Exam 4 Flashcards
What is the cause of teen pregnancy?
a. Changing moral attitudes
b. Sexual code
c. Economic circumstances
d. No uniform reason
ANS: D
There is no uniform cause of teen pregnancy. The causes of teen pregnancy are diverse and affected by changing moral attitudes, sexual codes, and economic circumstances.
According to the 2013 Youth Risk Behavior Surveillance System, fewer teens reported engaging in which behavior?
a. Riding in a car with a driver who had been drinking
b. Current alcohol usage
c. Trying marijuana
d. Episodic heavy drinking
ANS: A
Fewer teens reported binge drinking or riding in a car with a driver who had been drinking. However, these and other significant risk behaviors continued at high rates. Current alcohol use, trying marijuana, and episodic heavy drinking still continue at high rates in teens.
Which statement best illustrates that the main causes of teen mortality are high-risk behaviors?
a. Teenagers generally leave home before they are mature enough.
b. Teenagers often engage in activities that put them at risk for life-threatening diseases.
c. Teenagers are prone to developing chronic diseases that lead to disability early in life.
d. Teenagers want to get pregnant at an early age to be able to enjoy life later on.
ANS: B
Teenagers are often engaged in activities that put them at risk for life-threatening diseases. For example, the human immunodeficiency virus (HIV) infection and newly identified sexually transmitted diseases are prevalent in teenagers.
A high school-aged teen tells the school nurse that she wants to become pregnant. Which of the following would be the appropriate action for the nurse to take?
a. Ignore the comment
b. Tell the teen that she should not engage in sexual activity or get pregnant
c. Call the teen’s parents
d. Provide preconceptual counseling and emphasize the need to achieve good health
ANS: D
Providing preconceptual counseling and emphasizing the need to achieve good health demonstrates that the nurse has heard what the teen is saying. This provides useful information that may encourage the teen to examine her plans carefully, seriously, and maturely.
Many teenagers who give birth:
a. are from middle-class families.
b. are honor students.
c. planned to get pregnant.
d. see few advantages in delaying pregnancy.
ANS: D
Many teenagers who give birth see few advantages in delaying pregnancy. Many times these teenagers are poor and have limited educational achievements; they do not expect that their circumstances will improve at a later time. Most teens report that their pregnancy was unplanned.
Which factor has been linked to the decrease in pregnancies among teens?
a. Fewer are becoming sexually active
b. More are using complementary alternative methods of birth control
c. More have tighter parental control at home
d. Fewer are engaging in risky behaviors
ANS: A
The decrease in pregnancies among teens has been attributed to stabilization of the numbers of teens becoming sexually active, increased condom use, and increased use of more effective and long-acting hormonal methods of birth control.
A parent has requested access to his child’s medical records at a school-based health clinic. Which of the following statements about access and release of a minor’s medical record is correct?
a. Reproductive information is protected by the Health Insurance Portability and Accounting Act (HIPAA).
b. A minor cannot get birth control without parental consent.
c. Medical records are available to anyone who wishes to access them.
d. Parents can legally access all medical records of a minor child.
ANS: D
In many states, parents can legally access all medical records of their minor children, which limits the confidentiality assurances offered to a teen seeking reproductive health care. The HIPAA Privacy Rule established that if a minor consented to care, then only that individual could access and release those medical records. However, the Privacy Rule also deferred to existing state law.
A teenage mother discusses with the school nurse the possibility of having a second child. Which of the following risk factors would place this client at risk for having a second pregnancy?
a. Remaining in school
b. Reporting an unplanned first pregnancy
c. Being from a small family
d. Having a disadvantaged background
ANS: D
Having a disadvantaged background is a risk factor for a second teen pregnancy. Other risk factors include lower educational and cognitive ability, mental health issues, physical trauma, losses (such as death of a loved one), and substance use.
A nurse is providing information about parental consent to an adolescent client who is seeking an abortion. Which of the following information would be accurate?
a. Parental consent must be given to the abortion provider.
b. Parents must be notified by the abortion provider before the abortion is performed.
c. The adolescent’s right to privacy and ability to give consent varies by state.
d. Federal protection of the adolescent’s right to privacy makes consent unnecessary.
ANS: C
For an adolescent female seeking abortion, her right to privacy and ability to give consent vary by state. No federal protection is extended to adolescents requesting abortion services
Which factor increases a young woman’s risk for early sexual experiences and pregnancy?
a. History of sexual abuse
b. Parents who have high demands for their children to act maturely
c. Parents who communicate openly with their teens about birth control and sexuality
d. Male partner of the same age
ANS: A
Having a history of sexual abuse increases a young woman’s risk for early sexual experiences and pregnancy. Parental higher education, family communication, and good family health practices have been associated with decreased sexual risk behaviors. Parents who are extremely demanding and controlling or neglectful and who have low expectations are least successful in instilling parental values in their children. Parents who have high demands for their children to act maturely and who offer warmth and understanding with parental rules have children more likely to exhibit appropriate social behavior and to delay early sexual experiences and pregnancy.
A nurse is providing education to teenagers about prevention of unintended pregnancy. Which of the following principles should the nurse understand as to why some of these teenagers may get pregnant?
a. They often feel invincible and do not recognize risks related to their behaviors.
b. They enjoy engaging in sexual activity and want children.
c. They influence each other and succumb to peer pressure.
d. They have realistic attitudes about school, work, parenting, and socializing.
ANS: A
Teens often feel invincible, and they do not think about the negative outcomes they are advised could come true. Many teens believe that they are unique and different and that everything will work out fine. Teenagers often express the unrealistic attitude that they can do it all. Most pregnancies are unintended.
A young man has just learned that his partner is pregnant. Which of the following statements regarding his reaction to the pregnancy is true?
a. His reaction often depends on the nature of the relationship before the pregnancy.
b. Most young men believe that fathering a child can make them feel manly.
c. Most young men are not interested in their partner’s pregnancy.
d. His reaction often includes blaming the partner.
ANS: A
Young men’s reaction to their partner being pregnant often depends on the nature of the relationship before the pregnancy. A large percentage of young men will continue to accompany the young woman to some prenatal visits and may even attend the delivery. It is not usual for a young man to be excluded or even rejected by the young woman’s family (usually her mother).
A nurse is providing adoption counseling to pregnant teenagers. Which of the following is an important concept for the nurse to keep in mind?
a. Have the father present as well during the counseling session.
b. When speaking of adoption, use the words “giving the child away.”
c. Describe the details of raising a child in order to influence adoption decisions.
d. Do not impose opinions on the decision-making process of teen mothers.
ANS: D
Nurses must keep in mind that they should avoid imposing opinions on the decision- making process of teen mothers. The nurse should also assess the relationship between the pregnant teen and her partner and what role she expects him to play. Sensitive language should be used—avoid saying “giving away a child” or “putting up for adoption.”
A nurse is counseling a pregnant adolescent about her nutritional needs during pregnancy. Which of the following should the nurse use as the basis for providing the client information about nutritional needs?
a. Chronologic age
b. Gynecologic age
c. Age at menarche
d. Blood protein levels
ANS: B
Nutritional needs are based upon gynecologic age, the number of years between chronologic age, and age at menarche.
A nurse is assessing a pregnant teen’s weight gain. Which of the following would be the appropriate nursing intervention to implement?
a. Advise the teen to pay close attention to weight gain
b. Encourage the teen to gain as much weight as possible
c. Recommend weight gain based on prepregnancy weight
d. Instruct about the benefits to the fetus by gaining 2 pounds per week
ANS: C
The weight gain recommendations for the pregnant adolescent are based on the teen’s prepregnancy weight. Teenagers who begin the pregnancy at a normal weight should be counseled to begin weight gain in the first trimester and to average gains of 1 pound per week for the second and third trimesters.
A nurse is counseling an adolescent female about prevention of iron deficiency anemia. Which of the following would be the most appropriate nursing intervention?
a. Provide information about appropriate weight gain during puberty
b. Educate about consuming foods containing vitamin C
c. Instruct on drinking at least eight glasses of water each day
d. Emphasize the need to follow up with a dietician
ANS: B
Iron deficiency anemia is the most common nutritional problem among both pregnant and nonpregnant adolescent females. The nurse should educate about iron-rich foods and foods that promote iron absorption, such as those containing vitamin C. Proper hydration and weight gain do not help prevent iron deficiency anemia. Following up with a dietician is not necessary as the nurse discusses prevention of anemia.
The nurse plans a home visit to a pregnant teen to discuss proper prenatal nutrition. Which of the following best describes a demonstrated outcome of this nursing intervention?
a. Increase in birth weight and utilization of prenatal care and support services
b. Increase in family coping skills to prevent crisis
c. Coordinated and comprehensive teen pregnancy approach
d. Family approach to health care
ANS: A
An increase in birth weight and utilization of prenatal care and support services is a demonstrated outcome of a nurse planning a home visit to a pregnant teen. Home visits may not lead to an increase in family coping skills to prevent crisis, a coordinated and comprehensive approach, or a family approach to health care.
A nurse is teaching a pregnant teenager about the risks of contracting a sexually transmitted infection. Which of the following statements would the nurse most likely make?
a. Transmission of sexually transmitted infections is unlikely when you are pregnant.
b. Contracting a sexually transmitted infection may cause your infant to require assistance immediately after birth.
c. Sexually transmitted infections can cause premature labor.
d. The father of the baby is at high risk to contract a sexually transmitted infection.
ANS: C
When a young woman is pregnant, sexually transmitted infections can cause premature rupture of membranes, premature labor, and postpartum infection. Periodic screening during pregnancy should be done. Transmission of sexually transmitted infections can occur during pregnancy. There is no indication that transmission will cause a need for the infant to require immediate assistance following birth. Transmission of a sexually transmitted infection to the father is dependent on the father’s sexual activity.
A nurse is implementing an intervention at the primary level of prevention related to teen pregnancy. Which of the following would be most appropriate for the nurse to implement?
a. Teach well-baby classes to new mothers
b. Teach young people about sexual practices that will prevent untimely pregnancy
c. Provide services for pregnancy detection
d. Counsel a young couple about abortion and adoption
ANS: B
Education often occurs at the primary level of prevention. The primary level of prevention focuses on preventing a problem before it occurs. Teaching well-baby classes to new mothers focuses on tertiary prevention as the teen pregnancy has already occurred. Providing services for pregnancy detection is secondary prevention. Counseling a young couple about abortion and adoption is tertiary prevention.
What are reasons that adolescents may not seek care for health problems? (Select all that apply.)
a. Access to care may be hindered because there are not enough professionals with expertise in dealing with the teen population.
b. Cost of care or availability of insurance may limit services.
c. Teenagers do not care about their health.
d. Health care professionals may not be able to discuss sensitive topics in a non-judgmental way.
e. Parents are unaware of the services available for adolescents.
ANS: A, B, D
Adolescents may not seek care because their access to care is hindered by either lack of professionals or costs of the care; they may fear that health care professionals will not be able to discuss sensitive topics with them in a non-judgmental way. Although health may not be a top priority, it shouldn’t be assumed that teenagers do not care about it. Most likely, parents are aware of the services available for adolescents but may not be able to access these services for a variety of reasons.
A nurse is working with adolescent clients. Which of the following describes therapeutic approaches that would be appropriate for the nurse to use when working with this population? (Select all that apply.)
a. Creating a caring and understanding atmosphere
b. Using neutral words in eliciting symptoms
c. Insisting that teens use appropriate terminology when expressing their concerns
d. Paying attention to what the teen verbalizes and fails to verbalize
e. Encouraging the teen to talk to the school guidance counselor about problems
ANS: A, B, D
Creating a caring and understanding atmosphere, using neutral words to elicit symptoms, and paying attention to what the teen verbalizes and fails to verbalize are appropriate therapeutic approaches. The nurse can offer more appropriate terms for the client to use once trust is established. The nurse should listen to the teen first before referring the client to someone else.
