C The most chronic blood-borne infection in the United States is hepatitis C. Hepatitis A virus is most commonly transmitted through the fecal-oral route. Sources may be water, food, feces, or sexual contact. The hepatitis B virus (HBV) is spread through blood and body fluids and, like HIV, is a blood-borne pathogen. HIV is transmitted through exposure to blood, semen, trans-planted organs, vaginal secretions, and breast milk. Although hepatitis B and HIV are both blood-borne pathogens neither are the most chronic infection like hepatitis C.

Answer 54

ANS: D Of the new cases, 59% are foreign-born persons living in the United States, with Asians and Hispanics being the most common ethnic groups, representing 30% and 28% of national TB cas-es. The TB rates for African American, Native American, and White American are lower than the Asian and Hispanic populations.

Answer 55

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Screening blood products, organs, and tissues for infection protects the pop-ulation from exposure to hepatitis C, which prevents them from contracting the disease. Second-ary prevention includes screening for diseases to ensure their early identification, treatment, and follow-up with contact to prevent further spread. Tertiary prevention focuses on chronic care and rehabilitation. Health promotion focuses on the primary prevention activities to promote health and prevent disease.

Answer 56

ANS: A It is important that nurses be able to discuss these topics to help prevent and control STDs. Without discussion of these topics, it is possible that clients will not be aware that they have an STD and may transmit it to others. Thus, the transmission of STDs may increase. A trusting rela-tionship with a health care provider may or may not develop and is not dependent on whether these issues are discussed. There are not laws that mandate nurses to discuss sexual behavior and sexual orientation with clients.

Answer 57

ANS: B Using bleach on the needles and syringes is a way to decrease cross-contamination. This is the last-resort option. People who inject drugs are difficult to reach for health care services, so providing them education is important so that they can protect themselves and others as they most likely will not throw away their equipment, or be selective about whom they share their equipment with. Providing needles and syringes does not provide the appropriate education to prevent the spread of disease

Answer 58

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or dis-ability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention focuses on chronic care and rehabilitation. Pri-mary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

Answer 59

ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention refers to those interventions aimed at pre-venting the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

Answer 60

ANS: C Poor adherence has led to antibiotic resistant strains. These clients may care about their health but may have difficulty adhering to the treatment regimen. Medications to treat TB are available to the homeless population. The concern with the antimicrobial treatment is with non-adherence, not with side effects

Answer 61

ANS: A, C, D A person who is infected with HIV should have regular medical evaluations and follow-up ap-pointments; not donate blood or plasma; inform health care providers about the HIV infection; and consider the risk of perinatal transmission and follow-up with contraceptive use.

Answer 62

ANS: A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of disability may not be possi-ble. Health education does not teach about the Healthy People 2020 document or break popula-tions into individuals.

Answer 63

ANS: A Education is the establishment and arrangement of events to facilitate learning. Education em-phasizes the provider’s role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and skills. Education does not necessarily result in change, as change is typically not easy for most people. Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise.

Answer 64

ANS: B Healthy People 2020 focuses on implementing health promotion in priority areas using primary and secondary prevention. Understanding the three learning domains is crucial in providing ef-fective health care. Health fairs targeted at specific populations can provide a venue for provid-ing primary and secondary prevention.

Answer 65

ANS: C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain includes changes in attitudes and the development of values. The psychomotor domain includes the performance of skills that require some degree of neuromuscu-lar coordination and emphasizes motor skills. Memorization of skills is only one part of the cogni-tive domain.

Answer 66

ANS: D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the necessary requirements of the learner.

Answer 67

ANS: B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. The cognitive domain includes memory, recognition, un-derstanding, reasoning, and problem solving. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning.

Answer 68

ANS: D The psychomotor domain includes the performance of tasks that require some degree of neuro-muscular coordination and emphasizes motor skills. Developmental domain is not one of the do-mains of learning. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain is used to attempt to influence what individuals, fam-ilies, communities, and populations feel, think, and value.

Answer 69

ANS: A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is “Tune in”: listen be-fore starting to teach; the client’s needs should direct the content. Thus, this should be done be-fore the nurse does any demonstration, showing of audiovisual resources, or return demonstra-tion.

