LA#4 - Stanhope Chap 3 and 12

Question 1

While taking a family history, the community health nurse (CHN) finds out that the husband is a stepfather to the eldest child. This information should be documented as falling into which category?a.Family demographicsb.Family dynamicsc.Family functiond.Family system

Answer 1

AFamily demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing.

Question 2

The CHN needs to conduct a family assessment for a family that lives in a commune, but is uncertain about how to proceed because family lines appear blurred. Which one of the following questions should the CHN ask to determine the structure of a family comprising a mother and a child?a.“How many children do you have, and who is the father of each of them?”b.“Is there a register of families that are members of this commune?”c.“Tell me about your significant other.”d.“Who are the members of your and your child’s family?”

Answer 2

DThe members of a family are self-defined. CHNs working with families should ask people who they consider to be their family and then include those members in health care planning.

Question 3

Family functions and structures create unique challenges in family nursing. Which of the following is the primary reason for the existence of these challenges?a.The function and structure of families continue to change over time.b.Function and structure do not apply to all family units.c.Some clients do not have families.d.Traditional families are rare in today’s society.

Answer 3

AThe functions within families have evolved and changed over time. Some have become more important and others less so. Family structures also have changed over time. The structure–function theory perspective is a useful framework for assessing families and health. Illness of a family member results in the alteration of the family structure and function.

Question 4

Historically, CHNs focused on the care of individuals while viewing the families of individuals as either background resources or possible stressors. Which view of the family did this traditional conceptualization take?a.Family as the clientb.Family as a component of societyc.Family as contextd.Family as a system

Answer 4

CFamily as the context, or structure, represents a traditional focus that places the individual first and the family second. This conceptualization views the family as either a resource or a stressor to individual health and illness.

Question 5

A CHN researcher wants to know and better understand how the chronic illness of a child can affect a family’s communication patterns, relationships, role expectations, and role behaviours. Which of the following types of family nursing theory would best address the purpose of the CHN’s research?a.Developmental theoryb.Interactional theoryc.Structure–function theoryd.Systems theory

Answer 5

BAn interactional framework emphasizes interaction between and among family members and family communication patterns about health and illness behaviours appropriate for different roles.

Question 6

Which one of the following nursing functions that identify family problems and strengths is the foundation for family nursing interventions?a.Assessmentb.Planc.Implementationd.Evaluation

Answer 6

AFamily nursing assessment is the cornerstone for family nursing interventions. With use of a systematic process, family problem areas are identified and family strengths are emphasized, thus laying the foundation for interventions. The CHN works in partnership with the client to promote health. Each family nursing assessment model and approach is unique and creates a database upon which to plan interventions.

Question 7

Which of the following scenarios is an example of a normative event that can increase the risk for illness?a.A family is involved in a motor vehicle accident.b.A group of teens experiments with recreational drugs.c.A woman is pregnant with her first child.d.The family’s only earning member is laid off from work.

Answer 7

CCertain life events can increase the risk for illness and disability. Normative events are those events that are generally expected to occur at a particular stage of development or of the lifespan of a person. The normative event of the birth of a child, for example, requires considerable changes in family structures and roles. Furthermore, family functions are expanded from previous levels, requiring families to add new skills and establish additional resources.

Question 8

When drawing a genogram, which one of the following will the CHN use to demonstrate a marital relationship between two individuals?a.A broken lineb.A dashed linec.A solid lined.Two parallel lines

Answer 8

CIn a genogram, marriage is indicated by a solid line between two individuals.

Question 9

A CHN is preparing to terminate a visit with teenage parents and their new baby. During this phase of the home visit, which of the following actions will the CHN want to take?a.Determine the family’s willingness for home visits.b.Establish the purpose of the visit.c.Review important points of teaching discussed during the visit.d.Review the family record and reason for referral.

Answer 9

CDuring the termination phase, the CHN reviews the visit with the family and plans for future visits. The other options listed occur during the engagement phase.