Which objective related to adolescent health is discussed in Healthy People 2020? (Select all that apply.)
a. Increasing the age of legal consumption of alcohol to 25
b. Increasing the number of planned pregnancies
c. Increasing the proportion of teens who receive formal instruction on reproductive health issues
d. Increasing the proportion of teens who consistently use some form of birth control
e. Increasing the number of teens who are employed
ANS: C, D
Healthy People 2020 goals are to increase the proportion of 15 to 19 year olds who use condoms and hormonal contraceptives and increase the proportion of teens who receive reproductive health information through formal instruction as well as from their parents or guardians.
Why must nurses examine their attitudes about alcohol, tobacco, and other drug (ATOD) abuse and addiction before working with individuals with this health problem?
a. Working with clients who have addiction problems often puts the nurse at risk for violence.
b. The population of persons with drug and alcohol addiction is found in low-income neighborhoods.
c. To be therapeutic, a nurse must develop a trusting nonjudgmental relationship with clients.
d. Nurses are the primary persons who treat addiction problems.
ANS: C
To be therapeutic, the nurse must develop a trusting, nonjudgmental relationship with clients. Therefore, nurses must examine their own attitudes ahead of time. Working with clients who have addiction problems does not put the nurse at risk for violence. People with drug and alcohol addiction can be found in any neighborhood. Nurses do not treat addiction problems.
Which health problem causes more deaths, illnesses, and disabilities than any other in the United States?
a. Tobacco addiction
b. Alcohol abuse
c. Substance abuse
d. Caffeine addiction
ANS: C
Substance abuse is the number one national health problem, causing more deaths, illnesses, and disabilities than any other health condition. Tobacco addiction, caffeine addiction, and alcohol abuse are part of substance abuse.
The use of any substance that threatens a person’s health or impairs his or her social or economic functioning is:
a. drug dependence.
b. substance abuse.
c. drug addiction.
d. illegal.
ANS: B
Substance abuse is the use of any substance that threatens a person’s health or impairs his or her social or economic functioning. Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed. Illegal means that it is against the law, not all substances are illegal.
Dependence is a term that refers to the:
a. presence and severity of withdrawal symptoms.
b. necessary use of drugs to prevent withdrawal symptoms.
c. level of intoxication associated with addiction.
d. amount of substance needed to satisfy cravings.
ANS: B
Dependence refers to the necessary use of drugs to prevent withdrawal symptoms. This occurs because of a state of neuroadaptation (a physiological change in the central nervous system).
What happened in the United States as a result of prohibition?
a. Substance abuse declined
b. Violent crime and corruption increased
c. The need for community health nurses declined
d. Facilities to treat substance abuse improved
ANS: B
Prohibition led to increased crime and corruption among law officials related to the illicit market. Because of the problems that were caused, prohibition was eventually recognized as a failure and repealed.
Which factor has contributed to the problem of substance abuse?
a. Increased knowledge about the use of drugs
b. Social acceptability of certain drugs
c. Recognition of substance abuse as a health problem
d. Control of the content and strength of illegal drugs
ANS: B
Social acceptance of certain drugs, such as caffeine, alcohol, and tobacco, contributes to the substance abuse problem. Not all substances that are abused are illegal.
A nurse is providing care for a family in which a nonaddict is experiencing a stress-induced preoccupation with an addict’s life, leading to extreme dependence on the addict. Which of the following best describes what is happening?
a. Obsession
b. Codependency
c. Enabling
d. Addiction
ANS: B
Codependency occurs when a person in a close relationship with an addict develops unhealthy coping mechanisms to continue the relationship. Obsession is a thought that continually preoccupies ones’ thoughts. Enabling is the act of shielding or preventing the addict from experiencing the consequences of addiction. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use of a drug, securing its supply, and a high tendency to relapse if the drug is removed.
A client has not yet made a commitment to take action to change his health behaviors. Which stage of change is the client experiencing?
a. Precontemplation
b. Contemplation
c. Preparation
d. Action
ANS: B
During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the preparation phase, the individual is prepared for action and may reduce the problem behavior but has not yet taken effective action. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.
A nurse is working with a client during a smoking cessation program. The client has developed an action plan for smoking cessation, but has not yet implemented it. Which stage of change is the client experiencing?
a. Precontemplation
b. Contemplation
c. Preparation
d. Action
ANS: C
During preparation, the individual is prepared for action and may reduce the problem behavior but has not taken effective action yet. During contemplation, the individual is aware that a problem exists and is seriously thinking about overcoming it but has not yet made a commitment to take action. The nurse can encourage the individual to weigh the pros and cons of the problem and the solution to the problem. In precontemplation, the person does not intend to change in the foreseeable future. In the action stage, the individual modifies the behavior, experiences, or environment to overcome the problem.
A school nurse is coordinating the implementation of a drug education program in the school. Which of the following levels of prevention is being implemented?
a. Primary level of prevention
b. Secondary level of prevention
c. Tertiary level of prevention
d. Primary health care prevention
ANS: A
Primary prevention includes education about drugs and guidelines for their use, preventing the problem before it occurs. Secondary prevention aims for early detection and screening. Tertiary prevention addresses treatment and rehabilitation. Primary health care prevention is not a level of prevention.
A nurse is assessing a client for addiction. Which of the following primary symptoms of addiction should the nurse recognize?
a. Anger
b. Apathy
c. Denial
d. Violence
ANS: C
In assessing for addiction, the nurse should be aware that a primary symptom of addiction is denial. Anger, apathy, and violence are not considered the primary symptoms of addiction.
A nurse is giving advice using the acronym FRAMES. Which of the following actions would most likely be taken by the nurse?
a. Offer a suggestion as to how the behavior should change
b. Provide clear guidance to change risky behavior
c. Refer the client to a local support group
d. Emphasize the need for others to support the client’s change
ANS: B
Providing clear advice to change risky behavior is one of the elements of the FRAMES method of intervention, “A”—advice. The other FRAMES are feedback, responsibility, menu, empathy, and self-efficacy.
A nurse is caring for adolescents who have experienced substance abuse. Which of the following should the nurse recognize as a major influence in this population?
a. Family-related factors
b. Positive media messages
c. Socioeconomic level
d. Peer pressure
ANS: A
Substance abuse among adolescents is influenced most by family-related factors, such as genetics, family stress, and parenting styles. Research suggests that successful social influence-based prevention programs may be driven by their ability to foster social norms that reduce an adolescent’s social motivation to begin using ATODs. Peer pressure and socioeconomic level may play a role in the abuse of substances, but this has not been the major factor identified. Media messages promoting the use of substances may influence this population, but is not the major factor that has been identified.
A nurse is implementing the harm reduction model. Which of the following will be the focus of nurse when using this approach?
a. Education
b. Law enforcement
c. Scare tactics
d. Rehabilitation
ANS: A
The harm reduction model accepts the reality that psychoactive drug use is endemic, and it focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug abuse and get treatment for addicts. The harm reduction model encourages nurses to seek the underlying roots of various health problems and plan action that is realistic, nonjudgmental, holistic, and positive. Law enforcement, scare tactics, and rehabilitation are not part of the harm reduction model
A nurse recommends to a school board that other methods besides the “just say no” approach be considered when providing drug use prevention education to the elementary students. Which of the following best describes the rationale for this recommendation?
a. Children do not like to hear the word “no,” and the approach is too negative.
b. Project DARE is more effective and has decreased drug use.
c. Children are naturally curious and may experiment with drugs.
d. “Just say no” to drugs does not include smoking and alcohol abuse.
ANS: C
The “just say no“ approach does not help young people because children are naturally curious and drug experimentation is often a part of normal development, children from dysfunctional homes often use drugs to get attention and escape intolerable environments, and it does not address the powerful component of peer pressure. Most recent studies have found that the DARE program is less effective than other interactive prevention programs and may even result in increased drug use.
A nurse is providing comprehensive education about HIV transmission for an injection drug user (IDU). Which of the following would be the most important information to include?
a. How and where to acquire needles
b. Proper needle usage and possible injection sites
c. Spreading of the virus via homosexual activities
d. Using bleach between needle uses
ANS: D
IDUs represent the most rapidly growing source of new cases of AIDS, and they are the greatest risk for spread of the virus in the heterosexual community. Emphasis is being placed on reduction of the transmission of this disease through contaminated needles. Nurses should provide education on cleaning needles with bleach between uses to decrease the spread of the virus. Education on needle exchange programs is also appropriate; however, this population is not as likely to use these programs even when they are available.
A nurse has collected a urine specimen from a client for drug testing. Which of the following best describes the purpose of a urinalysis?
a. To assess whether a certain drug has been used in the recent past
b. To determine the degree of intoxication
c. To assess the extent of performance impairment
d. To determine how much alcohol was consumed
ANS: A
The nurse collects a urine specimen with the rationale that urinalysis for drug testing can be used to determine whether a certain drug has been used in the recent past. Urine testing indicates only past use of certain drugs, not intoxication. The extent of performance impairment cannot be determined with urine testing. Alcohol is not always included in a urine drug screen.
A nurse is assessing the community for potential settings of drug experiences. Which of the following describes what the nurse would most likely identify?
a. A back alley or abandoned building where people are using crack
b. An area at the local high school where students are known to smoke cigarettes
c. The individuals using the drug, including that individual’s expectations
d. The physical, social, and cultural environment within which the use occurs
ANS: D
Setting is the influence of the physical, social, and cultural environmental within which the use occurs. All of these environments influence the use of drugs. A back alley, an area at the local high school, and individuals using the drug do not address all of the aspects of setting.
A nurse is assessing the drug use patterns of a client. Which of the following questions would be most appropriate for the nurse to ask?
a. Where was the drug acquired?
b. Who gave the drug to you?
c. Why do you use the drug?
d. How often do you use the drug?
ANS: D
During an assessment, all relevant drug-use history is collected and aids in the assessment of drug-use patterns. The nurse should note any changes in drug-use patterns over time. Thus, the most appropriate question is the nurse asking how often a client uses drugs.
A nurse refers a client to alcoholics anonymous (AA). Who will play the most important role in the treatment of alcoholism at this support group?
a. Self
b. Spouses
c. Children
d. Peers
ANS: D
AA began a strong movement of peer support to treat a chronic illness. The fellowship, support, and encouragement among AA members provide a vital social network for the person recovering from an addiction.
A nurse partners with multiple agencies in the community to create a support group for those diagnosed with addiction in the community. Which of the following levels of prevention is being implemented?
a. Primary
b. Secondary
c. Tertiary
d. Health promotion
ANS: C
When using tertiary prevention, the nurse focuses on treatment and rehabilitation. The support group for those with addiction is helping the addict and the addict’s family, who already “have a problem.” Primary prevention focuses on health promotion and disease prevention. Secondary prevention focuses on early detection and screening. Health promotion is not a level of prevention.
A nurse lobbies with legislators for the passage of legislation to prohibit smoking of tobacco products in public places. Which of the following levels of prevention is being implemented?
a. Primary
b. Secondary
c. Tertiary
d. Health promotion
ANS: A
When using primary prevention, the focus is on health promotion and disease prevention. When using tertiary prevention, the nurse focuses on treatment and rehabilitation. Secondary prevention focuses on early detection and screening. Health promotion is not a level of prevention.
A nurse is caring for a client who has a history of chronic alcohol abuse. Which of the following medical problems should the nurse anticipate? (Select all that apply.)
a. Gastrointestinal disturbances
b. Cardiac dysrhythmias
c. Depression
d. Organic brain syndrome
e. Hepatitis B
ANS: A, B, C, D
Gastrointestinal disturbances, cardiac dysrhythmias, depression, and organic brain syndrome are some effects of chronic alcohol abuse
Which group has the highest rate of violence?
a. Older, Caucasian men
b. Young, minority men
c. Young, Caucasian women
d. Older, minority women
ANS: B
Young, minority men have the highest rate of unemployment in the United States, ranging upward to 50% even in times of prosperity. Unemployment may precipitate aggressive outbursts. Most analyses conclude that the differential rates of violence between African Americans and Caucasians in the United States have more to do with socioeconomic disparities, such as poverty, unemployment, and overcrowding, than with race.