Answer 70

ANS: B Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the educational process are: (1) identifying educational needs, (2) establishing educa-tional goals and objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5) evaluating the educational process.

Answer 71

ANS: B Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time. The other choices describe objectives.

Answer 72

ANS: A Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms. The objective “each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecu-tive trials” contains the components of a written objective. “The client will perform a blood sugar test on herself with an accurate blood sugar reading” does not provide any measureable terms. “The community will take their children to receive immunizations within 1 month of the immun-ization due date” does not provide a measurable percentage of the members of the community. “Fifty percent of the eligible women seen in the clinic will return for their scheduled mammo-gram appointment” focuses on a long-term goal, rather than a short-term objective and does not provide a time frame for when this would be measured.

Answer 73

ANS: D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. Planning is similar to selecting appropriate educational methods.

Answer 74

ANS: A Demonstration also includes return demonstration. Giving injections can best be learned by see-ing the behavior being done. Health fairs target specific populations and are held in a variety of locations. Non-native language sessions are a way to adapt the health fair to a population that does not speak English. Lecture is a non-interactive method of teaching.

Answer 75

ANS: C Gaining the learner’s attention must happen first before learning can take place. The following steps of implementation include telling the learners the objectives of the instruction, asking learn-ers to recall previous knowledge, presenting the essential materials, helping the learners apply the information, encouraging learning to demonstrate what they have learned, and providing feed-back to help learners improve their knowledge and skills.

Answer 76

ANS: C The environment must be conducive to learning for educational programs to be effective. The environment should be free of distractions and consistent with the message. The other strategies may assist with the educational program, but are not one of the major educational principles dis-cussed in the textbook.

Answer 77

ANS: A The educator should have the learners recall previous knowledge related to the topic of interest. The principle of gaining attention should have been applied as the program started the week be-fore. Recall should be done before new material is presented and before learning guidance is pro-vided.

Answer 78

ANS: A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned. Gaining attention occurs at the beginning of the program. Assessing performance occurs at the end of the program. Enhancing retention and transfer of knowledge occurs as the learners are asked to apply the information to their lives and situations (not to the care of the dolls).

Answer 79

ANS: D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners. In pedagogy the teacher assumes full responsibility for making decisions about what will be learned, and how and when it will be learned. In authoritarianism the leader controls group movement and progress through interpersonal power. Learning style refers to how some-one learns best.

Answer 80

ANS: D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information. Clients with low literacy levels and limited vocabularies are considered to be a learner-related barrier, not a barrier of the educator. Memorizing the information to teach may cause problems with the presentation but would not be a barrier for the educator.

Answer 81

ANS: B Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may focus on details and deal in literal or concrete concepts versus abstract concepts. They may select responses on a survey without necessarily understanding them and may be unable to understand math. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home. The level of anxiety may vary among these individuals; it is more common for these in-dividuals to request to read it later.

Answer 82

ANS: A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated. The Internet has reliable infor-mation, but the quality of the information must be assessed. Pharmaceutical websites may have biased information. Physicians are another source of information, but this may or may not be better than what is found on the Internet.

Answer 83

ANS: C Process evaluation means looking at the components of an educational program. The educational product is the outcome of the educational process. Short-term evaluation evaluates the immediate effects of a health program. Long-term evaluation is geared toward following and assessing the status of an individual, family, community, or population over time.

Answer 84

ANS: C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members. A group with several leaders may have difficulty obtaining co-hesion if each of the leaders has a different idea. Common attitudes and values among the group members will be important for the group to obtain cohesion. Efficiency does not play a role in developing cohesion.

Answer 85

ANS: D Group norms serve to maintain the group through various supports to members. They are the standards that guide, control, and regulate individuals and communities. They suggest what a group believes is important, what it finds acceptable or objectionable, or what it perceives as of no consequence. Group norms may limit the creativity and variety among the group members. Members’ perception of the community could be influenced by group norms, but this is not why this consideration should be made when planning community health education. Group norms are not used to evaluate the effectiveness of the group.