Question 10

A CHN has just signed as a witness to an agreement between a couple, in which they pledge not to yell at each other in the presence of their children. What is this approach to improving family health called?a.Contractingb.Crisis interventionc.Empowermentd.Strategic planning

Answer 10

AContracting, the making of an agreement between two or more parties, involves a shift in responsibility and control toward a shared effort by the clients and the professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthy choices is increased.

Question 11

Which one of the following is the most important predictor of health?a.Biological riskb.Economic riskc.Life-event riskd.Health values

Answer 11

BEconomic risk is one of the foremost predictors of health and is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources enables the family to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

Question 12

Which of the following actions by the CHN has the most potential to empower the family of a mother with newly diagnosed breast cancer?a.Applying for emergency financial assistance on the family’s behalfb.Arranging for community members to assist with child carec.Recommending that the mother join a cancer support groupd.Teaching the family how to navigate the health care system

Answer 12

DDefinitions of empowerment reflect three factors involved in a family seeking help: (1) access and control over needed resources, (2) decision-making and problem-solving abilities, and (3) the ability to communicate and to obtain needed resources. Applying for emergency financial assistance and arranging for community members to assist with child care are enabling interventions. Recommending that the mother join a cancer support group, although certainly helpful for coping, is not a component of empowerment.

Question 13

The CHN conducting a health risk appraisal assesses which one of the following?a.Health promotion activitiesb.Illness prevention activitiesc.Risk reduction activitiesd.Unhealthy events

Answer 13

DHealth risk appraisal refers to the process of assessing and analyzing in order to identify specific factors in each of the categories associated with an increased likelihood of development of an illness, such as cancer, or an unhealthy event, such as a motor vehicle accident.

Question 14

During which of the following phases should documentation of home visits take place?a.Engagement phaseb.In-home phasec.Termination phased.Postvisit phase

Answer 14

DEven after a CHN has concluded a home visit and left the client’s home, the responsibility for the visit is not complete until the interaction has been recorded. Documentation of the visit is a basic requirement for legal and clinical purposes. It is important that the recording be current, dated, and signed.

Question 15

In a predominantly poor community, where eating clay (pica) is a common practice, through which of the following actions can the CHN intervene at the tertiary prevention level?a.Helping the clients obtain extra welfare money, after explaining that clay, although filling, does not provide necessary nutrientsb.Initiating early intervention in the school system through education programs designed to focus on healthy food choicesc.Conducting laboratory testing and physical assessments to identify nutritional deficits resulting from pica and the lack of regular food intaked.Surveying families to determine the presence and extent of pica

Answer 15

ATertiary prevention is undertaken to prevent additional health problems when a problem has already occurred. Initiating early intervention to focus on healthy food choices in the school system is an example of primary prevention. Laboratory testing to identify nutritional deficits and surveying families to determine presence of pica are screening activities to determine if problem behaviour is present and to identify it in the early phases. Screening activities are representative of secondary prevention.

Question 16

Which of the following categories is addressed by the developmental assessment aspect of the Calgary Family Assessment Model (CFAM)?a.Family life-cycle stagesb.Instrumental and expressive functionsc.Activities of everyday livingd.Family strengths

Answer 16

AWithin the CFAM, developmental assessment contains family life-cycle stages, tasks usually achieved in relation to life-cycle stages, and attachments for the family.

Question 17

Which of the following best describes the concept of public health?a.A population health approach designed to prevent disease, promote health, and protect populationsb.Health care provision offered in primary and secondary institutions or in clients’ homesc.Provision of health care services in institutions located in the community but outside the hospitald.Use of the nursing process and evidence-informed practice to meet the objectives for community health improvement

Answer 17

AIn Canada, public health takes a population health approach to protecting and promoting health and preventing disease for all Canadians. Public health nurses (PHNs) work with many partners, both within the public health unit or health authority (e.g., nutritionists, epidemiologists, dental hygienists, health inspectors) and external to the health unit (e.g., community coalitions for heart health, cancer screening, diabetes, and obesity prevention; school and hospital administrators; regional planners; social service and child-care workers; lobbyists for health issues such as antismoking legislation and homelessness).