Homicide is the second leading cause of death among which population?
a. Individuals between 15 and 24 years of age
b. Native American infants
c. Caucasian women between 25 and 34 years of age
d. African American children between 15 and 19 years of age
ANS: A
Homicide is the second leading cause of death for individuals between 15 and 24 years of age. Rates of homicide for children under the age of 1 were highest in Non-Hispanic blacks and American Indian/Alaska Native infants.
What factor associated with crime and violence is particularly important to community health nursing practice?
a. Violence is a universal problem.
b. Violence impacts everyone in the United States.
c. Nurses must spend a great deal of time on the results of violence.
d. Significant mortality and morbidity result from violence.
ANS: D
Communities across the United States are concerned about crime and violence rates because of significant mortality and morbidity that often result. These issues are closely related to community health nursing. While it is true that violence is universal, and so to some degree affects all citizens, resulting in the need for nursing care, these issues relate to nursing in general and especially those involved in direct care of the patient’s physical and emotional needs.
Which statement about rape is true?
a. Rural areas are high-risk areas for rape to occur.
b. Most rapes occur in the winter.
c. Male victims suffer more emotional trauma than females.
d. College women are at high risk for experiencing rape.
ANS: D
College women are at particularly high risk for sexual victimization in the United States, with research estimating that approximately 25% of female college students will experience an attempted or completed rape at some point during their college experience.
It appears that the emotional trauma for a male rape victim is at least as serious as that for a woman.
Homicides are least likely to be perpetrated by a(n):
a. friend.
b. acquaintance.
c. family member.
d. stranger.
ANS: D
Homicides are least likely to be committed by a stranger. When strangers are involved, many of these are related to the illegal substance abuse network. Homicides are usually perpetrated by friends, acquaintances, or family members during an argument.
The greatest risk factor for suicide in adult women is:
a. divorce.
b. unemployment.
c. intimate partner violence.
d. terminal illness.
ANS: C
The greatest risk factor for actual and attempted suicide in adult women is intimate partner violence.
A public health nurse (PHN) is working in a community where there have been multiple closures of large factories, leaving many individuals without employment. Which of the following is this population most at risk for?
a. Becoming an abuser at home
b. Committing violence in and outside the home
c. Developing addictive behaviors
d. Neglecting the needs of their children
ANS: B
Unemployment is associated with violence within and outside the home. Abuse may increase both in and outside of the home due to unemployment. Applying for unemployment benefits is not a risk for this population. Neglecting the needs of their children only addresses what could happen inside of the home and not outside of the home.
A nurse is developing a community program to prevent violence. Which of the following should be the first action taken by the nurse?
a. Talk to people who are victims of violence for their opinion
b. Identify factors that lead to violence
c. Develop a plan of action to combat violence
d. Evaluate current community programs
ANS: B
A community’s population can influence the potential for violence. The starting point is the identification of factors that lead to violence, such as poverty, urban crowding, and racial inequality. In addition, one’s perceptions of the safety in a community can be influenced by racism and perceptions of criminality.
A nurse is counseling a client who has been abusive toward a spouse. Which of the following experiences has the client most likely had in the past?
a. Perceived or actual crisis
b. History of social isolation
c. Previous exposure to violence
d. Long-term marital strain
ANS: C
Perpetrators of intimate partner violence often believe that violence within an interpersonal relationship is a normal behavior pattern, based on their upbringing, living conditions, and increased stress.
A nurse is working with children who may be at risk for experiencing abuse. In which situation is child abuse most likely to occur?
a. When the parents have high expectations for their children
b. When the parents’ sense of control is threatened
c. When the parents are sensitive to their children’s needs
d. When the parents lack a social support network
ANS: D
Parents with a lack of social support, history of abuse as a child, or who have minimum education, a tendency toward depression, or multiple stress factors may be at risk for abusing their children. Parents who have high expectations for their children or are sensitive to their children’s needs do not have a tendency toward abuse. Parents who have their sense of control threatened do not have a tendency toward abuse.
What type of abuse is occurring when a child does not receive the basic nurturing and caring needed for healthy development?
a. Sexual abuse
b. Emotional neglect
c. Physical neglect
d. Child abuse
ANS: B
Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child. Physical neglect is failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care and is most often associated with extreme poverty. Child abuse ranges from violent physical attacks to passive neglect. Sexual abuse is a form of child abuse when a child has had nonconsensual sexual contact of any kind.
A nurse is caring for a child who lives in extreme poverty. Which of the following types of abuse is this child at greatest risk for?
a. Sexual abuse
b. Emotional neglect
c. Physical neglect
d. Child abuse
ANS: C
Physical neglect is failure to provide adequate food, proper clothing, shelter, hygiene, or necessary medical care. Emotional neglect is the omission of basic nurturing, acceptance, and caring of a child. Child abuse ranges from violent physical attacks to passive neglect. Sexual abuse is a form of child abuse when a child has had nonconsensual sexual contact of any kind.
A nurse is making a home visit to a low-income, frail, older person’s home. Which of the following would most likely cause the nurse to suspect adult maltreatment?
a. The older person reports giving money to family members on a regular basis.
b. The windows of the house are in need of repair.
c. The older person spends a great deal of time watching television.
d. There are dogs running loose in the yard of the home.
ANS: A
Older adults are at risk for financial abuse through fraud, coercion to relinquish property rights, and money mismanagement. A low-income, frail, older person would most likely not be giving money to family members on a regular basis, because the client would need the money to meet basic needs.
A nurse is working with a recent rape survivor. Which of the following actions would be most appropriate for the nurse to implement?
a. Provide continuous care once the victim enters the health care system
b. Examine evidence for its authenticity
c. Work with the criminal justice system to find the rapist
d. Provide long-term therapy for psychological trauma
ANS: A
Not only do nurses often provide continuous care, in some states nurses are trained as sexual assault examiners who gather forensic evidence. Nurses provide victims with privacy, respect, and assurance of confidentiality. The nurse would not be providing long-term therapy for the survivor or have the responsibility to find the rapist.
A nurse is completing a community assessment. Which of the following community characteristics would be identified as a factor for violence?
a. Lack of family cohesion
b. High crime rate
c. Social isolation
d. Substance abuse
ANS: B
High crime rate is the only “community characteristic.” Lack of family cohesion is a familial factor. Social isolation and substance abuse are individual factors.
A nurse helps the community to take a stand against violence and advocates for elected officials and local media to make nonviolence a priority. Which of the following levels of prevention is being implemented?
a. Primary
b. Secondary
c. Tertiary
d. Primary care
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Being an advocate for nonviolence demonstrates primary prevention. Secondary prevention refers to interventions aimed at early detection and screening. Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Primary care is not a level of prevention.
A nurse assists an injured victim in finding a safe location to live after being abused. Which of the following levels of prevention is being implemented?
a. Primary
b. Secondary
c. Tertiary
d. Primary care
ANS: B
Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Finding shelter for a victim of abuse demonstrates secondary prevention. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Primary care is not a level of prevention.
A nurse is providing tertiary prevention. Which of the following interventions should be included?
a. Education
b. Prevention
c. Referral
d. Detection
ANS: C
Tertiary prevention refers to interventions aimed at treatment and rehabilitation. Nurses should know about available community resources for abuse victims and perpetrators. Education and prevention primarily deal with primary prevention strategies. Detection is part of secondary prevention.
A nurse is assessing an individual who has been the victim of domestic violence. Which part of the body should the nurse assess first?
a. Front of the body
b. Back of the body
c. Proximal parts of the body
d. Distal parts of the body
ANS: C
Attacks are often inflicted on proximal parts of the body that can easily be disguised by clothing, so the nurse should assess this area first.
A nurse is caring for a woman who has been battered for a number of years. Which of the following has the client most likely seen an increase in over the years?
a. Self-blame
b. Remorse by the man
c. Severity of the abuse
d. Emotional strength
ANS: C
Severity of abuse and its frequency is most likely to increase over time. Both the man and the woman tend to blame the incident on something external. The man’s remorse tends to lessen over time.
A nurse working at a battered woman’s shelter is counseling a pregnant woman who has just entered the shelter. When assessing the client’s history, which information would the client most likely report?
a. A history of abuse before pregnancy
b. A history of child abuse
c. A history of multiple pregnancies
d. A history of substance abuse
ANS: A
Abuse before pregnancy is the most important risk factor for physical battery during pregnancy. A history of child abuse, multiple pregnancies, and substance abuse are not as closely associated with the risk of physical battery during pregnancy.
A child has reported to the school nurse that he is being bullied. Which of the following is most likely happening to this child?
a. Difficulty talking to the guidance counselor
b. Inclusion in group activities
c. Intimidation by a peer
d. Discipline from parents at home
ANS: C
Bullying has become a major problem in schools. Bullying can be physical and/or psychological abuse, intimidation, or verbal abuse; the exclusion of some children in group activities is another form of bullying.
A community health nurse visits a home and notices multiple bruises on a 4-year-old child. The mother reports that her husband is an alcoholic and is currently sleeping. What is the most appropriate action for the nurse to take?
a. Question the mother about sexual abuse
b. Initiate interventions directed at family violence
c. Report the case of suspected child abuse to authorities
d. Refer the mother to a social worker or Al-Anon group
ANS: C
It is required by law that nurses report all cases of suspected child abuse. The mandatory reporting laws protect reporters from legal action on cases that are never substantiated. It is essential that this is the first action to be taken by the nurse. After this action is taken, it may be appropriate to initiate interventions related to decreasing family violence or asking specifically about abuse. Referral of the mother to a social worker would not assist in decreasing the potential abuse that may be occurring.
A nurse is assessing a school-age child whose parents have reported recent violent activity from the child that is atypical from this child. Which of the following may have contributed to the child’s change in behavior?
a. Getting a new pet
b. Watching too much television
c. Playing violent video games
d. Having a new sibling at home
ANS: C
Research on violent television and films, video games, and music demonstrates that media violence increases the likelihood of aggressive and violent behavior, both immediately and long-term. Parents and caregivers are critical in monitoring what reaches their children
A nurse is assisting with community planning. Which of the following facilities should the nurse encourage be developed to reduce the potential for crime and violence in the community? (Select all that apply.)
a. Playgrounds
b. Movie theaters
c. Swimming pools
d. Shopping malls
e. Restaurants
ANS: A, B, C
Recreational facilities including playgrounds, movie theaters, and swimming pools all provide socially acceptable outlets for a variety of feelings, including aggression. Shopping malls and restaurants would not be considered recreational facilities.
A nurse is providing care to a child who has been abused. Which characteristics are most likely present in this child’s family? (Select all that apply.)
a. The parents are unemployed.
b. There is no support network willing to offer assistance.
c. The parents are not knowledgeable about child development.
d. The mother seems frightened of her partner.
e. There is no primary caregiver in the home.
ANS: A, B, C, D
Risk factors for child abuse include unemployed parents, no support network, parents not knowledgeable about child development, and a mother who is scared of her partner.
Which statement about advanced public health nurses (APHNs) and nurse practitioners (NPs) is correct?
a. They often work in similar settings.
b. They have identical educational preparation.
c. Their practices have become more similar during the past decade.
d. The clinical nurse specialist role always involves prescriptive practice.
ANS: A
APHNs and NPs often work in similar settings. APHNs and NPs have differing educational preparation depending on the specialty focus. The practices have continued to differ during the past decade. The clinical nurse specialist role typically does not involve prescriptive practice.