Answer 86

ANS: C The gatekeeper controls outsiders’ access to the group. The follower seeks and accepts the au-thority or direction of others. The leader guides and directs group activity. The task specialist focuses or directs movement toward the main work of the group.

Answer 87

ANS: A Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points.

Answer 88

ANS: B Patriarchal is authoritative, whereas one may control members through rewards and threats. Pa-ternal leaders win respect and dependence through parent-like devotion. Democratic leadership is cooperative in nature and promotes and supports members’ involvement in all aspects of decision making and planning. Socialist leadership supports community ownership and involvement of the community.

Answer 89

ANS: D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful. An established group would have a stable group membership. Learning occurs better in all groups with demonstrations instead of lectures. In an established group, they may be together because of a common interest, but may not share all of the same interests.

Answer 90

ANS: C Maintaining members is an important intervention to facilitate group process. The topics that are taught should be of importance to the group. The group should be part of the decision-making process. The membership of the group should be maintained, inviting new members to the group may hinder the processes of the group.

Answer 91

ANS: A Soliciting input from individuals and organizations is a communication competency. Various strategies should be used to present the information. The group should assist in determining the topic, but not developing the program. The material should be presented to professional and lay audiences.

Answer 92

ANS: B Recognition of accomplishments in the group and of the group is built into the evaluative pro-cess. The type of teaching strategies used, types of leadership, and conflict are not part of the evaluative process of the group.

Answer 93

ANS: A, B, D Using a clear, succinct style, active voice, and using aids to highlight key points are all basic ed-ucational principles that should be used by the nurse. Reliable sources must be used, and infor-mation found on the Internet is not always reliable. Repeating information is not an education principle.

Answer 94

ANS: A Modifiable behaviors remain the major contributors to deaths in the United States. Tobacco use, poor diet, physical inactivity, and alcohol consumption are examples of modifiable behaviors. Cancer, emphysema, cardiovascular disease, gender, age, and genetic abnormalities are not modifiable behaviors.

Answer 95

ANS: D A disease-oriented approach assumes that humans are composed of organ systems and cells; in this instance, health care focuses on identifying what is not working properly with a given system and repairing it. In this context, health behavior begins with patient compliance with health professionals’ recommendations. This approach does not promote a greater level of positive health as this would be related to health promotion. This approach does not provide education about common disease processes or acute care management of chronic disease.

Answer 96

ANS: B The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced

Answer 97

ANS: C The health-oriented perspective includes the view that humans are complex and interconnected with others and the environment. Health behavior within this perspective involves a holistic view of lifestyle and interaction with the environment and not simply compliance with a prescribed regimen.

Answer 98

ANS: C The client system is multidimensional with nursing and health care targeting the multiple levels of clients. When the individual is the client, the environment includes the family, the broader aggregate, and the community of which the individual is a part. The nurse and health care provider are concerned with how these environments affect the individuals’ health. The focus for care is on health promotion, illness prevention, and illness care.

Answer 99

ANS: A Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people. The community is the environment for the aggregate and is the system being applied.

Answer 100

ANS: A Each succeeding level of the client system is more complex. In this situation, the PHN is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education. Illness prevention is linked to the negative view of the absence of disease. Illness care is the care provision of someone with the disease.

Answer 101

ANS: B The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention. Health promotion focuses on positive measures of health. The family level and aggregate level both focus on inclusion of more than one person.

Answer 102

ANS: D The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions. This is the broadest client system as the nurse is examining the neighborhood. Individual focus is looking at individuals, family focuses on families, and aggregates focuses on populations.

Answer 103

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Health promotion activities are interventions focused on improving one’s health.

Answer 104

ANS: B Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease.

Answer 105

ANS: C Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health protection strategies include environmental measures to improve health and quality of life.

Answer 106

ANS: B The woman is exercising to prevent an illness that runs in her family. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of

Answer 107

ANS: A The woman is exercising to improve and promote her health. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of life.

Answer 108

ANS: D Health protection strategies include environmental measures to improve health and quality of life. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards.

Answer 109

ANS: D Genes, biology, and health behavioral choices account for 25% of population health and social determinants of health, including medical care; the physical and social environment account for the remaining 75%.