Question 18

The increasing complexity of societal needs and rapid changes in public health no longer allow adequate time for on-the-job training and education. As a result, which of the following is the current minimum level of educational preparation for a military nurse?a.Training as a registered practical nurseb.Training as a registered nursec.A baccalaureate degree in nursingd.A master of science degree in nursing

Answer 18

CEducational preparation for military nurses should be at least a baccalaureate degree.

Question 19

Which of the following is a core competency required of PHNs?a.Advanced knowledge in the use of high-technology diagnosticsb.Familiarity with current life-support technologyc.Highly tuned skills for assessment of critically ill clientsd.Skill in developing policy and planning programs to improve health

Answer 19

DSkill in developing policy and planning programs to improve health is part of the set of core public health competencies, which are divided into the following eight domains: 1) Public Health and Nursing Sciences; 2) Assessment and Analysis; 3) Policy and Program Planning, Implementation, and Evaluation; 4) Partnerships, Collaboration, and Advocacy; 5) Diversity and Inclusiveness; 6) Communication; 7) Leadership and Professional Responsibility; and 8) Accountability. The other competencies listed are better suited to nurses who work in tertiary facilities, such as hospitals.

Question 20

A public health administrator is in the process of hiring a new PHN. Which of the following statements by a potential employee would raise the greatest concern for the employer?a.“I like to be the only person working on a project because individual team members have their own ideas and plans, and the resulting debate slows progress.”b.“I prefer to work in teams because no single person has too much responsibility and the burden is shared.”c.“Teamwork is better than work done by individuals because teamwork incorporates different perspectives.”d.“Whether teamwork is better than work done by individuals depends on the nature of the work being performed.”

Answer 20

AWorking in collaborative partnerships is an essential role of public health nursing. Partnerships and collaboration among groups are much more powerful in making changes than are the individual client and the PHN working separately. Part of the reason for this is that multiple perspectives are examined in the process of arriving at the best solution.

Question 21

Which one of the following is a primary prevention activity for decreasing the incidence of communicable diseases?a.Identifying and treating clients in a clinic for sexually transmitted infections (STIs)b.Partnering with school teachers to teach handwashing to elementary school children and observe their techniquesc.Providing case management services that link clients with communicable diseases to health care and community support servicesd.Providing directly observed therapy (DOT) to clients with active tuberculosis (TB)

Answer 21

BAn example of primary prevention is to educate daycare centres, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases.

Question 22

A PHN is participating in which activity when tracing the sexual contacts of clients with STIs for screening purposes?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Secondary and tertiary prevention

Answer 22

APrimary prevention activities include contacting and tracing individuals exposed to a client with an active case of TB or an STI. Once contact has been made, the actual screening is a secondary prevention activity.

Question 23

Through which one of the following actions can the community health nurse (CHN) provide tertiary prevention?a.Disseminating information about mental health to community organizationsb.Partnering with PHNs for early identification of children with mental health challengesc.Providing case management services that link clients with serious mental illnesses to mental health and community support servicesd.Screening clients at high risk for mental disorders

Answer 23

CAn example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services.

Question 24

Which of the following represents the primary difference between parish nursing and all other fields of nursing?a.Affiliation with a church or congregationb.Incorporation of spiritual aspects into nursing carec.Provision of holistic nursing cared.Residence within the community of service

Answer 24

AParish nurses are found in faith congregations, including communities that serve diverse cultures. Parish nurses also serve faith communities in other countries.

Question 25

To help congregation members better meet their nutritional needs, a parish nurse encourages them to participate in activities that focus on fellowship, as well as serving healthy meals to both attending and homebound church members. What do programs such as this exemplify?a.Entitlement programsb.Health ministriesc.Partnershipsd.Pastoral care practices

Answer 25

BHealth ministries comprise those activities and programs in faith communities that are organized around health and healing to promote whole health across the lifespan. Health ministries’ services may be specifically planned or informal and may include visiting the homebound, providing meals for families in crisis or for those returning home after hospitalization, organizing prayer circles, volunteering in community HIV/AIDS care groups, serving “heart healthy” church suppers, and holding regular grief support groups.