The NP movement began at the University of Colorado with nurses providing _____ care.
a. maternity
b. well-child
c. nursing home
d. diabetes
ANS: B
It was determined that educating community-oriented nurses could decrease morbidity among medically deprived children. Nursing practice for pediatric NPs included the identification, assessment, and management of common acute and chronic health problems, with appropriate referral of more complex problems to physicians.
An advanced practice nurse uses knowledge and physical, psychosocial, and environmental assessment skills to respond to common health and illness problems. Which of the following best describes this individual?
a. Advanced practice nurse
b. APHN
c. NP
d. Clinical nurse specialist
ANS: C
An NP applies nursing knowledge with physical, psychosocial, and environmental assessment skills. An advanced practice nurse is a licensed professional nurse prepared at the master’s level or doctoral level to take leadership roles in applying the nursing process and public health sciences to achieve specific health outcomes for the community. An APHN has a minimum of a master’s degree and has specialized courses related to public health. Clinical nurse specialists influence care outcomes by providing expert consultation for nursing staffs and by implementing improvements in health care delivery systems.
An NP is employed in a primary health care setting. Which services are most likely provided in this setting?
a. Primary health services and prison medicine services
b. Public health and primary care services
c. Family practice and geriatrics care
d. Home health and school health services
ANS: B
Primary health care includes public health and primary care services by definition
Which statement accurately describes how NP programs began?
a. Started as a physician’s assistant program
b. Were an offshoot of midwifery
c. Have not always required a master’s degree
d. Began in Europe and didn’t reach the United States until 1970
ANS: C
The early NP degree programs were often continuing education programs and certificate programs that did not require a master’s degree or even a baccalaureate degree. NP programs began with a focus on well children. The NP movement began in 1965 at the University of Colorado.
A student is pursuing a graduate nursing education with preparation as a generalist, functioning at the micro-systems level, and assuming accountability for health care outcomes for a specific group of clients. Which educational preparation is this student receiving?
a. Clinical nurse leader
b. APHN
c. NP
d. Doctor of Nursing Practice (DNP)
ANS: A
A clinical nurse leader is defined as a nurse who is a master’s prepared generalist who functions at the micro-system level and assumes accountability for health care outcomes for a specific group of clients within a unit or area. An NP applies nursing knowledge with physical, psychosocial, and environmental assessment skills. An APHN has a minimum of a master’s degree and has specialized courses related to public health. A DNP is the preferred educational preparation for specialty advanced practice nurses.
A registered nurse (RN) would like to become an NP. Which level of education is required?
a. Bachelor of science in nursing degree
b. Master’s or higher degree in nursing and NP education
c. Bachelor of science in nursing degree and completion of a formal NP program
d. Master’s degree with a specialty in public health nursing
ANS: B
As of 1992, the American Nursing Credentialing Center (ANCC) required a master’s degree or higher for NP certification. The practice doctorate is encouraged for NP certification, but is not required.
An APHN is completing the process for certification renewal in the specialty. What time period has passed making renewal necessary?
a. 1 year
b. 3 years
c. 5 years
d. 7 years
ANS: C
Certification for APHNs and NPs is for 5 years.
An advanced practice nurse is pursuing professional certification. Who will the nurse need to contact to obtain certification?
a. American Nurses Association
b. National League for Nursing
c. State board of nursing
d. Department of Health and Human Services
ANS: A
Examinations are administered through the ANCC, which is part of the American Nurses Association. The National League for Nursing and state board of nursing do not provide professional certification for advanced practice nurses
An advanced practice nurse has obtained certification. Which of the following provides the rationale for receiving certification?
a. To assure competence at an advanced level
b. To verify minimal competency levels of practice
c. To create a network for nurses to collaborate
d. To make it difficult to become a nurse
ANS: A
The purpose of certification is to assure the public that nurses who claim to be competent at an advanced level have had their credentials verified through examination. Licensure verifies minimal competency levels of practice, not certification. Certification does not regulate the ability to become a nurse; that occurs with licensure. Certification does not create a network of nurses for the purpose of collaboration.
In which role are the most differences seen between the APHN and the NP?
a. Administrator
b. Clinician
c. Consultant
d. Educator
ANS: B
Many differences are seen between the APHN and the NP in the clinician role. APHNs are focused on the needs of the overall community, whereas NPs are focused on the care of individuals. APHNs and NPs both provide education within a nursing framework and as a professional nurse educator. Both may have administrative roles within the agency setting. Both may serve as consultants to help with problem solving for an individual, family, or community to improve health care delivery.
An APHN is offering classes on breast self-exam. Which of the following levels of prevention is being implemented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Classes on breast self-exam focus on preventing the occurrence of breast cancer. Secondary prevention refers to those interventions aimed at early detection and screening. Tertiary prevention refers to those interventions aimed at treatment and rehabilitation. Assessment is not a level of prevention.
A population-focused advanced public health nursing activity is implementing a secondary prevention strategy. Which of the following best describes the intervention that is being completed?
a. Flu immunizations at churches
b. Education on need for early detection
c. Screenings for blood pressure and cholesterol
d. Follow-up clinics for diabetics
ANS: C
Secondary prevention focuses on early detection and screening—screenings for blood pressure and cholesterol. Flu immunizations at churches and education on need for early detection are primary prevention strategies, and follow-up clinics for diabetes are a tertiary prevention strategy
An APHN provides other nurses with information about how to improve client care. Which of the following roles is being performed?
a. Researcher
b. Administrator
c. Educator
d. Consultant
ANS: D
The consultant role is being practiced when an APHN provides other nurses with information on improving client care. As a researcher, the advanced practice nurse conducts their own investigations and collaborates with doctorate-prepared nurses, answering questions related to nursing practice and primary health care. As an administrator, the advanced practice nurse may be responsible for and have direct or indirect authority and supervision over the organization’s staff and client care. As an educator, the advanced practice nurse provides formal and informal teaching.
An APHN is working as an administrator. Which of the following would the nurse most likely be doing?
a. Engaging in consultation and problem solving with individuals, families, and the community
b. Providing direct authority and supervision over the staff and client care
c. Working with doctorate-prepared nurses on research projects
d. Educating the public on current health care practices
ANS: B
The APHN or NP functioning in the role of administrator is often responsible for and has direct authority and supervision over the staff and client care. As a consultant, the APHN engages in consultation and problem solving with individuals, families, and the community. As a researcher, the APHN works with doctorate-prepared nurses on research projects. As an educator, the APHN educates the public on current health care practices.
An APHN has recently been hired by a public health department. Which of the following best describes what the PHN will most likely be doing in this role?
a. Diagnosing health problems
b. Managing chronic disease
c. Limiting disability
d. Conducting community assessments
ANS: D
Practicing within the role of clinician, the APHN is involved in conducting community assessments; identifying needs of populations at risk; and planning, implementing, and evaluating population-focused programs to achieve health goals. Diagnosing health problems, managing chronic disease, and limiting disability are roles of an NP.
An NP has recently been hired by a public health department. Which of the following best describes what the NP will most likely be doing in this role?
a. Disease prevention activities
b. Deciding on a treatment plan
c. Identifying needs of populations at risk
d. Identifying health needs of the community
ANS: B
In the role of a clinician, the NP diagnoses actual or potential health problems; decides on treatment plans jointly with clients; intervenes to promote health, to protect against disease, to treat illness, to manage chronic disease, and to limit disability; and evaluates with the client and other primary care team members about how effective and comprehensive the nursing intervention may be in providing continuity of care. Disease prevention activities, identifying needs of populations at risk, and identifying health needs of the community are roles of an APHN.
An APHN has been working with multiple agencies to establish a nursing center in the community. What is the purpose of creating a nursing center?
a. To provide opportunities for collaborative relationships
b. To offer specialized care for certain medical conditions
c. To promote the autonomy of NPs
d. To focus on primary prevention for the community
ANS: A
Nursing centers provide opportunities for collaborative practice among APHNs, NPs, baccalaureate-prepared nurses, and community members. Nursing centers address the health needs of vulnerable populations. Their central mission is community development; public involvement; interprofessional practice; and health promotion and disease prevention supported by the principles of primary health care.
An NP recently began employment in an emergency department. What would the primary role of the NP be in this setting?
a. Triage clients
b. Manage nonemergent client problems
c. Assess medically uninsured clients
d. Provide health education about preventive health care
ANS: B
The primary role of the NP in emergency departments is usually to manage nonemergent uninsured clients. Provision of health education about preventive care most likely would occur in an outpatient clinic, not in an emergency department. NPs are able to treat patients in this setting. Both medically insured and uninsured individuals will be seen in this practice setting.
A nurse is performing a population-focused intervention. Which of the following activities is the nurse most likely completing?
a. Setting up a health fair with nursing students at a local university
b. Teaching a new mother how to breastfeed
c. Completing a physical examination on a preschool child
d. Contacting local officials about the rise in crime in one area of the city
ANS: A
Setting up a health fair with nursing students at a local university is an example of a population-focused intervention. Population-focused interventions address the needs of the community rather than only the needs of individuals. Teaching a new mother how to breastfeed and doing physical examinations on each preschool child are examples of individual-focused interventions. Contacting local officials about the rise in crime is an example of a system-focused intervention.
An APHN wants to establish an independent practice. Which is the best method to achieve this goal?
a. Act as a legal expert
b. Learn complex assessment skills
c. Market a service package
d. Serve as a liaison for community programs
ANS: C
One of the best ways for an APHN to establish an independent practice is to market a service package, providing certain services for a specific population. Acting as a legal expert, serving as a liaison, and learning complex assessment skills would not be helpful in establishing an independent practice.
An NP is investigating regulations for third-party reimbursement. Which information will the NP most likely discover?
a. NPs are reimbursed when directly supervised by a physician.
b. NPs only receive reimbursement when working in rural areas.
c. NPs are reimbursed at 85% of the physician rate.
d. NPs are unable to be reimbursed by Medicare and Medicaid.
ANS: C
In 1997, with the passage of the national reconciliation spending bill, NPs can be directly reimbursed, regardless of geographic setting, at 85% of what a physician would have been paid (if the service is covered under Medicare Part B). NPs are able to have an independent practice and do not need direct supervision by a physician. NPs can receive reimbursement regardless of practice setting. NPs are able to be reimbursed by a variety of payer sources.
An NP recently obtained licensure and certification as an advanced RN. Where would the nurse find information about prescriptive privileges?
a. Reimbursement policies
b. Certification requirements
c. Educational preparation
d. Nurse practice acts
ANS: D
The scope and practice of the NP, including prescriptive authority, is defined by the state’s nurse practice act. Reimbursement policies, certification requirements, and educational preparation would not provide any information about prescriptive privileges.
Which is most likely to be a major stressor for an APHN?
a. Autonomy of practice
b. Professional isolation
c. Flexible work hours
d. Collaboration
ANS: B
The major stressor for an APHN is likely to be professional isolation, because they are likely to be hired in remote practice employment sites. Autonomy of practice in these sites attracts many NPs and APHNs. Long drives, long hours, lack of social and cultural activities, and lack of opportunity for professional development are often experienced.
Which functions are shared by APHNs and NPs? (Select all that apply.)
a. Leadership
b. Research
c. Comprehensive assessment
d. Systems focus
e. Community assessment
ANS: A, B, C
Leadership, research, and comprehensive assessment are functions that are completed by both APHNs and NPs. The APHN is more systems focused and would conduct a community assessment, whereas the NP has an individual/family focus and would conduct an individual health assessment.
Which factors cause stress for advanced practice nurses? (Select all that apply.)
a. Legal issues
b. Professional isolation
c. Conflicting expectations
d. Role confusion
e. Advanced education
ANS: A, B, C
Legal issues, professional isolation, conflicting expectations, liability, collaborative practice, and professional responsibilities all may cause stress for advanced practice nurses. Role confusion and advanced education are not factors causing stress for advanced practice nurses.