Answer 110

ANS: A The National Prevention Strategy offers recommendations on what can be done to improve population health in specified contexts and across goal areas. This document does not assist in interpreting Healthy People 2020, providing a basis for public health nursing practice, or providing health risk appraisal instruments.

Answer 111

ANS: C It can assist with planning programs to increase an individual’s motivation to take positive health action. This theory was one of the first theories of health behavior, which began in the 1950s. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. There is nothing to support that the use of this model will reduce the incidence of diseases and disabilities. It focuses on motivation of changing health behaviors, not participating in screening programs.

Answer 112

ANS: B The HBM can assist with planning programs to increase an individual’s motivation to take positive health action. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. Conducting a group risk appraisal and risk reduction, completing a community wellness inventory, and considering legislative changes do not address an individual’s motivation to adopt a health behavior.

Answer 113

ANS: B A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it. This model does not address the resources available to promote health, physical environment, or demographics.

Answer 114

ANS: C The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. By collecting periodic health assessments and morbidity and mortality data, major risk factors associated with CHD mortality were identified. The investigators used health risk appraisals to relate the risk factors in well individuals to the probability of future cardiovascular disease. This study did not provide information on the effectiveness of risk-reduction interventions, document the relationship between social variables and heart disease, or identify factors contributing to the development of heart disease.

Answer 115

ANS: A, B Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community.

Answer 116

ANS: B, C, D, E The Stanford Five-City Heart Disease Prevention Program, North Karelia Study, Minnesota Heart Health Program, and Dutch Heart Health Community Intervention provided beginning scientific evidence for the implementation of community-level risk reduction programs, although the results were modest and often not statistically significant. The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure.

Answer 117

ANS: D An intentional release of viruses, bacteria, or other toxins would be described as biological terror-ism. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terror-ism.

Answer 118

ANS: B Powers of local government include surveillance of unusual clusters of illness. A health depart-ment does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

Answer 119

ANS: A One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

Answer 120

ANS: B Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to erad-icate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

Answer 121

ANS: C Hospital surveillance is used to improve quality of care and outcomes. An example is an infection that occurs in patients who had procedures at that facility. Reduction of the incidence of venti-lator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

Answer 122

ANS: D Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

Answer 123

ANS: C Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligi-ble population vaccinated against influenza in any 1 year.

Answer 124

ANS: B In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occur-ring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

Answer 125

ANS: A In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indi-cators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

Answer 126

ANS: A Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collab-oration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

Answer 127

ANS: C Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO.

Answer 128

ANS: B The first step in this model considers whether the surveillance was appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model.

Answer 129

ANS: C After data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the im-pact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.

Answer 130

ANS: D Each case has a unique set of criteria based on what is known about the particular disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.

Answer 131

ANS: A The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.

Answer 132

ANS: A A suspected case is a clinically compatible case of illness without isolation. A confirmed case is a clinically compatible case that is laboratory confirmed by isolation. A prolonged case and identi-fied case are not types of cases discussed in the text.

Answer 133

ANS: B A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. Holoendemic implies a highly prevalent problem found in a population commonly ac-quired early in life.

Answer 134

ANS: B Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or probable death.

Answer 135

ANS: D There are many sources of morbidity data (rate of disease incidence), including specialized dis-ease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.

Answer 136

ANS: C A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures re-lated to person-to-person contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incuba-tion period

Answer 137

ANS: D Unusual illness in a population should trigger an investigation that may signal a covert bioterror-ism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.

Answer 138

ANS: A, B, C Estimating the magnitude of the problem, determining geographic distribution of an illness, and detecting epidemics are all uses of public surveillance. Reduction of the prevalence of obesity and determining the incidence of cardiovascular disease are not how public health surveillance is used.

Answer 139

ANS: A, B, C, D The staff nurse must have analytic assessment skills, communication skills, and community di-mensions of practice to be a participant in surveillance and investigation. The ability to interpret laboratory findings is not a core competency.

Answer 140

ANS: B, C, D The objectives of an investigation are to control and prevent disease or death, identify factors that contribute to the disease outbreak/event occurrence, and implement measures to prevent oc-currences. Enhancing the knowledge of the nurse working in public health and participating in the core functions of public health are not objectives of an investigation.

