LA 7- Chapter 11 Stanhope, Chapter 20 Stamler

Question 1

Which one of the following is the designation given to groups at high risk of having poor health outcomes?

a. Cumulative risk groups
b. Health disparity groups
c. Resilient populations
d. Vulnerable populations

Answer 1

Ans. D

Question 2

Which one of the following is the best intervention a community health nurse (CHN) can initiate to increase lasting resilience among new immigrants?

a. Directing clients to English-as-a-second-language courses
b. Giving immigrant clients money to help them get settled
c. Identifying areas in the city where housing is less expensive
d. Soliciting donations for food, clothing, and other needs

Answer 2

Ans. A

Question 3

Which of the following interventions by the CHN would best serve a vulnerable population?

a. Addressing multiple health concerns, including preventive education, when clients present for treatment of an illness
b. Establishing a system of networks so that clients may be referred to different services such as preventive care, acute illness care, and chronic treatment
c. Providing acute care services that focus on the client’s main health concern and setting up appointments at discharge for other concerns
d. Referring clients to specialists to address specific health concerns

Answer 3

Ans. A

Question 4

Which definition accurately reflects the meaning of the term health inequities?

a. Health inequities are the accumulation of multiple factors that lead to poor health.
b. Health inequities occur when people are more inclined to become ill and usually do not seek appropriate care.
c. Health inequities are unfair differences in health that could be avoided with reasonable action.
d. Health inequities are wide variations in health status and services among certain population groups.

Answer 4

Ans. C

Question 5

Which of the following is a primary cause of vulnerability?

a. Breakdown of family structures
b. Poverty
c. Prejudice
d. Social isolation

Answer 5

Ans. B

Question 6

Which level of prevention is a CHN practising when she offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive?

a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Secondary and tertiary prevention

Answer 6

Ans. B

Question 7

A CHN is orienting a new recruit to a health clinic that primarily serves vulnerable populations. Which of the following statements by the CHN indicates a need for additional information?

a. “If a client who does not speak English comes in, you must obtain an interpreter right away.”
b. “We try to take care of as many problems as possible in one visit, so when you check the client in, ask about additional concerns.”
c. “You will like working with Filipino immigrants because they have close-knit family structures.”
d. “You will need to assist the client by scheduling any referral or follow-up appointments.”

Answer 7

Ans. C

Question 8

While screening for diabetes at a community clinic, a CHN found out that a new client had type 2 diabetes. The CHN then provided counselling, referred the client to an endocrinologist for initial assessment and treatment, helped with arrangements for financial assistance, arranged transportation, and booked a follow-up appointment. What role is this type of service most representative of?

a. Case management
b. Client advocacy
c. Holistic care
d. Wrap-around services

Answer 8

Ans. A

Question 9

CHNs at a clinic for homeless persons are concerned that clients rarely return for follow-up after their TB skin (Mantoux) tests. Which policy would be the most appropriate one for addressing this situation?

a. Call all homeless clients 48 hours after testing to remind them to return to the clinic for follow-up.
b. Have the homeless persons read the test result themselves and then mail in the results on a postage-paid card coded to protect privacy.
c. Readminister the test if the client returns later than scheduled for follow-up.
d. Routinely refer all homeless clients for chest X-rays.

Answer 9

Ans. B

Question 10

Which of the following actions should a CHN take when using the case management approach with vulnerable populations?

a. Be willing to enter into a long-term relationship with families.
b. Direct and control the client’s care because the CHN knows what is most needed.
c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals.
d. Rotate assignments periodically, to prevent attachment and codependency.