Official agencies are financed primarily by:
a. charities.
b. individual clients.
c. third-party payers.
d. tax funds.
ANS: D
Official agencies are financed primarily by tax funds. These agencies are typically operated by state, county, city, or other local government units, such as health departments.
Medicare-certified home health agencies place emphasis on _____ care.
a. chronic
b. distributive
c. intermittent
d. primary
ANS: C
As part of the Conditions of Participation, Medicare-certified home health agencies must place an emphasis on intermittent care. Home care services that are provided must be intermittent and provide a skilled service. Primary care refers to the care that is often provided in a physician’s office. Medicare-certified agencies provide care following an acute hospitalization or medical change; they do not provide long-term care for chronic illnesses.
A nurse is implementing a population-focused model of home care delivery. Which of the following actions would most likely be taken by the nurse?
a. Use an assessment protocol when conducting visits
b. Collaborate with other disciplines
c. Provide care for a specific population
d. Apply high-intensity interventions
ANS: A
Population-focused home care models of care usually include structured approaches to regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching.
A home care nurse is employed by a proprietary agency. What does this mean?
a. The agency is exempt from federal income taxes.
b. The agency is governed by a board of directors.
c. The agency is a profit-making agency.
d. The agency is reimbursed primarily by tax funds.
ANS: C
Proprietary agencies are profit-making agencies. Proprietary agencies are free-standing, for-profit agencies that are required to pay taxes. Many are part of large chains and now dominate the home care industry.
A nurse is coordinating care to ensure a comfortable and peaceful death. Which of the following factors should be an important consideration for the nurse?
a. The unique stress dying patients often experience
b. The cultural values, expectations, and preferences of the family
c. The communication style of each family member
d. The abilities of the nurse and health care team
ANS: B
Cultures vary in their beliefs and responses to death. Nurses should know the differences in cultural responses so that they can effectively help people in their time of need. It will be important for the nurse to take cues from the client and the loved ones regarding their needs. The stress experienced by dying patients is different based on the client’s culture.
A nurse has referred a home care client to hospice care. Which of the following best explains the rationale for this referral?
a. To provide comfort and peace at a difficult time
b. To reduce the cost of care for the terminally ill
c. To keep clients at home until the end of life
d. To provide care for terminally ill clients expected to live longer than 6 months
ANS: A
The focus of hospice care is comfort, peace, and a sense of dignity at a very difficult time. Comprehensive services emphasize continuity of care. Hospice care is provided for those with a life expectancy of less than 6 months. Hospice is the only Medicare benefit that includes medications, medical equipment, 24 hours/7 days a week access to care, and support for family members after death. Hospice care does not reduce the cost of care.
The nurse provides direct care services to a stroke victim to avoid complications. Which of the following levels of prevention is being implemented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: C
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Thus, direct care for a stroke victim is focusing on limiting disability and encouraging rehabilitation. Primary prevention focuses on preventing the disease before it occurs. Secondary prevention focuses on early detection and screening. Assessment is not a level of prevention.
A nurse is providing a skilled nursing service. Which of the following best describes the intervention the nurse is performing?
a. Teaching the client and family about medication administration
b. Consulting with other nurses about the care of a client in the home
c. Coordinating services for maximum benefit at minimal cost
d. Reviewing nursing assistant charting at the end of each day
ANS: A
Skilled nursing service is the Medicare term that describes the duties of the registered nurse, and refers to the requirement of nursing judgment. Those services involve assessment, teaching, and selected procedures. Teaching the client and family to implement a therapeutic plan, such as taking medications, is an example of a skilled nursing service. Consultation, coordination, and review of documentation do not fit the definition of a “skilled nursing service.”
A nurse is employed in home health nursing practice. Which of the following terms best describes the care that is being provided?
a. Intermittent nursing care
b. Custodial care
c. Family caregiving
d. Palliative care
ANS: A
Provision of intermittent skilled visits is a component of home health care nursing. Custodial care refers to the care given in long-term care facilities. Family caregiving may be an important role of keeping the client at home, but it is not a necessary component of home care. Palliative care is an extended continuum of chronic serious illness to acute serious illness during which stabilization and exacerbations may occur.
Which organization publishes the current scope and standards of home care practice?
a. Centers for Medicare and Medicaid Services
b. American Nurses Association (ANA)
c. Robert Wood Johnson Foundation
d. Visiting Nurse Association
ANS: B
The ANA publishes scope and standards for Home Health Nursing and Hospice and Palliative Nursing. The Centers for Medicare and Medicaid Services control the regulations and reimbursement mechanisms for the majority of home care services. The Robert Wood Johnson Foundation provides grant funding for a variety of projects that support nursing. The Visiting Nurse Association is a home care agency.
A nurse has discovered that a client should be receiving Meals on Wheels. Which of the following steps of the nursing process is the nurse performing?
a. Diagnosis
b. Planning
c. Assessment
d. Implementation
ANS: C
The Standards of Care and the Standards of Professional Performance both include the six steps of the nursing process: (1) assessment, (2) diagnosis, (3) outcomes identification, (4) planning, (5) implementation, and (6) evaluation. As a nurse performs an assessment, the nurse recognizes the current needs of the client.
Which concepts are used to evaluate client outcomes when using the Omaha System Problem Rating Scale for Outcomes?
a. Problem, Intervention, and Outcome
b. Knowledge, Behavior, and Status
c. Knowledge, Skill, and Attitude
d. Problem, Category, and Modifiers
ANS: B
The Omaha System Problem Rating Scale for Outcomes uses the concepts of Knowledge, Behavior, and Status.
After conducting a comprehensive client assessment, the nurse would organize information about the client’s medication regimen into which domain of the Omaha System Problem Classification Scheme?
a. Environmental
b. Psychosocial
c. Physiological
d. Health-related behaviors
ANS: D
The Omaha System Problem Classification Scheme uses four domains to organize client information. The Health-related behaviors domain includes information related to patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease. The environmental domain includes material resources and physical surroundings both inside and outside the living area. The psychosocial domain includes patterns of behavior, emotion, communication, relationships, and development. The physiological domain includes functions and processes that maintain life.
A nurse is using the Omaha System Problem Classification Scheme. Which of the following situations is the nurse most likely experiencing?
a. Measuring client outcomes
b. Collaborating with other professionals
c. Providing health education
d. Organizing a comprehensive assessment
ANS: D
The Omaha System Problem Classification Scheme is used to organize a comprehensive assessment according to four priority domains. It’s simple and concrete terms are used to organize a comprehensive assessment, an important standard of nursing practice. It does not measure client outcomes, promote collaboration with other professionals, or provide health education.
A community health nurse is using the Omaha System. Which of the following best describes the rationale for using this system?
a. To define each health care provider’s role
b. To use nursing diagnoses in community health nursing practice
c. To foster collaborative practice
d. To provide practitioners a method for communication
ANS: C
The goals of developing the Omaha System were to develop a structured and comprehensive system that could be both understood and used by members of various disciplines and to foster collaborative practice. Therefore, the Omaha System was designed to guide practice decisions, sort and document pertinent client data uniformly, and provide a framework for an agency-wide, multidisciplinary clinical information management system capable of meeting the daily needs of clinicians, managers, and administrators.
A nurse is trying to facilitate interprofessional collaboration. Which of the following actions should be taken by the nurse?
a. Understand who is in charge of the client’s care
b. Make appropriate referrals
c. Recognize what other professionals do and how they view their roles
d. Request assistance when performing complex skills
ANS: C
The factors for successful interprofessional functioning include the categories of knowledge, skill, and attitudes with subheadings including the understanding of the roles of each professional.
A home care agency has applied for accreditation from the Joint Commission. What is the next step the agency will take?
a. Attend a conference to learn more about the accreditation process
b. Schedule a site visit with the Joint Commission
c. Complete a self-study of the agency
d. Improve methods of documentation of client visits
ANS: C
After applying for accreditation, a lengthy self-study must be completed that addresses all aspects of the agency’s operation. Following completion of the self-study, an accreditation team schedules a site visit. Attending a conference to learn more about accreditation should be done before applying. A site visit with the Joint Commission occurs after the self-study has been reviewed. Improving methods of documentation of client visits should be addressed before applying for accreditation.
A nurse is using the first stage of the Outcomes and Assessment Information Set (OASIS) outcomes analysis. Which of the following best describes what the nurse is doing?
a. Comparing an agency’s performance to a national sample
b. Reporting data on patient care to a national registry
c. Stabilizing a client’s condition to continue to receive funding
d. Documenting client assessment data and findings
ANS: A
The first stage, outcomes analysis, enables an agency to compare its performance to a national sample, identify factors that may affect outcomes, and identify final outcomes that show improvement in or stabilization of a client’s condition. The second stage, outcomes enhancement, enables the agency to select specific client outcomes and determine strategies to improve care.
Which historical event caused dramatic changes in home care nursing?
a. Passage of Medicare legislation
b. Establishment of Visiting Nurse Associations
c. Creation of the Montefiore Hospital Home Care Program
d. Provision of funds by the Civil Works Administration
ANS: A
Medicare introduced regulations for home care practice as well as for reimbursement mechanisms.
A nurse is using telehealth technology in the home setting. Which of the following best describes the intervention that is being used by the nurse?
a. Uses Web TV to teach clients about their health
b. Shares health information using electronic communications
c. Makes regular visits to clients to check the technology
d. Risks violation of the Health Insurance Portability and Accountability Act
ANS: B
Telehealth includes sharing health information between the client and clinicians using electronic communications. Telehealth may or may not include video technology for live interactions. Telehealth allows for monitoring health status and symptom recognition, providing education, increasing communication, and enabling clients to become active partners in their own care.
A nurse is coordinating care through a high-intensity transitional care program. Which of the following best describes the populations that the nurse is working with? (Select all that apply.)
a. Adults with cognitive impairments
b. Women with high-risk pregnancies
c. Older adults with heart failure
d. People who are moving from one state to another
e. Men who have just experienced divorce
ANS: A, B, C
Transitional care ensures the coordination and continuity of health care as clients transfer between different locations and different levels of care in the same location. High-intensity transitional care programs are designed for populations who have complex or high-risk health problems.
Which are categories of classifying interventions according to the Omaha System Intervention Scheme? (Select all that apply.)
a. Health education
b. Case management
c. Treatments and procedures
d. Direct care services
e. Skilled nursing care
ANS: B, C
The Omaha System Intervention Scheme is comprised of four broad categories of interventions: (1) teaching, guidance, and counseling; (2) treatments and procedures; (3) case management; and (4) surveillance.
Which illegal and unethical activities have occurred in health care systems in the past? (Select all that apply.)
a. Inappropriate use of home health services
b. Inaccurate billing for services
c. Excessive administrative staff
d. “Kickbacks” for referrals
e. Primary care services provided in the home
ANS: A, B, C, D
Examples of Medicare fraud and abuse in home health and hospice include inappropriate use of services, excessive payments to administrative staff or owners, “kickbacks” for referrals, and billing for visits and/or medical supplies that are not authorized or provided. The home care nurse must abide by established federal regulations when delivering care to clients.
Which legislation required that schools make allowances to balance educational and health care needs of children with special needs?
a. Rehabilitation Act
b. Individuals with Disabilities Education Act
c. No Child Left Behind
d. Education for All Handicapped Children Act
ANS: B
The Individuals with Disabilities Education Act guarantees educational services. The Rehabilitation Act states that children cannot be excluded from schools because of a handicap. No Child Left Behind states that all children must receive standardized education in a healthy environment. Education for All Handicapped Children states all children should attend school in the least restrictive environment.