Answer 141

ANS: D The meaning of poverty differs across cultures. Western cultures view poverty negatively, whereas other cultures often respect the poor.

Answer 142

ANS: C Mentally ill individuals were considered undeserving poor and did not receive any community assistance. Widowed women, orphaned children, and injured laborers were deserving poor because their poverty was considered to be beyond their control.

Answer 143

ANS: D The Elizabethan Poor Laws began in seventeenth-century England by helping the poor receive help within the boundaries of their original community. Needy travelers would not be helped and were sent back to their original community where they would be helped by their own folk. It was no disgrace to live in poverty because nearly everyone was poor.

Answer 144

ANS: B Understanding the concept of poverty with historical, social, political, economic, biological, psychological, and spiritual dimensions is the first step in providing effective care to this population. It is not necessary to move to the area, take a trip abroad, or become immersed in the concept of poverty in order to provide effective nursing care to this population

Answer 145

ANS: A Fears and misconceptions of nurses related to poverty is a barrier that may prevent nurses from fully engaging in relationships with people who come from different socioeconomic and cultural backgrounds. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.

Answer 146

ANS: B By calling the client by name, nurses can then begin the process of breaking down barriers of fear, isolation, uncertainty, and the unknown. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.

Answer 147

ANS: C Nurses’ behaviors in situations are influenced by their relationship with clients. It is important to evaluate clients and populations in the context of the environment to develop nursing interventions. Reading a book is not adequate. Setting up a homeless shelter or having a client ask for money does not force the nurse to self-reflect as much as when the nurse is in the client’s environment.

Answer 148

ANS: B Changes in the labor force affect the growing number of poor persons in the United States. Decreased company earnings, decreased access to education and job skills, and inadequate welfare benefits also influence the growing number of poor persons.

Answer 149

ANS: B The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants. Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.

Answer 150

ANS: B Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants. The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.

Answer 151

ANS: A Federal income guidelines are used primarily to determine financial eligibility for government assistance programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The federal income guidelines do not identify those with inadequate resources for basic needs or provide guidelines for reform of social programs.

Answer 152

ANS: C The Federal Income Poverty Guideline is issued by the U.S. Department of Health and Human Services and is used to determine if a person or family is financially eligible for assistance or services from various federal programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The CPI is a measure of the average change over time in the prices paid by households for a fixed market basket of consumer goods and services. TANF is a program, not a guideline, that assists families in need.

Answer 153

ANS: A In 2012, 21.6% of those 18 years or less were living in poverty. Poverty is highest among children, and in 2012, it was 21.8% higher than any other age group.

Answer 154

ANS: C Not only do persons living in poverty have higher rates of chronic illness, but less access to care. They have a shorter life expectancy, more complex health problems, and hospitalization rates greater than those for persons with higher incomes.

Answer 155

ANS: C TANF requires participants to find jobs and/or enroll in job training programs. The current TANF program was formerly called AFDC. Medicaid provides health insurance to poor families, but does not require participants to find jobs. WIC provides food vouchers entitling participants to free nutritious foods and infant formulas from local grocers, but does not require participants to find jobs.

Answer 156

ANS: B Poor neighborhoods are more likely to have exposure to environmental hazards. Lower socioeconomic neighborhoods have been linked with poorer general health status, chronic conditions, mortality, birth outcomes, disability, injury and violence, and other health indicators. They are more likely to have higher rates of crime and poorer access to health care services.

Answer 157

ANS: A Episodic homelessness is a characteristic of crisis poverty. Physical disability, mental disability, and drug abuse would be considered in persistent poverty.

Answer 158

ANS: A Those who are in persistent poverty typically are older, with physical and mental disabilities, alcohol and other drug abuse, severe mental illness, chronic health problems, and significant family difficulties. Transient homeless persons, victims of domestic violence, and persons with temporary housing would be considered in crisis poverty.

Answer 159

ANS: B When urban housing is upgraded, the supply of low-income housing drops. It is often said that when neighborhoods were “gentrified” or upgraded, they reduced the ability of the poor people to live in them because they became unaffordable for poorer former residents. Homeless can be found in both rural and urban areas. Deinstitutionalization of the chronically mentally ill individuals from public psychiatric hospitals in the 1980s increased the number of homeless persons. After this happened, federal and state governments failed to allocate the needed funds to provide community-based services.