Answer 10

Ans. A

Question 11

Which one of the following is an example of tertiary prevention by a CHN?

a. Administering the Mantoux (skin) test to identify persons with TB
b. Assessing for signs and symptoms of active TB
c. Directly observing clients with active TB as they take their antituberculosis medications
d. Interpreting TB skin test results

Answer 11

Ans. C

Question 12

Which one of the following is the cause of the greatest overall costs to the community for providing health care to the homeless?

a. The need for increased preventive services to address the health conditions of the homeless population
b. The need for more frequent clinic visits by homeless clients for multiple health problems
c. The spread of contagious diseases by homeless people to those they pass on the street
d. The fact that most of the care for homeless people takes place in hospital emergency departments

Answer 12

Ans. d

Question 13

A CHN presents a proposal for a program for preventing teen pregnancy to a group of parents. In the discussion that follows the presentation, which of the following responses by a parent indicates the need for additional teaching by the CHN?

a. “I do not know if my son is sexually active; however, I have decided that I am going to talk to him about birth control, just in case.”
b. “I have found that being very strict and checking on my daughter whenever she is out are the best ways to prevent trouble.”
c. “I plan to sit down with my daughter and have an honest talk about sexuality and potential risks.”
d. “I will start spending more time with my teens when I get home from work.”

Answer 13

Ans. B

Question 14

By which of the following actions can the CHN best ensure long-term positive health outcomes in pregnant teens from low-income groups and their children?

a. Help teen mothers learn about body changes during pregnancy.
b. Develop programs that enable teen mothers to complete their education.
c. Offer courses in proper care of babies.
d. Monitor pregnant teens for early detection of problems in pregnancy.

Answer 14

Ans. B

Question 15

A CHN who works at a clinic for homeless persons wants to institute a more efficient treatment for chronic wounds. Which of the following actions offers the best way to improve outcomes for these clients?

a. Administer antibiotics to all homeless persons with chronic, nonhealing wounds.
b. Facilitate daily access to a room with soap, water, and bandages.
c. Provide free bandaging supplies to clients at each clinic visit.
d. Regularly monitor the wound condition of clients.

Answer 15

Ans. B

Question 16

What information is most important to keep in mind when caring for a pregnant teen?

a. All teen pregnancies are considered high risk.
b. Limited knowledge can lead to pregnancy complications.
c. Pregnant teens are less likely to focus on proper prenatal nutrition.
d. Pregnant teens who are poor are more likely to have poorer health outcomes.

Answer 16

Ans. C

Question 17

Which of the following actions is a way in which the CHN can help prevent depression in older adults who are at high risk for it?

a. Encourage them to move to a nursing home where they will have the company of others in the same age group.
b. Monitor for signs and symptoms of depression.
c. Organize a health promotion program for older adults at the local centre.
d. Encourage older adult clients to focus on their strengths rather than their weaknesses.

Answer 17

Ans. C

Question 18

A CHN is concerned about caregiver stress in the children of older clients with health concerns. Which of the following secondary prevention strategies can the CHN implement to limit caregiver stress?

a. Asking caregivers how they are coping with their role
b. Encouraging caregivers to periodically take a few hours away from their duties
c. Establishing support groups for caregivers of older adult parents
d. Referring some caregiving responsibilities to home health nurses (HHNs) or professional caregivers

Answer 18

Ans. A

Question 19

Which of the following actions can a CHN take to potentially increase accessibility to health care services for mentally ill homeless clients?

a. Apply for a grant to fund a mobile clinic to take health care to the clients.
b. Distribute flyers to homeless persons that detail the location of various healthcare services.
c. Refer homeless clients to temporary housing facilities.
d. Solicit donations for food and clothing to be distributed to the homeless.

Answer 19

Ans. A

Question 20

A CHN suspects that an elementary school student is being physically abused. Which action would be the most appropriate one for the CHN to take?

a. Ask the student about the abuse.
b. Document findings in the student’s school record.
c. Discuss the suspicions of abuse with the student’s teachers or the family’s spiritual leader.
d. Notify legal authorities.