The National Association of School Nurses (NASN) recommends which educational preparation for school nurses?
a. Licensed practical nursing
b. Bachelor of science in nursing (BSN) and certification in school nursing
c. School nurse practitioner
d. Master of science in nursing with specialization in school nursing
ANS: B
The NASN recommends that school nurses be registered nurses (RNs) with BSNs and special certification in school nursing. Licensed practical nursing education is insufficient. School nurse practitioner and master of science in nursing with specialization in school nursing exceeds the minimum recommendations for school nurses.
A school nurse reviews the standards of professional practice published by the NASN. Which professional standard will the school nurse rely upon when providing care?
a. Interact with interdisciplinary health team members
b. Communicate with teachers to effectively manage classrooms
c. Teach cardiopulmonary resuscitation to every member of the school staff
d. Do research on students at the school
ANS: A
Interacting with interdisciplinary health team members is one of the criteria for school nurses developed by the NASN. The professional standards rely on nurses to give care based on 11 criteria: (1) develop school health policies and procedures; (2) evaluate their own nursing practice; (3) keep up with nursing knowledge; (4) interact with the interprofessional health care team; (5) ensure confidentiality in providing health care; (6) consult with others to give complete care; (7) use research findings in practice; (8) ensure the safety of children, including when delegating care to other school personnel; (9) have good communication skills; (10) manage a school health program effectively; and (11) teach others about wellness.
A school nurse is demonstrating community outreach in practice. Which of the following interventions is most likely being used by the nurse?
a. Coordinating health care of students with complex health problems
b. Teaching students about the importance of proper nutrition
c. Providing direct care to ill and injured students
d. Participating in a community health fair
ANS: D
When participating in community outreach, nurses are involved in community health fairs, using that opportunity to teach others. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. The role of direct caregiver is used when providing direct care to ill and injured students.
A school nurse is coordinating the health care for children with complex health problems. Which of the following roles is being implemented?
a. Health educator
b. Case manager
c. Consultant
d. Counselor
ANS: B
The nurse may perform the role of case manager for the child who is disabled or chronically ill needing to see many health care providers. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their impact on the health of the children. As a counselor, the school nurse may be the person whom the children trust to tell important secrets about their health.
A school nurse is providing health information to school administrators, teachers, and parent-teacher groups. Which of the following roles is being implemented?
a. Health educator
b. Case manager
c. Consultant
d. Counselor
ANS: C
As a consultant, the school nurse provides health information to various school groups. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. As a counselor, the school nurse may be the person whom the children trust to tell important secrets about their health.
A nurse is employed in the school setting. Which of the following activities would the nurse most likely perform?
a. Care for children who are home sick from school
b. Coordinate the health education program of the school
c. Facilitate school attendance for students with communicable diseases
d. Schedule appointments to specialists for students with chronic disease
ANS: B
The school nurse’s role is comprehensive and often involves coordinating activities, such as coordinating the school health program. A common misperception is that school nurses only put bandages on cuts and soothe children with stomachaches. However, that is not their major role. School nurses give comprehensive nursing care to the children and the staff at the school. At the same time, they coordinate the health education program of the school, consult with school officials to help identify and care for other persons in the school community, and provide leadership in promoting health and safety.
A site that provides primary health care services to children and youths by nurse practitioners in the school setting is a:
a. primary care clinic.
b. school-based health center.
c. school health service.
d. child health improvement plan.
ANS: B
A site that provides primary health care services to children and youths by nurse practitioners in the school setting is a school-based health center. Primary care clinic refers to care that is typically provided in a physician’s office. School health services provide the various types of services that are available in schools. A child health improvement plan is not a setting for health care services to be delivered.
The leading cause of death in children and teenagers is:
a. leukemia.
b. injuries.
c. suicide.
d. diabetes.
ANS: B
The leading cause of death in children and teenagers is injuries.
Which statement about head lice is true?
a. Prevalence of head lice in U.S. schools is nearly 50%.
b. Most cases of head lice are found in white, middle-class children.
c. Having head lice is associated with living in an unclean home.
d. Most incidents of head lice occur in those with dirty hair.
ANS: B Lice are mostly found in white, middle-class children as a result of the oval shape of the hair shaft. Prevalence of head lice in U.S. schools ranges from 10% to 40%, being found most commonly in school-aged children, typically in late summer and autumn. Lice are more often seen in clean hair. The suggestion that lice are associated with unclean homes in poverty areas is incorrect.
A school nurse is teaching a group of teenagers about the dangers of using “club drugs.” The nurse provides information that which drug may cause a very high body temperature leading to death?
a. Gamma hydroxybutyrate (GHB)
b. Rohypnol
c. Alcohol
d. Ecstasy
ANS: D
A very high body temperature can lead to death when taking ecstasy. GHB, Rohypnol, and Ecstasy are known as “club drugs.”
A nurse is administering medications at school. Which of the following guidelines should be used by the nurse?
a. A current drug reference should be available in case information is needed.
b. The nurse should administer medications brought by the child.
c. Medications cannot be administered without a physician order.
d. Narcotics and controlled substances should be kept in a locked cabinet.
ANS: A
A current drug reference should always be available so it can be consulted for information. All medications should be kept in a locked cabinet. Medications should be in the original container and have the original prescription label on it. The nurse is responsible for giving the medication and is expected by state law to know its action, side effects, and implications.
A nurse is providing education to prevent health problems in children. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Providing education to prevent health problems in children is part of primary prevention. Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Tertiary prevention is the continued care of children who need long-term health care services, along with education within the community.
The nurse is caring for children when they need health care. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
ANS: B
Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention is the continued care of children who need long-term health care services, along with education within the community.
A nurse is providing ongoing care to a pregnant teenager. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
ANS: C
Tertiary prevention is the continued care of children who need long-term health care services, along with education within the community. Ongoing care to a pregnant teenager is part of tertiary prevention. Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.
A nurse identifies a child who may be abused or receives information from a teacher that a child may have been abused. Which of the following actions must the nurse take?
a. Call the police immediately to take the child to a safe place
b. Contact the parents and ask about it
c. Contact the legal authorities as well as the school’s principal
d. Examine the child to see if the abuse really occurred
ANS: C
It is the law in most states for child abuse or suspected child abuse to be reported. When a nurse identifies a child who may be abused, or receives information from a teacher about potential abuse, the nurse must contact the appropriate legal authorities as well as the school’s principal. A confidential file should be made about the incident. In all cases, the child must be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.
A school nurse is preparing to administer a prescription medication to a student. Which of the following information is necessary for the nurse to have?
a. A copy of the prescription label on bottle
b. A small container for the medication
c. Signed consent parental consent form
d. A signed order from the physician
ANS: C
A current, signed parental consent form for administering the medication is essential for the student’s file. The prescribed drug must have the original prescription label on it and be in the original container so that there are no errors. It is recommended that the physician contacts the school nurse or vice versa, but a signed order from the physician is not necessary.
A child’s parents have requested that their child be exempt from obtaining the required immunizations for a religious reason. What action should a school nurse take related to this request in order to be compliant with the law?
a. Deny entry into school for children without the required immunizations
b. Educate the parents about the need for immunizations
c. Be aware of the state laws regarding acceptable reasons for exemption
d. Allow the student to attend school without the immunizations
ANS: C
The state mandates the rules about having immunizations that the nurse must follow. Thus, it is the responsibility of the school nurse to be aware of the laws in the state regarding acceptable reasons for immunization exemption.
Which school health practice may occur in the future?
a. Teaching health education using telehealth and telecounseling
b. Using robotic nurses in schools
c. Fulfilling the role of both classroom teacher and nurse by nurses
d. Developing private practices for treatment of the entire family
ANS: A
Using telehealth and telecounseling to provide health education is useful for homebound students and their parents. It is unlikely that there will be robotic nurses, that nurses will serve the role of both nurse and classroom teacher, and that private practices will be developed to treat the entire family.
A nurse is implementing the Centers for Disease Control and Prevention (CDC) School Health Program within a school. Which components of school health will need to be evaluated? (Select all that apply.)
a. Health promotion for students
b. Nutrition services
c. Counseling, psychological, and social services
d. Health education
e. Community safety
ANS: B, C, D
Components of the CDC School Health Program includes health education, physical education, health services, nutrition services, counseling, psychological, social services, healthy school environment, health promotion for staff, and family/community involvement.
A school nurse is implementing strategies to prevent violence in the school setting. Which of the following interventions would most likely be used? (Select all that apply.)
a. Support policies of zero tolerance for weapons on school property
b. Facilitate student connectedness to the school community
c. Encourage students to lock up and protect their personal property
d. Serve as a positive role model
e. Encourage students to play club sports outside of school
ANS: A, B, D
Supporting policies of zero tolerance for weapons on school property, facilitating student connectedness to the school community, and serving as a positive role model are all strategies that the nurse can use to prevent violence in the school setting. Student connectedness is encouraged if students play sports at school rather than with area clubs. Locking up and protecting personal property is not an effective strategy to prevent violence.
A school nurse develops emergency plans for students who may need immediate care while at school. Which of the following elements should be included in this plan? (Select all that apply.)
a. When to call 911 for local emergency personnel
b. Education about standard precautions for staff members
c. Role children may play in providing basic first aid
d. How to maintain confidentiality and privacy of injured students
e. Where the shelter areas are located at the school
ANS: A, B, C
According to the American Academy of Pediatrics’ (AAP’s) and American Heart Association’s (AHA’s) guidelines, the plan should address when to call 911 for local emergency personnel, education about standard precautions for staff members, and the role that children may play in providing basic first aid. Information related to how to maintain confidentiality and privacy of injured students is not part of the emergency plan. The location of the shelter areas is part of a school-wide emergency or disaster plan, but not for emergency plans for individual students.
The first industrial nurse is considered to be:
a. Betty Moulder.
b. Ada Mayo Stewart.
c. Lillian Wald.
d. Florence Nightingale.
ANS: B
Ada Mayo Stewart was hired in 1885 by the Vermont Marble Company; she is often considered the first industrial nurse. Betty Moulder provided care of ailing coal miners and their families. Lillian Wald is known as the founder of public health nursing. Florence Nightingale is one of the pioneers of the nursing profession.
Which population would have been the focus of care for an occupational health nurse in the early 1900s?
a. Injured workers
b. All workers
c. Families
d. The community
ANS: C
In the early days of occupational health nursing, the nurse’s work was holistic and centered on the family. The care provided by Betty Moulder and Ada Mayo Stewart focused on both ill workers and their families.
A nurse is working in an occupational health setting. Which of the following roles will the nurse most likely have?
a. Administrator
b. Clinicians/practitioner
c. Consultant
d. Educator
ANS: B
An occupational health nurse could be employed in any of these roles. However, the majority of occupational health nurses work as nurse clinicians/practitioners.
A nurse is pursuing certification as an occupational health nurse. Which organization will provide this certification?
a. American Board for Occupational Health Nurses
b. Occupational Safety and Health Education and Research Center
c. National Institute for Occupational Safety and Health (NIOSH)
d. Occupational Safety and Health Administration (OSHA)
ANS: A
Certification in occupational health nursing is provided by the American Board for Occupational Health Nurses. The Occupational Safety and Health Education and Research Center supports master’s and doctoral education with emphases in occupational health nursing, industrial hygiene, occupational medicine, and safety. NIOSH examines potential hazards of new work technologies and practices. OSHA educates employers about occupational health and safety.
A nurse in the occupational health arena is implementing a secondary prevention strategy. Which of the following best describes the action that was taken by the nurse?
a. Providing education on safety in the workplace to prevent injury
b. Working with chronically diabetic workers to ensure appropriate medications
c. Screening for hearing loss resulting from noise levels in the plants
d. Ensuring that a person with cardiovascular disease attends a rehab program
ANS: C
Secondary prevention occurs after a disease process has already begun—screening for hearing loss. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—working with chronically diabetic workers and ensuring that a person with cardiovascular disease attends rehab. Primary prevention is aimed at prevention of a disease before it occurs—providing education on safety in the workplace to prevent injury.