Answer 160

ANS: C Emergency housing is shelter for persons who are already homeless. These shelters typically are only open at night and in many cities only on extremely cold nights.

Answer 161

ANS: B The original goal was to replace large psychiatric hospitals with community-based treatments centers. However, federal and state governments failed to allocate the needed funds.

Answer 162

ANS: C Intended and unintended injuries such as traumas are a significant cause of morbidity and mortality in the homeless. Those who are homeless are at greater risk for peripheral vascular disease and hypertension. Because of their poor living conditions, a minor skin injury or infections left untreated can result in widespread infection.

Answer 163

ANS: C Offering effective job training programs is an example of primary prevention—attempting to prevent the problem before it occurs. Emergency housing is secondary prevention. Drug and alcohol treatment and comprehensive case management are tertiary preventions.

Answer 164

ANS: D Secondary preventive services target persons on the verge of homelessness as well as those who are newly homeless. An example of secondary prevention is a soup kitchen. Employer incentives and safe sex education are primary prevention strategies; comprehensive case management is a tertiary prevention strategy.

Answer 165

ANS: B To implement effective nursing interventions for homeless clients, nurses need to be aware of their own beliefs and values about the homeless as well as understand the concepts of homelessness.

Answer 166

ANS: D Establishing a needle exchange program could be considered both primary (preventing a problem before it occurs by helping clients avoid disease transmission) and tertiary (working with a population who already has a “problem” of drug abuse). Providing emergency shelter housing and offering physical and mental health services are both secondary and tertiary prevention interventions. Developing a targeted case management program is secondary prevention.

Answer 167

ANS: A, B, C, D The media is a powerful influence on how people view poverty. Media images of persons who are poor influence and are influenced by cultural attitudes and values. Poor persons may be cast in negative ways by the media, which influences what we believe to be true about poor persons

Answer 168

ANS: B, C, D Those who are homeless are hard to find since they may sleep in boxcars, on building roofs, in doorways, or under freeways or pedestrian overpasses; temporarily stay with friends or family; refuse to be interviewed or deliberately hide the fact that they are homeless; have only short or intermittent episodes of being without a home; or may not fit in a general category.

Answer 169

ANS: B The majority of migrant farm workers are foreign-born (72%) and predominantly Mexican (68%). Estimates suggest there are approximately 1.0 to 1.8 million hired farmworkers. Five states account for 65% of all farm workers: (1) California, (2) Florida, (3) Washington, (4) Oregon, and (5) North Carolina. Of the migrant and seasonal farmworkers, 52% have legal authorization to work in the United States.

Answer 170

ANS: D Availability and affordability of food in the United States depends on these individuals, yet their economic and social status has not changed significantly over the past decades. Most migrant workers do not seek out health care services.

Answer 171

ANS: B A migrant farm worker is a laborer whose principal employment is in agriculture on a seasonal basis and, for the purposes of such employment, establishes a temporary abode. A seasonal farmworker returns to his permanent residence, works in agriculture for at least 25 days or parts of days, and does not work year round only in agriculture. A transient worker moves from place to place to find work. A share cropper is a tenant farmer who uses part of the crop to pay for rent.

Answer 172

ANS: A Migrant workers traditionally have followed one of three migratory streams: (1) Eastern, originating in Florida; (2) Midwestern, originating in Texas; and (3) Western, originating in California.

Answer 173

ANS: A Accurate morbidity and mortality data are difficult to obtain due to farm workers leaving when no longer working, going back to their home to receive medical services, and decreases in infectious diseases that are easier to record.

Answer 174

ANS: A | Farm workers of all ages consistently have more dental disease than the general population.

Answer 175

ANS: D Cancer is an identified but not well-documented health problem for migrant farm workers associated with their exposure to chemicals. Other identified health risks are musculoskeletal injuries, traumatic injuries, respiratory problems, dermatitis, infectious diseases, and eye problems.