Answer 20

Ans. D

Question 21

Which of the following actions by a case manager would be classified as primary prevention?

a. Advocating for the client whose values conflict with those of the medical service provider
b. Collaborating between nursing and occupational health personnel
c. Educating a group regarding community services that are available if they are ever needed
d. Resolving conflict between a primary care clinic and a tertiary care facility

Answer 21

Ans. C

Question 22

A client reports that the narcotic she took for pain on a regular basis made her feel bad and that when she tried an alternative analgesic, she experienced withdrawal symptoms. What is this client suffering from?

a. Drug abuse
b. Drug addiction
c. Drug dependence
d. Substance abuse

Answer 22

Ans. C

Question 23

A CHN is asked by a parent group to explain the risk factors for alcoholism. Which of the following statements should the CHN include in the explanation?

a. Alcoholism is determined solely by environment.
b. Alcoholism is determined partly by genes.
c. Alcoholism is higher in women.
d. Persons born with fetal alcohol syndrome are alcoholics from birth.

Answer 23

Ans. B

Question 24

At a district board meeting, the CHN requests funding for an after-school recreation program that promotes healthy, fun activities in an effort to decrease drug abuse. Which level of prevention does this exemplify?

a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Primary and secondary prevention

Answer 24

Ans. A

Question 25

An intravenous (IV) drug abuser admits to the CHN that he has no desire to give up his addiction, so the CHN counsels him on the importance of sterilizing his needles to prevent infection and transmission of blood-borne diseases. Which level of prevention does this action represent?

a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Primary and tertiary prevention

Answer 25

Ans. C

Question 26

A CHN suspects that a new client may be a drug addict. When getting the health history of the client, the CHN needs to keep in mind that the client may not admit to drug use. Which one of the following is a primary symptom of addiction?

a. Confusion
b. Denial
c. Forgetfulness
d. Mental status changes

Answer 26

Ans. B

Question 27

Which one of the following actions is the best example of enabling in a family with an alcoholic father?

a. The father asks the CHN to explain why his continued drinking is dangerous.
b. The son threatens to leave the home because he finds his father’s behaviour embarrassing.
c. The teenage daughter turns to a favourite teacher for support.
d. The wife tells her husband’s boss that her husband is sick when he is actually inebriated.

Answer 27

Ans. D

Question 28

Which of the following statements made by a parent indicates a need for more education about child abuse?

a. “I have stopped slapping my child, and I am learning to count to 10 before reacting.”
b. “I never spank or hit my children; I yell at them to stop being stupid and if they don’t, I tell them that the boogeyman will steal them away at night if they don’t obey.”
c. “I use ‘time out’ when my child acts out or is naughty. Sometimes, my child doesn’t cope well with this, but I am persistent.”
d. “When my child misbehaves, I distract him and try to focus his attention on other things. If he throws a tantrum, I just pick him up and leave the store or show or wherever we may be.”

Answer 28

Ans. B

Question 29

During a group counselling session for perpetrators of intimate partner violence, which of the following statements made by one of the clients indicates a lack of insight into his violent behaviour?

a. “I have been taking out my frustrations about work on my girlfriend.”
b. “I love my girlfriend and didn’t want to hurt her; it was an accident.”
c. “It might be a good idea for me to temporarily leave the house when I feel I am getting angry.”
d. “When I drink alcohol, I become more abusive toward my girlfriend.”

Answer 29

Ans. B

Question 30

A mother confides to the CHN that her live-in boyfriend pushed her 2-year-old child because he was crying too much. She begs the CHN not to tell anyone because her boyfriend has agreed to take anger management classes. What should the CHN do?

a. Abide by the mother’s wishes because this information was provided in confidence.
b. Arrange for the earliest available counselling for the boyfriend.
c. Advise the mother to take the child away from the boyfriend and find alternate housing right away.
d. Report the incident to the child protection agency.

Answer 30

Ans. D

Question 31

Which one of the following characteristics observed in a teenage boy should always alert the CHN to the possibility of suicide?

a. Age between 15 and 19 years
b. A homosexual orientation and history of depression
c. Threatening to cause harm to peers
d. A history of torturing and abusing animals

Answer 31

Ans. B

Question 32

Discuss the meaning of the terms homosexuality, homosexual, gay, lesbian, bisexual, transgenders, and two-spirited.