The nurse is doing a walk-through to identify workplace hazards. Which of the following levels of prevention is being implemented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. A walk-through is part of an assessment, which is part of primary prevention. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.
An employer offers a limited duty program after an employee has experienced a cumulative trauma injury. Which of the following levels of prevention is being implemented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: C
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—limited duty program after injury. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.
A nurse is employed in an occupational health setting. Which of the following activities would be a primary role of the nurse?
a. Caring for employees and their families
b. Providing health promotion and emergency care
c. Updating the Material Safety Data Sheets (MSDSs)
d. Reporting communicable diseases
ANS: B
The customary role of the occupational health nurse extends beyond emergency treatment and prevention of illness and injury and also includes the promotion and maintenance of health, overall risk management, care for the environment, and efforts to reduce health-related costs in business. The occupational health nurse does not typically care for families of employees, update MSDSs, or report communicable diseases.
An occupational health nurse is assessing workplace hazards. Which of the following would be the best method for the nurse to use?
a. Review incident reports
b. Walk through the worksite
c. Interview key employees
d. Read the Standard Industrial Classification (SIC) Code
ANS: B
One of the best methods an occupational health nurse can use in assessing workplace hazards is to walk through the worksite. Reviewing incident reports, interviewing key employees, and reading the SIC Code do not provide the nurse with as much information as walking through the worksite.
Which was the first legislation that specifically required certain prevention programs for workers?
a. Occupational Safety and Health Act
b. NIOSH
c. Mine Safety and Health Act
d. SIC Code
ANS: C
The Mine Safety and Health Act was enacted in 1968. It was the first legislation that specifically required certain prevention programs for workers. The Occupational Safety and Health Act established OSHA and NIOSH to carry out the Act’s purpose of ensuring “safe and healthful working conditions for working men and women.” NIOSH examines potential hazards of new work technologies and practices. The SIC Code did not require certain protection programs for workers.
Which types of industries are noted for high degrees of hazards associated with the work?
a. Data entry, animal rescue, and hospice
b. Engineering, science, and laboratories
c. Manufacturing, mining, and agriculture
d. Aeronautics, plastics, and nursing
ANS: C
Manufacturing, mines, construction, and agriculture are noted for their high degree of hazards associated with their work. However, no worksite is free of occupational health and safety hazards.
The most disabling occupational condition reported in 2011 was/were:
a. cuts and punctures.
b. fractures.
c. bruises.
d. sprains and strains.
ANS: D
In 2011, sprains and strains were by far the most frequent disabling conditions, accounting for 38% of the cases of days away from work.
An occupational health nurse is educating employees about work-related hazards. Which of the following hazards would the nurse most likely discuss in the presentation?
a. Workplace stress leading to hypertension and cardiovascular disease
b. Asbestos, plastics, lead, and solvents leading to dermatitis
c. Cement dust and metals leading to bronchitis
d. Hormones and nitroglycerine leading to reproductive effects
ANS: A
Work-related stress or burnout has been defined as an important problem for many individuals. Responses to negative interpersonal relationships, particularly those with authority figures in the workplace, are often the cause of vague health symptoms and increased absenteeism. Education about stress would be pertinent to all workers, regardless of specific job or setting.
A nurse is identifying agents that are part of the epidemiologic triad. Which of the following will the nurse most likely identify?
a. Environmental pollution
b. Radiation
c. Susceptible human beings
d. High-risk groups of individuals
ANS: B
Radiation is an example of an agent. The agents, factors associated with illness and injury, are occupational exposures that are classified as biological, chemical, enviromechanical, physical, or psychosocial. Environmental pollution is part of the environmental factor in the epidemiologic triad. Susceptible human beings and high-risk groups of individuals are part of the host factor of the epidemiologic triad.
A nurse is assessing host factors as part of the epidemiologic triad. Which of the following factors would the nurse most likely assess?
a. Crowding
b. Shift work
c. Worker’s family
d. Chemical exposure
ANS: C
The worker’s family is considered a part of the host factor. Crowding and shift work are environmental factors, and chemical exposure is the agent factor.
Which population is at the greatest risk for experiencing work-related accidents with subsequent injuries?
a. Workers of child-bearing age
b. Workers with less than 1 year of experience
c. Workers with diminished sensory abilities
d. Workers with chronic illnesses
ANS: B
New workers with less than 1 year of experience on the current job are at the greatest risk for experiencing work-related accidents with subsequent injuries. The highest percentages were in mining; agriculture, forestry, and fishing; construction; and wholesale and retail trade.
A nurse is assessing a worker who has had a health reaction to a “safe” low-level exposure. Which of the following most likely describes what has happened?
a. An allergic reaction
b. A compromised immune system
c. Hypersusceptibility
d. Malnutrition
ANS: C
A number of host factors appear to be associated with this hypersusceptibility: light skin, malnutrition, compromised immune system, glucose-6-phosphae dehydrogenase deficiency, serum alpha1-antritrypsin deficiency, chronic obstructive pulmonary disease, sickle cell trait, and hypertension. A worker who has a health reaction to “safe” low-level exposures is experiencing hypersusceptibility.
Which statement about chemical agents is accurate?
a. Chemicals are not ordinarily found in the body tissues of the general population.
b. Most chemicals have been studied to determine the effects of exposure on humans.
c. Chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk.
d. Human effects of chemical exposure are associated with single agents rather than with the interaction of agents.
ANS: C
It is true that chronic exposure to low-level doses of workplace chemicals below standards constitutes a potential health risk. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. As a consequence of general environmental contamination with chemicals from work, home, and community activities, a variety of chemicals have been found in the body tissues of the general population. Predicting human responses to chemical exposures are complicated because multiple chemicals often combine and interact to create a new chemical agent.
An occupational health nurse has conducted a walk-through assessment and has identified potential hazards in the workplace. The nurse recognizes that it will be easiest to modify exposure to which hazard?
a. Bacteria
b. Aerosols
c. Noise
d. Burnout
ANS: C
Controlling physical agents, such as noise, can usually be accomplished through engineering strategies and personal protective equipment. It is much harder to change biological agents (bacteria), chemical agents (aerosols), and psychosocial agents (burnout).
An employee has come into contact with a biological agent. Which of the following considerations should be made by the nurse?
a. The biological agent may cause accidents in the work environment.
b. The biological agent is commonly found in the agriculture industry.
c. The biological agent may potentiate stress in the workplace.
d. The biological agent indicates exposure to bacteria, viruses, fungi, or parasites.
ANS: D
Biological agents are living organisms whose excretions or parts are capable of causing human disease, usually by an infectious process. Biological hazards are common in workplaces such as health care facilities and clinical laboratories where employees are potentially exposed to a variety of infectious agents, including viruses, fungi, and bacteria.
An occupational health nurse is assessing slippery floors as a safety hazard in the work setting. Which of the following best describes the type of hazard the nurse is assessing?
a. Enviromechanical
b. Physical
c. Chemical
d. Psychosocial
ANS: A
Enviromechanical agents are those that can potentially cause injury or illness in the workplace. They are related to the work process or to working conditions, and they can cause postural or other strains that can produce adverse health effects when certain tasks are performed repeatedly. Slippery floors are known as enviromechanical hazards. They can cause or potentiate accidents, injuries, strain, or discomfort.
An occupational health nurse refers an employee to an employee assistance program. Which of the following problems would most likely be addressed?
a. Obesity
b. Smoking
c. Alcohol abuse
d. Lack of exercise
ANS: C
Employee assistance programs are designed to address personal problems such as marital/family issues, substance abuse, or financial difficulties. These issues are addressed because they affect the employee’s productivity. These efforts are cost-effective for businesses.
A nurse is conducting an occupational health assessment. Which of the following best describes the rationale for this assessment?
a. It is required by OSHA.
b. It is required by NIOSH.
c. It helps to identify agent and host factors that place employees at risk.
d. It helps to educate workers about potential hazards.
ANS: C
The purpose of this assessment is to become knowledgeable of the work processes and the materials, the requirements of various jobs, the presence of actual or potential hazards, and the work practices of employees. This assessment allows the nurse to identify agents and host factors that place employees at risk. An occupational health assessment is not required by any organization.
What is the purpose of OSHA?
a. Educate occupational health and safety professionals
b. Identify and research occupational health and safety hazards
c. Distribute research findings relevant to occupational health and safety
d. Educate employers about occupational health and safety
ANS: D
OSHA educates employers about occupational health and safety. NIOSH identifies and researches occupational health and safety hazards, distributes research finding relevant to occupational health and safety, and educates occupational health and safety professionals.
What is the purpose of NIOSH?
a. Examine potential hazards of new work technologies and practices
b. Educate employees about environmental risks and hazards
c. Develop and maintain a database of work-related deaths
d. Set standards that regulate workers’ exposure to potentially toxic substances
ANS: A
NIOSH examines potential hazards of new work technologies and practices. OSHA educates employees about environmental risks and hazards, develops and maintains a database of work-related deaths, and sets standards that regulate workers’ exposure to potentially toxic substances.
An occupational health nurse is assessing the need for MSDSs at the worksite. Which of the following items would require an MSDS?
a. Hand soap
b. Eye goggles
c. Aprons
d. Earplugs
ANS: A
The Hazard Communication Standard requires that all worksites with hazardous substances inventory their toxic agents, label them, and provide information sheets, called MSDSs, for each agent. Hand soap is a toxic agent. Eye goggles, aprons, and earplugs are not toxic agents and therefore, do not need an MSDS.
Which is a requirement of the Superfund Amendment and Reauthorization Act (SARA)?
a. Applying stricter rules to determine Superfund sites
b. Sharing written disaster plans with key resources in the community
c. Authorizing each industry to write their own disaster plan
d. Evaluating the effectiveness of a written disaster plan
ANS: B
SARA requires that written disaster plans be shared with key resources in the community, such as fire departments and emergency departments. SARA does not apply stricter rules, authorize each industry to write their own disaster plan, or evaluate the effectiveness of a written disaster plan.
An occupational health nurse is involved in disaster planning. Which of the following actions would be most appropriate for the nurse to take?
a. Assess for possible disasters
b. Prevent injuries and death of workers
c. Store Medical Data Sheets in a safe place
d. Collaborate with government authorities to plan disaster management
ANS: B
The occupational health nurse is a key player in occupational disasters. The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of different personnel within the company and community. There are not Medical Data Sheets rather MSDSs.
An occupational health nurse is working in an occupational health and safety program. Which of the following services is the nurse most likely to provide? (Select all that apply.)
a. Health/medical surveillance
b. Health screening
c. Case management
d. Job task analysis
e. Counseling
ANS: A, B, C, D
The services provided by onsite occupational health programs range from those focused only on work-related health and safety problems to a wide scope of services that includes primary health care. An occupational health and safety program may include health/medical surveillance, health screening, case management, and job task analysis.
An occupational health has become a member of the AAOHN. Why would a nurse join this organization? (Select all that apply.)
a. To promote the health and safety of workers
b. To lobby in Congress for safer work places
c. To advance the profession by supporting research
d. To promote and provide continuing education in the specialty
e. To obtain certification as a specialist in occupational health nursing
ANS: A, C, D
The AAOHN is the professional organization for occupational health nurses. It supports the work of the occupational health nurse and advances the specialty by: promoting the health and safety of workers, defining the scope of practice and setting the standards of occupational health nursing practice, developing the code of ethics for occupational health nurses with interpretive statements, promoting and providing continuing education in the specialty, advancing the profession through supporting research, and responding to and influencing public policy issues related to occupational health and safety. A nurse joining the AAOHN would most likely not go to lobby in Congress; rather, AAOHN provides a lobbyist to address pertinent issues. Joining the AAOHN will not assist the nurse in obtaining specialty certification.