Question 26

As part of primary prevention, a parish nurse wants to encourage some elementary school students to increase their vigorous exercise. Which action by the parish nurse will help these students attain an improved health status?a.Encouraging families to ensure that the students receive healthy diets and plenty of restb.Fostering relationships among families with children of similar ages so that they can work together toward goal attainmentc.Partnering with a youth pastor to establish sports activities that will include those individuals with special needsd.Working with faith-based school teachers to include in the curriculum teaching about healthy diet and food selection

Answer 26

CParish nursing’s goal is to develop and sustain health ministries within faith communities. Some of the usual functions of parish nurses include providing personal health counselling and health education, acting as a liaison between the faith community and the local community, facilitating activities, and providing pastoral care.

Question 27

Which statement by a parish nurse exhibits a misunderstanding of the concept of pastoral care?a.“By working with my clients to help them identify their spiritual strengths, I am drawing on the pastoral care aspects of practice.”b.“I incorporate pastoral care in my practice when I involve the pastor in ministering to the members of the congregation.”c.“I am practising pastoral care when I emphasize the spiritual dimension of nursing while providing care.”d.“Lending support to clients during their times of joy as well as times of sorrow is part of providing pastoral care.”

Answer 27

BPastoral care by a parish nurse implies providing care by stressing the spiritual dimension of nursing, lending support during times of joy and sorrow, guiding the person through health and illness throughout life, and helping identify the spiritual strengths that assist in coping with particular events. The parish nurse is able to provide pastoral care; she or he does not have to involve the pastor.

Question 28

Through which one of the following interventions can the parish nurse implement primary prevention of obesity in school-aged church members?a.Establishing a walking program that is sufficiently challenging, yet not too strenuous, for those who are obeseb.Partnering with youth camp cooks to ensure that a nutritious diet is providedc.Supervising height and weight measurements taken by clinic assistantsd.Working with parents of obese children to implement lifestyle changes in the family

Answer 28

BAn example of primary prevention is encouraging the provision of healthy snacks and meals to children and adults at all events inside and outside of school.

Question 29

What is the basic difference between home health care and other types of health care?a.Home health care is individualized care for the client and family.b.Home health care is provided in the client’s environment.c.Reimbursement for home health care is different from that of care provided in institutions.d.Home health care focuses on community health.

Answer 29

BHome health care differs from other types of health care in that home health care providers practice in the client’s environment.

Question 30

A CHN has just received word that the provincial health care plan will provide compensation for the care that she provided to a homeless man with schizophrenia, who was unwilling to come to the clinic to receive health care. How can this type of nursing service be best classified?a.Community-oriented nursingb.Home health nursingc.Hospice nursingd.Private duty nursing

Answer 30

BHome health nursing is provided in the client’s environment, wherever that may be. “Home” may be a house, apartment, trailer, boarding and care home, shelter, car, makeshift shelter under a bridge, or cardboard box.

Question 31

Which of the following is the best way a home health nurse (HHN) can help a client who has right-sided paresis secondary to a stroke?a.Arranging for private duty nurses to assist the client with daily needsb.Assisting the client with activities of daily living (ADLs)c.Teaching self-care to the clientd.Teaching the family to assist the client with ADLs

Answer 31

CBecause home health care is often intermittent, a primary objective for the HHN is to facilitate self-care. This allows clients to have some control over their lives and activities and can help prevent hopelessness and a loss of self-esteem. Although assistance may be provided occasionally, this comes after helping clients help themselves.

Question 32

An HHN in training states, “I don’t understand why we have to collaborate with so many other disciplines. Doesn’t this conflict with the concept of holistic nursing practice?” Which of the following statements would be the best response by an experienced colleague?a.“The nurse still functions holistically; however, interdisciplinary collaboration is necessary to prevent fragmentation of care.”b.“Holistic nursing is a concept applied to care in tertiary facilities such as hospitals, where materials are centrally located in one facility. In home health, this is not possible.”c.“Even though home health nursing is not as holistic as other areas of community health nursing, each discipline contributes to client needs from its special knowledge base.”d.“Yes, it does create conflict, but we as nurses are mandated to practise interdisciplinary collaboration.”