Answer 32

• Homosexuality: refers to people whose sexual and emotional attraction is to persons of the same sex
• Homosexual: refers to both men and women whose sexual and emotional attraction is to persons of the same sex
• Gay: a self-identified homosexual man
• Lesbian: a self-identified homosexual woman
• Bisexual: a person who is attracted to both men and women
• Transgenders: men or women who believe that their physical body and sexual characteristics do not match their self-concept
• Two-spirited: people of Aboriginal descent who self-identify as having two spirits (male and female) within themselves

Question 33

Nancy is a nursing student working within a community agency that provides services to a large gay/lesbian community. In her orientation she learns about heterosexism and how it affects gay/lesbian/bisexual/transgender people. Discuss the information that Nancy is likely to have learned. Provide a community health nursing practice example that would counter this view.

Answer 33

Heterosexism is:
- viewing the world through the lens of heterosexuality as the norm and
a lack of realization or acknowledgment that alternatives to this exist
- assuming that everyone is heterosexual and anything else is not normal

Effects:

• alienates gay/lesbian/bisexual/transgender clients
• has far-reaching social and psychological effects
• delays entry into the health care system

CHN e.g., asking about relationship or partner status in a client interview versus marital status

Question 34

Discuss three assumptions that are often made about gay/lesbian clients related to their health status and sexual behaviours, and provide the counter argument against the assumptions.

Answer 34

• All gay men have anal sex (many gay men enjoy other forms of sexual expression).
• All gay men are at high risk of HIV (gay men are at risk only if they have unprotected anal intercourse, the same as heterosexual people).
• All lesbians don’t have penetrative vaginal/penile sex (some lesbians do have/have had sex with men).
• Lesbians don’t need mammograms or Pap tests (lesbians need these screenings the same as other women, more so if they have no children or have ever had vaginal/penile sex).
• Gay youth all have HIV (only a small percentage of gay youth have HIV).
• Gay youth are more likely to be targets of hate crimes.
• Gay youth are more likely to exhibit self-destructive behaviours.

Question 35

In a group of 100 people, how many are likely to self-identify as gay or lesbian?

a. 1 person
b. 20 people
c. 2 to 3 people
d. 5 to 10 people

Answer 35

c. 2 to 3 people

Question 36

Ms. Davis, 30 years old, describes herself in masculine terms. What term describes this behaviour?

a. Transgender
b. Intersexual
c. Bisexual
d. Lesbian

Answer 36

a. Transgender

Question 37

An instructor is teaching her community health students about homophobia. What comment made by a student would indicate that additional teaching is required?

a. “So making gay jokes is not acceptable.”
b. “I worry that a homosexual person will be attracted to me.”
c. “I guess asking someone about their sexual orientation in a job interview is wrong.”
d. “I understand why some gay men are beaten.”

Answer 37

b. “I worry that a homosexual person will be attracted to me.”

Question 38

What is the best response by the nurse when a client shares that he is involved in a long-term relationship with another man?

a. “Okay, but you really didn’t have to tell me.”
b. “Thank you for sharing that information.”
c. “Have you had the chance to get married?”
d. “Do you want an HIV test done while I am here?”

Answer 38

b. “Thank you for sharing that information.”

Question 39

A nurse is concerned about heterosexism and has worked with a colleague to create a new assessment tool. What question would indicate that the nurse needs to discuss heterosexism with the colleague?

a. Have you ever had a sexually transmitted infection?
b. Are you in a relationship currently?
c. What form of birth control do you use?
d. Do you or your partner have any children?

Answer 39

c. What form of birth control do you use?

