Exam 4 Flashcards

Question

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.

Answer 1

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.

Answer 2

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).

Answer 3

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 Because of the problems that were caused, prohibition was eventually recognized as a failure and repealed.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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.

Answer 9

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.

Answer 10

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.

Answer 11

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.

Answer 12

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

Answer 13

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.

Answer 14

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.

Answer 15

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.

Answer 16

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.

Answer 17

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.

Answer 18

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.

Answer 19

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.

Answer 20

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.

Answer 21

ANS: A, B, C, D Gastrointestinal disturbances, cardiac dysrhythmias, depression, and organic brain syndrome are some effects of chronic alcohol abuse

Answer 22

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.

Answer 23

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.

Answer 24

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.

Answer 25

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.

Answer 26

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.

Answer 27

ANS: C | The greatest risk factor for actual and attempted suicide in adult women is intimate partner violence.

Answer 28

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.

Answer 29

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.

Answer 30

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.

Answer 31

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.

Answer 32

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.

Answer 33

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.

Answer 34

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.

Answer 35

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.

Answer 36

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.

Answer 37

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.

Answer 38

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.

Answer 39

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.

Answer 40

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.

Answer 41

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.

Answer 42

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.

Answer 43

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.

Answer 44

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.

Answer 45

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

Answer 46

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.

Answer 47

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.

Answer 48

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.

Answer 49

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.

Answer 50

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.

Answer 51

ANS: B | Primary health care includes public health and primary care services by definition

Answer 52

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.

Answer 53

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.

Answer 54

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.

Answer 55

ANS: C | Certification for APHNs and NPs is for 5 years.

Answer 56

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

Answer 57

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.

Answer 58

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.

Answer 59

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.

Answer 60

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

Answer 61

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.

Answer 62

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.

Answer 63

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.

Answer 64

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.

Answer 65

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.

Answer 66

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.

Answer 67

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.

Answer 68

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.

Answer 69

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.

Answer 70

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.

Answer 71

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.

Answer 72

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.

Answer 73

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.

Answer 74

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.

Answer 75

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.

Answer 76

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.

Answer 77

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.

Answer 78

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.

Answer 79

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.

Answer 80

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.

Answer 81

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.”

Answer 82

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.

Answer 83

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.

Answer 84

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.

Answer 85

ANS: B | The Omaha System Problem Rating Scale for Outcomes uses the concepts of Knowledge, Behavior, and Status.

Answer 86

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.

Answer 87

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.

Answer 88

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.

Answer 89

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.

Answer 90

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.

Answer 91

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.

Answer 92

ANS: A | Medicare introduced regulations for home care practice as well as for reimbursement mechanisms.

Answer 93

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.

Answer 94

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.

Answer 95

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.

Answer 96

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.

Answer 97

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.

Answer 98

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.

Answer 99

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.

Answer 100

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.

Answer 101

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.

Answer 102

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.

Answer 103

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.

Answer 104

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.

Answer 105

ANS: B | The leading cause of death in children and teenagers is injuries.

Answer 106

``` 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. ```

Answer 107

ANS: D A very high body temperature can lead to death when taking ecstasy. GHB, Rohypnol, and Ecstasy are known as “club drugs.”

Answer 108

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.

Answer 109

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.

Answer 110

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.

Answer 111

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.

Answer 112

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.

Answer 113

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.

Answer 114

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.

Answer 115

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.

Answer 116

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.

Answer 117

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.

Answer 118

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.

Answer 119

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.

Answer 120

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.

Answer 121

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.

Answer 122

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.

Answer 123

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.

Answer 124

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.

Answer 125

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.

Answer 126

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.

Answer 127

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.

Answer 128

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.

Answer 129

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.

Answer 130

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.

Answer 131

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.

Answer 132

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.

Answer 133

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.

Answer 134

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.

Answer 135

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.

Answer 136

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.

Answer 137

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).

Answer 138

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.

Answer 139

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.

Answer 140

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.

Answer 141

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.

Answer 142

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.

Answer 143

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.

Answer 144

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.

Answer 145

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.

Answer 146

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.

Answer 147

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.

Answer 148

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.

Answer 149

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.

Answer 150

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.

Answer 151

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.

Answer 152

ANS: D | Documentation of all forms of violence should include written documentation as well as photography.

Answer 153

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.

Answer 154

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.

Answer 155

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.

Answer 156

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.

Answer 157

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.

Answer 158

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.

Answer 159

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.

Answer 160

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.

Answer 161

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.

Answer 162

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.

Answer 163

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.

Answer 164

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.

Answer 165

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.

Answer 166

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.

Answer 167

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.

Answer 168

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.

Answer 169

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?”

Answer 170

ANS: B Forensic nurses collaborate with corrections officers and law enforcement, epidemiologists, emergency department providers, psychiatric practitioners, and public health nurses.

Answer 171

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.

Answer 172

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.

Answer 173

ANS: B, D | Forensic environments include courtrooms, jails, prisons, and psychiatric facilities for the criminally insane.