Answer 32

AHome health nursing involves interdisciplinary care. Coordination of care provided by an interdisciplinary team is an essential indirect function of the HHN. Team conferences are an ideal time for enhancing collaboration and continuity of services for optimal client care and use of resources and services. Without effective collaboration, there would be no continuity of care and the client’s home care program would be fragmented. This does not conflict with the concept of holism, however. Holism does not require that the HHN provide all services (i.e., direct client care). Many services, such as coordination of care, provide indirect care and contribute to holistic nursing care provision.

Question 33

A family member asks an HHN to explain the concept of hospice care. Which of the following actions would the HHN need to include as the fundamental underlying philosophy of hospice?a.Making it possible for the client to die at homeb.Ensuring that the client’s living will is honouredc.Placing experts in the position of power of attorneyd.Providing comfort measures before death

Answer 33

DHospice care refers to the delivery of palliative care to the very ill and dying, offering both respite and comfort. If the client and family agree, hospice care can be comfortably delivered at home with family involvement under the direction and supervision of health care providers, especially a home health nurse.

Question 34

In an effort to prevent drug abuse among junior high–school students, a CHN has enlisted the assistance of high-school role models in the areas of both sports and scholarship for an antidrug presentation. Which level of prevention is represented by this activity?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Both primary and secondary prevention

Answer 34

ACHNs partner with the community to develop programs in response to identified needs. Primary prevention interventions by the CHN include educating children and adolescents about the effects of illegal drugs (e.g., marijuana, cocaine, and heroin) and alcohol abuse. By educating students, the CHN helps them stay away from these harmful substances. It is not both primary and secondary because secondary prevention involves screening, which would not take place in this instance.

Question 35

The CHN has arranged for students in all classes at the local school to receive visual acuity testing to determine if they need glasses. Which level of prevention is represented by this activity?a.Primaryb.Secondaryc.Tertiaryd.Both primary and secondary

Answer 35

BCHNs implement screening programs for genetic disorders or metabolic deficiencies in newborns; breast, cervical, and testicular cancers; diabetes; hypertension; and sensory impairments in children. They also ensure follow-up services for clients with positive test results. Secondary prevention involves screening children for illnesses or conditions. In this instance, visual acuity testing is being used to screen for visual problems requiring corrective lenses.

Question 36

A CHN is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which level of prevention is represented by this activity?a.Primaryb.Secondaryc.Tertiaryd.Both primary and secondary

Answer 36

CCHNs provide case management services that link clients with chronic illnesses to health care and community support services. Tertiary prevention includes caring for children with long-term health concerns, such as asthma, and disabling conditions. At first glance, this appears to have elements of primary and secondary prevention, but this is not the case because primary prevention aims at ensuring that a condition does not develop (whereas these children already have the disease). Furthermore, although the children are being taught techniques for recognizing respiratory danger, it is in the context of disease management (i.e., when to use an inhaler).

Question 37

Which of the following is being implemented by the occupational health nurse (OHN) who removes a foreign body from a client’s eye?a.Primary careb.Primary preventionc.Secondary preventiond.Tertiary prevention

Answer 37

AThe nurse is implementing primary care of the client. This action does not meet the criteria for injury prevention because the injury has already occurred and the OHN is providing treatment for the injury. Prevention strategies will need to follow treatment to prevent recurrence and to prevent development of secondary problems related to the foreign body.

Question 38

Which of the following is being practised by the OHN who periodically conducts spirometry testing of employees working with hazardous gases?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Tertiary care

Answer 38

BSecondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible stage and elimination or modification of the hazard-producing situation.

Question 39

An employee in a laboratory drops a flask, resulting in the chemical splashing into her eyes. Which of the following is the agent in this scenario?a.Chemicalb.Employeec.Flaskd.Laboratory

Answer 39

AThe agents, or factors associated with illness and injury, comprise occupational exposures that are classified as biological and infectious, chemical, ergonomic, physical, or psychosocial hazards.

Question 40

A hospital nurse working in employee health notes that several nurses from one unit are missing from work after having contracted a communicable disease from a client. In this scenario, which one of the following is the host?a.Each sick nurseb.The communicable diseasec.The hospitald.The client

Answer 40

AThe host is described as any susceptible human being; each sick nurse represents a host within the worker population group.