Question 40

What is the most significant health risk for gay/lesbian/bisexual/transgender individuals?

a. Substance abuse
b. HIV
c. Violence
d. Avoiding routine health care

Answer 40

d. Avoiding routine health care

Question 41

Mr. Watkins, 51 years old, is gay. He is suffering from the mental health effects of stigma, prejudice, and discrimination. What is this termed?

a. Minority stress
b. Mid-life crisis
c. Sexual orientation stress
d. Post-traumatic stress disorder

Answer 41

a. Minority stress

Question 42

What statement is true about homosexuality prior to 1970?

a. Seen as vector for HIV
b. Treated with drug therapy
c. Classified as a mental illness
d. Ignored as a health problem

Answer 42

c. Classified as a mental illness

Question 43

Harvey, 16 years old, is gay. He has tried to commit suicide several times. What is the most likely reason for this?

a. Alcohol abuse
b. Bullying
c. Being evicted from his home
d. Shame

Answer 43

d. Shame

Question 44

Ruth, 28 years old, has decided to tell her parents she is lesbian. What factor will determine the degree of difficulty in disclosing this information?

a. The nature of the relationship she has with her parents
b. How long she has admitted to herself that she is a lesbian
c. How long she has been in a relationship with another woman
d. The support she gets from her partner

Answer 44

a. The nature of the relationship she has with her parents

Question 45

Jody, 17 years old, is a lesbian. When will Jody’s risk for suicide be the greatest?

a. After her first relationship ends
b. After her first encounter with homophobia
c. When she tells her best friend
d. When she tells her parents

Answer 45

d. When she tells her parents

Question 46

Which person is more likely to disclose his or her orientation to a female nurse?

a. Max/Maxine, a 60-year-old transgender
b. Harold, a 50-year-old gay man
c. Mark, a 76-year-old gay man
d. Tricia, a 29-year-old lesbian

Answer 46

d. Tricia, a 29-year-old lesbian

Question 47

An instructor is teaching her community health students about homophobic attitudes and beliefs that will negatively impact the care of gay, lesbian, bisexual, and transgender clients. Which comment should be addressed by the instructor?

a. “So gay men have anal sex.”
b. “How can I acknowledge when someone discloses their orientation to me?”
c. “I will tell my father that gay men are not mentally ill.”
d. “How can I stop my friends from saying ‘fag’?”

Answer 47

a. “So gay men have anal sex.”

Question 48

A nurse is working on using more inclusive language in her health assessment with new female clients. What question has more inclusive language?

a. “Do you use the birth control pill?”
b. “Are you in a relationship?”
c. “What is your marital status?”
d. “Does your boyfriend hurt you?”

Answer 48

b. “Are you in a relationship?”

Question 49

A nurse wants to become more gay-affirming with gay/lesbian/bisexual/transgender clients. What is one action the nurse can take?

a. Ignore misinformation about gay/lesbian/bisexual/transgender clients
b. Obtain education about the gay/lesbian/bisexual/transgender lifestyles
c. Create a support group for gay/lesbian/bisexual/transgender clients with local clergy
d. Supply a list of psychiatrists who treat gay/lesbian/bisexual/transgender clients

Answer 49

b. Obtain education about the gay/lesbian/bisexual/transgender lifestyles

Question 50

Honora is a young lesbian woman who is suffering from low self-esteem and self-loathing. This has resulted in a substance abuse problem. What is Honora experiencing?

a. Heterophobia
b. Heterosexism
c. Internalized homophobia
d. Homosexuality

Answer 50

c. Internalized homophobia

Question 51

Debbie, age 42, is a lesbian. What is true about her health needs?

a. Has a lower risk of developing breast cancer
b. Is at greater risk for lung cancer
c. Does not require a Pap test as does not have penetrative sex
d. Is less likely to have a mammogram

Answer 51

d. Is less likely to have a mammogram

Question 52

A nurse is in a meeting with her colleagues. One of the colleagues mentions that a young client, who many know, is a bisexual. What should the nurse do first?

a. Talk to the colleague about confidentiality
b. Report the nurse to the professional association
c. Ask when the client disclosed this information
d. Inquire whether the client’s parents have been told

Answer 52

a. Talk to the colleague about confidentiality