What has been the focus of the majority of scientific research in forensic nursing?
a. Role of the forensic nurse and client population
b. Sexual assault team response
c. Client satisfaction with forensic nurses
d. Collaboration with other disciplines
ANS: A
Scientific research in forensic nursing is in its early stages. Currently, research is largely a description of the forensic nursing role and client population.
A forensic nurse has collected trace evidence. Which of the following best describes what has been collected?
a. Fingerprints
b. Bloodstains
c. Hand gun
d. Autopsy report
ANS: B
The most common types of trace evidence from victims of violence are clothing, bullets, bloodstains, hairs, fibers, and small pieces of material, such as fragments of metal, glass, paint, and wood.
A nurse uses the scope and standards for forensic nursing practice to differentiate this practice from other nursing specialties. Which parameter best describes the practice of forensic nursing?
a. Assessment includes assessing the community for potential violence.
b. Identification of outcomes of care are accomplished by collaborating with health care professionals.
c. Coordination of care involves education and other strategies to prevent injuries well after the occurrence.
d. Evaluation of outcomes relates to program evaluation.
ANS: D
Coordination of care relevant to forensic outcomes often involves education and other strategies to prevent injuries well after the occurrence, perhaps after the death of an individual who has been injured. Assessment includes the collection of forensic data, identification of realistic outcomes of care are most commonly performed in collaboration with a team of professionals outside of nursing and medicine, and evaluation of outcomes may involve dissemination of results to the client and the community.
A forensic nurse assesses a child who has injuries that indicate possible abuse. What is the best way to document the assessment findings?
a. Tape recorded statements from the child
b. Digital photographs of injuries
c. Video recording to record statements and show injuries
d. Written documentation and photography
ANS: D
Documentation of all forms of violence should include written documentation as well as photography.
What is the main purpose of the National Center for Injury Prevention and Control?
a. Assist victims of violence
b. Maintain records of the incidence of injuries
c. Coordinate the prevention of injuries, violence, and their consequences
d. Encourage collaboration among professionals from various disciplines
ANS: C
The National Center for Injury Prevention and Control was established to coordinate the prevention of injuries, violence, and their consequences. The work of this center includes providing grants that fund prevention programs, dissemination of research findings, and maintenance of a website, blogs, podcasts, and electronic newsletters. This funding helps to inform the public of the epidemiology of injury and to provide other resources for professionals.
A forensic nurse is demonstrating the role of advocate. Which of the following best describes the intervention being performed by the nurse?
a. Partner with public health professionals to implement programming
b. Promote programs that prevent injuries
c. Investigate injuries in the community
d. Provide holistic care to victims of violence
ANS: B
Forensic nurses can demonstrate the role of advocate by promoting programs that prevent injuries. Partnering with public health professionals to implement programming demonstrates collaboration. Investigating injuries in the community demonstrates the role of epidemiologist. Providing holistic care to victims of violence demonstrates the role of caregiver.
A homicide has occurred in a community. To whom would this information need to be reported?
a. United States Public Health Service
b. World Health Organization (WHO)
c. Centers for Disease Control and Prevention (CDC)
d. National Violent Death Reporting System (NVDRS)
ANS: D
The NVDRS was initiated by the CDC in an effort to develop a national state-based surveillance system that could identify the cause and manner of death, leading to prevention efforts by pulling together data on violent deaths, unintentional firearm injury deaths, and deaths of undetermined intent. The United States Public Health Service and WHO have the goal of reducing injury, but homicides are not reported to these organizations.
What is the extent of the economic burden of injuries in the United States?
a. It is extensive, including medical treatment and lost productivity.
b. It is minimal, as limited funds are spent treating injuries.
c. It varies depending on the extent of the injury.
d. It has been reduced through risk reduction strategies.
ANS: A
The economic burden of injuries in the United States is extensive, especially when considering the costs of medical care and treatment, productivity losses (lost wages, accompanying fringe benefits), and lost ability to perform normal household responsibilities.
A nurse is providing emergency care to an assault victim. Which of the following would be the most appropriate action for the nurse to take?
a. Support the privacy of the victim
b. Assess the socioeconomic status of the victim
c. Question the victim about the details of the assault
d. Educate the victim about violence prevention
ANS: A
Supporting the privacy of the assault victim is the most appropriate action for the nurse to take when providing care. When providing emergency care, it is not the most appropriate time to assess the client’s socioeconomic status or educate the victim about violence prevention. The forensic nurse will need to document the victim’s account of the assault; however, there will be law enforcement involved to collect this data.
A forensic nurse implements a program aimed at preventing domestic abuse. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: A
Primary prevention focuses on preventing violence and injuries before they occur—program focused on preventing domestic abuse. Secondary prevention occurs following the occurrence of injuries and crime. This includes direct care provided to victims and perpetrators as well as the collection of evidence. If disability, incarceration, or death occurs, tertiary prevention is applied in settings appropriate to address rehabilitation or identify factors that have put individuals at risk.
A nurse collects evidence from a victim following a sexual assault. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: B
Secondary prevention occurs following the occurrence of injuries and crime. This includes direct care provided to victims and perpetrators as well as the collection of evidence. Primary prevention focuses on preventing violence and injuries before they occur. If disability, incarceration, or death occurs, tertiary prevention is applied in settings appropriate to address rehabilitation or identify factors that have put individuals at risk.
A nurse is providing direct client care while working in a correctional setting. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: C
If disability, incarceration, or death occurs, tertiary prevention is applied in settings appropriate to address rehabilitation or identify factors that have put individuals at risk. Primary prevention focuses on preventing violence and injuries before they occur. Secondary prevention occurs following the occurrence of injuries and crime. This includes direct care provided to victims and perpetrators as well as the collection of evidence.
A nurse is conducting a community assessment in a healthy community. Which of the following findings should the nurse anticipate?
a. Low crime rates
b. High rates of injury
c. Significant health disparities
d. Low mortality rates
ANS: A
The rate of injury and crime is lower in communities that promote good health. Where inequities of resources and education exist, health disparity, violence, and other crimes rise and accidental injuries occur more often.
A nurse is caring for an individual who has been a victim of trauma. Which of the following most likely describes the client that the nurse is caring for?
a. A middle-class, Caucasian female
b. A middle-class, African American male
c. A low-income, Caucasian male
d. A low-income, African American female
ANS: D
Trauma victims are overrepresented in minority, disenfranchised, and disadvantaged groups. Where inequities of resources and education exist, health disparity, violence, and other crimes rise and accidental injuries occur more often.
A nurse assesses the factors that may place a client at risk for injury from a violent act by considering the role these factors play before, during, and after the violent act. The work of which theorist is being applied?
a. Matrix
b. Maslow
c. Haddon
d. Hammer
ANS: C
Haddon developed a matrix when examining methods to identify the risk of injury. The matrix looks at factors related to personal attributes, vector or agent attributes, and environmental attributes before, during, and after an injury or death. Hammer recognized that in forensic nursing practice, the caring component must address caring for oneself as well as caring for clients. Maslow’s theory focuses on clients’ meeting their hierarchy of needs.
A nurse is employed as a forensic nurse during the 1950s. Which of the following tasks would the nurse most likely have been implementing?
a. Working in a sexual assault clinic
b. Identifying indicators of assault
c. Implementing protocols for sexual assault care
d. Receiving sexual assault nurse examiners (SANE) training
ANS: B
During the 1940s through the 1960s, nurses became aware of their role in identifying indicators of assault. The first nurse-run sexual assault clinic opened in 1974, with subsequent development of the first protocols for sexual assault care. SANE programs appeared in the 1990s.
A forensic nurse is implementing Hammer’s definition of caring. Which of the following actions would the nurse most likely perform?
a. Utilizing intuition when assessing a client
b. Providing self-care and care for the client
c. Assuring that the client’s basic needs are met
d. Assessing the bio-psychosocial and spiritual characteristics of the client
ANS: B
Hammer recognized that in forensic nursing practice the caring component must address caring for oneself as well as caring for clients. A sense of self-worth must be cultivated and nurtured to the degree that caring is conscientious, objective, and demanding of the scientific truth. Caring must also be curious and questioning; it should be directed toward colleagues; and finally, caring should be about firm and valued concepts that inform practice.
Which setting is a forensic nurse most likely to be employed?
a. Physician’s office
b. Urgent care center
c. School-based health center
d. Medical examiner’s office
ANS: D
Practice arenas for forensic nurses include health care facilities such as private clinics and emergency departments, criminal justice centers for victims of crime, medical examiner offices, police departments, correctional facilities, and mental health centers.
A nurse may need to use medical coercion with a client. Which of the following medical diagnoses would the client most likely have?
a. Human immunodeficiency virus (HIV)
b. Depression
c. Schizophrenia
d. Hypertension
ANS: C
Medical coercion may be necessary in certain situations. These situations include incapacity to make decisions and making decisions that could result in harm to self or harm to others in the absence of interventions. For instance, mentally ill inmates may be medically coerced to take psychotropic medications against their will if the mental disorder is serious, the inmate is dangerous to himself, and the medication prescribed is in the inmate’s best medical interest. Schizophrenia is the diagnosis most likely to require medical coercion.
A nurse vocalizes a concern that a group of refugees in the community is not receiving equal access to health care services when compared to the other residents in the community. Which of the following concepts is being applied?
a. Victimization
b. Perceptivity
c. Questioning
d. Beneficence
ANS: A
Victimization occurs when individuals or groups are treated unfairly; generally when there is an imbalance of power. Perceptivity, as an element of intuitiveness, is one tool the forensic nurse uses to investigate injury; it involves an increased awareness of human behavior and environment that is interpreted by knowledge and lived experience in making expert decisions. Questioning has led to a greater understanding of what most would consider the unexplainable and unimaginable. Beneficence is an ethical principle that relates to caring.
A forensic nurse is applying the concept of distributive justice. Which of the following questions would be most appropriate for the nurse to ask?
a. How will limited funds be spent?
b. Who will benefit the most from the services?
c. How will an additional service benefit the population?
d. How will the privacy of the population be respected?
ANS: A
Principles of distributive justice address questions in deciding what goods will be distributed to which persons in what proportions. This is best addressed by asking “How will limited funds be spent?” The principle of beneficence is addressed through “Who will benefit the most from the services?” and “How will an additional service benefit the population?” The principle of confidentiality is addressed through the question “How will the privacy of the population be respected?”
A forensic nurse plans to collaborate with another professional to provide care to the client. Which of the following professionals would the nurse be most likely to collaborate with?
a. Social worker
b. Corrections officer
c. Clinic manager
d. Dietician
ANS: B
Forensic nurses collaborate with corrections officers and law enforcement, epidemiologists, emergency department providers, psychiatric practitioners, and public health nurses.
How would a registered nurse become a forensic nurse? (Select all that apply.)
a. No additional education is needed after obtaining an undergraduate nursing degree
b. Complete additional course work in police science
c. Enroll in a certificate program for forensic nursing
d. Select a graduate program that offers a track in forensic nursing
e. Complete a nurse practitioner program
ANS: C, D
There are three primary routes for training in forensic nursing. Additional skills and knowledge can be gained through continuing education courses or basic concepts introduced in generalist education. Certificate programs and graduate programs offer additional opportunities to specialize in forensic nursing.
A nurse would like to obtain certification as a forensic nurse. Which specialty certifications are available for the forensic nurse? (Select all that apply.)
a. Legal Nurse Consultant
b. Death Investigator
c. Adolescent and adult SANE A
d. Forensic Consultant
e. Forensic nurse
ANS: A, B, C
Certification is available as an adolescent and adult SANE A, Legal Nurse Consultant, and Death Investigator. Forensic Consultant and forensic nurse are not certifications that are available.
Which is considered a forensic environment? (Select all that apply.)
a. Crime scene
b. Courtroom
c. Mental health nursing unit
d. Prison
e. Emergency department
ANS: B, D
Forensic environments include courtrooms, jails, prisons, and psychiatric facilities for the criminally insane.