Question 41

Which one of the following hazards tends to particularly affect employees who work in 2-week shifts?a.Biological hazardsb.Environmental hazardsc.Physical hazardsd.Psychosocial hazards

Answer 41

DPsychosocial hazards are factors and situations encountered or associated with one’s job or work environment that create or potentiate stress, emotional strain, or interpersonal problems.

Question 42

Which of the following is the primary role of the forensic nurse in Canada?a.Health promoterb.Disaster plannerc.Sexual assault nurse examiner (SANE)d.Outreach worker

Answer 42

CIn Canada, forensic nurses primarily work as SANEs.

Question 43

From which of the following health care professionals is a rural resident with asthma more likely to receive health care services?a.Allergistb.Nurse practitionerc.Pediatriciand.Pulmonologist

Answer 43

BIn rural communities, often a health care professional may live and practise in a community for decades, also providing care to people who live in several other communities. A limited number of CHNs, such as PHNs or nurse practitioners, may offer a full range of services for all residents in a specified area, which may span more than 150 km. Consequently, rural physicians and CHNs provide care to individuals and families with all kinds of conditions, in all stages of life, and across several generations. In urban communities, residents are more likely to seek care from a medical specialist.

Question 44

In addition to the common barriers faced by most rural residents, which one of the following is an additional barrier to health care that a Mexican migrant farm worker is more likely to encounter?a.Absence of culturally appropriate careb.Availability of specialistsc.Distance of health care facilities from the place of residenced.Lack of anonymity

Answer 44

ABarriers to health care affecting all rural clients may be the availability, affordability, or accessibility of services and professionals. Two pertinent identified barriers to health care in rural areas are language barriers and lack of culturally appropriate care and services.

Question 45

For the CHN who plans to move from an urban centre to a rural region of the country, which one of the following statements should be included in the advice on preparing for role alterations?a.“Community members will probably hold you in higher regard and will look up to you.”b.“Expect to have less autonomy than you have working as a CHN in the city.”c.“You can expect more resources and supplies because there are fewer clinics.”d.“You will need to focus on developing specialized knowledge and skills.”

Answer 45

ACHNs working in rural areas have a prestigious status in the community and are viewed as role models. They have greater (not less) independence and autonomy as well as fewer (not more) resources, and they need to have more generalist (not specialized) knowledge and skills.

Question 46

Which of the following primarily distinguishes case management from managed care?a.Case management is a tool for health maintenance organizations.b.Case management is targeted toward a specific segment of the population.c.Case management is implemented with individual clients.d.Case management is used to monitor the health status, resources, and outcomes for an aggregate.

Answer 46

CCase management, in contrast to managed care, comprises activities implemented with individual clients in the system.

Question 47

For a CHN, which of the following describes the goal of advocacy?a.Gaining organizational and governmental support for the promotion of nursing objectivesb.Improving community service needs identified by research findingsc.Integrating evidence-informed practice guidelines in the provision of community nursing serviced.Promoting self-determination in a client, family, group, or community

Answer 47

DThe goal of advocacy is to promote self-determination in a constituency or client group. The constituency may be a client, family, group, or community. The advocate role includes the following three major strategies: (1) interacting with clients and families, (2) interacting with other health care providers, and (3) working through the system.

Question 48

Research demonstrates that exercise is important for general wellness and weight control. The CHN can use this information to implement primary prevention by doing which of the following?a.Developing individualized exercise programs for overweight childrenb.Drafting policy for increases in noncompetitive physical activity programsc.Monitoring body mass index in children to identify elevations before they become difficult to managed.Notifying parents or guardians of their child’s height–weight scale in comparison with national norms

Answer 48

BAt the primary prevention level, campaigns to support regular exercise, greater emphasis on school-based physical education programs, and environmental and policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children. Developing individualized exercise programs for overweight children is an example of tertiary prevention. Monitoring body mass index in children to identify elevations before they become difficult to manage is an example of secondary prevention. Notifying parents or guardians of their child’s height–weight scale in comparison with national norms increases family awareness but does not meet the definition of a preventive measure.