Answer 176

ANS: C Alcohol can contribute to farm-related injuries. Drug and alcohol use has been identified as a significant source of stress. Alcohol can also contribute to health problems, greater risk for human immunodeficiency virus (HIV), violence in camps/home sites, domestic violence, and decreased funds for personal and family needs.

Answer 177

ANS: B Because of isolation, migrant farm workers lack usual sources of information regarding available services. Migrant workers typically are unable to afford health care, have limited services available, and may not have adequate transportation to get to health care services.

Answer 178

ANS: B Clinics are usually a great distance from work and offer health services only during work hours. Health records do not typically follow the client.

Answer 179

ANS: A Memory loss is a symptom that is displayed following an acute exposure to a pesticide. Musculoskeletal problems, cancer, and infertility are from chronic exposure.

Answer 180

ANS: A Chronic exposure to pesticides may lead to cancer. Acute exposure to pesticides may cause memory loss, skin rashes, and headaches.

Answer 181

ANS: C Occupational health risks for migrant farm workers include working conditions, exposure to chemicals, and using machinery. Denial of care and difficulty obtaining health insurance are not occupational health risks. Episodic violence from farm owners is not a known occupational health risk.

Answer 182

ANS: C The Welfare reform legislation of 1996 changed the availability of federal services accessible to certain immigrants in the United States. The Migrant Health Act provides funds for primary and supplemental health services to migrant workers and their families. Because of the welfare reform legislation of 1996, many legal immigrants and unauthorized immigrants are ineligible for services such as SSI and food stamps.

Answer 183

ANS: D The primary level of prevention often includes education for the prevention of diseases, measures to reduce pesticide exposure, and immunizations. Caring for persons afflicted with pesticide exposure, setting up clinics for persons with HIV, and doing research in the field related to heat stress are examples of tertiary prevention.

Answer 184

ANS: D Reduction of pesticide exposure is an example of primary prevention. Urine screening and TB skin testing are secondary prevention, and treatment of lead poisoning is tertiary prevention.

Answer 185

ANS: A Monitoring for prenatal care is an example of a secondary prevention strategy. Treatment for anemia is tertiary prevention, and HIV prevention and tetanus immunization are primary prevention strategies.

Answer 186

ANS: B Rehabilitation for musculoskeletal injury is an example of tertiary prevention. Diabetes screening and pregnancy testing are secondary prevention strategies, and birth control is a primary prevention.

Answer 187

ANS: A There are four common folk illnesses that a nurse may encounter with the Mexican client: (1) mal de ojo (evil eye), (2) susto (fright), (3) empacho (indigestion), and (4) caida de mollera (fallen fontanel). When faced with one of these illnesses, the traditional Mexican individual would prefer to seek care with a folk healer. Healers known as curanderos, herbalistas, and espiritualistas are often sources of health care for folk illnesses.

Answer 188

ANS: A Simpatía means having polite, non-confrontational relationships with others. Respeto means respect, dignidad means dignity, and personalismo is relating to the individual.

Answer 189

ANS: B Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Physician assistants and nurse aides do not serve in this lay person role in the community.

Answer 190

ANS: A | The male is considered to be the major decision maker in the family, whereas the female is considered the caretaker.

Answer 191

ANS: D It would be incorrect to assume that all Mexicans have the same cultural beliefs. The nurse must remember that beliefs and practices differ between regions and localities of a country, and among individuals. Mexico is a multicultural country; therefore, the cultural backgrounds of Mexican immigrants vary depending on their place of origin.

Answer 192

ANS: A HAC is a nonprofit organization whose mission is to improve affordable housing in rural areas. TANF is a program that assists families in need. The local housing authority provides public housing assistance. Public Housing Development for Families promotes the development of local strategies for affordable public housing.

Answer 193

ANS: C Political advocacy can include educating communities about these individuals. This education helps to provide legislators and policy makers at local, state, and national levels with the information needed to make policy decisions

Answer 194

ANS: A, B, C, D Leaving one’s home every year, traveling, experiencing uncertainty regarding work and housing, and lack of resources are some of the challenges of the migrant lifestyle. The specifics for payment differ depending on the location and type of work. Reports of average income for farmworkers have varied.